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2015 ; 43
(11
): 1661-9
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P450-Based Drug-Drug Interactions of Amiodarone and its Metabolites: Diversity of
Inhibitory Mechanisms
#MMPMID26296708
McDonald MG
; Au NT
; Rettie AE
Drug Metab Dispos
2015[Nov]; 43
(11
): 1661-9
PMID26296708
show ga
In this study, IC50 shift and time-dependent inhibition (TDI) experiments were
carried out to measure the ability of amiodarone (AMIO), and its circulating
human metabolites, to reversibly and irreversibly inhibit CYP1A2, CYP2C9, CYP2D6,
and CYP3A4 activities in human liver microsomes. The [I]u/Ki,u values were
calculated and used to predict in vivo AMIO drug-drug interactions (DDIs) for
pharmaceuticals metabolized by these four enzymes. Based on these values, the
minor metabolite N,N-didesethylamiodarone (DDEA) is predicted to be the major
cause of DDIs with xenobiotics primarily metabolized by CYP1A2, CYP2C9, or
CYP3A4, while AMIO and its N-monodesethylamiodarone (MDEA) derivative are the
most likely cause of interactions involving inhibition of CYP2D6 metabolism. AMIO
drug interactions predicted from the reversible inhibition of the four P450
activities were found to be in good agreement with the magnitude of reported
clinical DDIs with lidocaine, warfarin, metoprolol, and simvastatin. The TDI
experiments showed DDEA to be a potent inactivator of CYP1A2 (KI = 0.46 ?M,
kinact = 0.030 minute(-1)), while MDEA was a moderate inactivator of both CYP2D6
(KI = 2.7 ?M, kinact = 0.018 minute(-1)) and CYP3A4 (KI = 2.6 ?M, kinact = 0.016
minute(-1)). For DDEA and MDEA, mechanism-based inactivation appears to occur
through formation of a metabolic intermediate complex. Additional metabolic
studies strongly suggest that CYP3A4 is the primary microsomal enzyme involved in
the metabolism of AMIO to both MDEA and DDEA. In summary, these studies
demonstrate both the diversity of inhibitory mechanisms with AMIO and the need to
consider metabolites as the culprit in inhibitory P450-based DDIs.