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The effects of CYP2D6 and CYP3A activities on the pharmacokinetics of immediate release oxycodone

Wagner, M.
Rebsamen, M. C.
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Published in British Journal of Pharmacology. 2010, vol. 160, no. 4, p. 907-918
Abstract BACKGROUND AND PURPOSE: There is high interindividual variability in the activity of drug-metabolizing enzymes catalysing the oxidation of oxycodone [cytochrome P450 (CYP) 2D6 and 3A], due to genetic polymorphisms and/or drug-drug interactions. The effects of CYP2D6 and/or CYP3A activity modulation on the pharmacokinetics of oxycodone remains poorly explored. EXPERIMENTAL APPROACH: A randomized crossover double-blind placebo-controlled study was performed with 10 healthy volunteers genotyped for CYP2D6 [six extensive (EM), two deficient (PM/IM) and two ultrarapid metabolizers (UM)]. The volunteers randomly received on five different occasions: oxycodone 0.2 mg x kg(-1) and placebo; oxycodone and quinidine (CYP2D6 inhibitor); oxycodone and ketoconazole (CYP3A inhibitor); oxycodone and quinidine+ketoconazole; placebo. Blood samples for plasma concentrations of oxycodone and metabolites (oxymorphone, noroxycodone and noroxymorphone) were collected for 24 h after dosing. Phenotyping for CYP2D6 (with dextromethorphan) and CYP3A (with midazolam) were assessed at each session. KEY RESULTS: CYP2D6 activity was correlated with oxymorphone and noroxymorphone AUCs and C(max) (-0.71 < Spearman correlation coefficient rhos < -0.92). Oxymorphone C(max) was 62% and 75% lower in PM than EM and UM. Noroxymorphone C(max) reduction was even more pronounced (90%). In UM, oxymorphone and noroxymorphone concentrations increased whereas noroxycodone exposure was halved. Blocking CYP2D6 (with quinidine) reduced oxymorphone and noroxymorphone C(max) by 40% and 80%, and increased noroxycodone AUC(infinity) by 70%. Blocking CYP3A4 (with ketoconazole) tripled oxymorphone AUC(infinity) and reduced noroxycodone and noroxymorphone AUCs by 80%. Shunting to CYP2D6 pathway was observed after CYP3A4 inhibition. CONCLUSIONS AND IMPLICATIONS: Drug-drug interactions via CYP2D6 and CYP3A affected oxycodone pharmacokinetics and its magnitude depended on CYP2D6 genotype.
Keywords AdultAnalgesics, Opioid/administration & dosage/blood/chemistry/*pharmacokineticsCross-Over StudiesCytochrome P-450 CYP2D6/antagonists & inhibitors/*genetics/*metabolismCytochrome P-450 CYP3A/antagonists & inhibitors/*metabolismDouble-Blind MethodDrug Interactions/geneticsEnzyme Inhibitors/pharmacologyGenotypeHumansKetoconazole/pharmacologyMaleMetabolic Detoxication, Phase I/geneticsOxycodone/administration & dosage/blood/chemistry/*pharmacokineticsPhenotype*Polymorphism, GeneticQuinidine/pharmacologyReceptors, Opioid, mu/metabolismYoung Adult
PMID: 20590587
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Research groups Pharmaco-omiques et médecine de précision (1003)
Chimie et protéomique clinique (270)
Groupe Desmeules Jules (pharmacologie/toxicologie) (567)
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SAMER, Caroline Flora et al. The effects of CYP2D6 and CYP3A activities on the pharmacokinetics of immediate release oxycodone. In: British Journal of Pharmacology, 2010, vol. 160, n° 4, p. 907-918. doi: 10.1111/j.1476-5381.2010.00673.x https://archive-ouverte.unige.ch/unige:21283

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Deposited on : 2012-05-23

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