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In vitro forecasting of drugs that may interfere with codeine bioactivation

Published in European Journal of Drug Metabolism and Pharmacokinetics. 1992, vol. 17, no. 2, p. 115-20
Abstract The O-demethylation of codeine (methylmorphine) into morphine is mediated by the polymorphic cytochrome P450 DB1 (P450 IID6). By means of in vitro screening in human liver microsomes we have studied the effect on codeine bioactivation of several drugs used as analgesics or as adjuvants for pain control. In microsomes from an extensive metabolizer subject, paracetamol (acetaminophen) and NSAIDs (acetylsalicylic acid, diclofenac, indomethacin, piroxicam, and pirprofen), benzodiazepines (chlordiazepoxide, clonazepam, diazepam, flunitrazepam, and midazolam), and anticonvulsants (carbamazepine and phenytoin) did not alter the reaction. There was marked inhibition of in vitro morphine production by neuroleptics (chlorpromazine, haloperidol, levomepromazine, and thioridazine), metoclopramide, and tricyclic antidepressants (amitriptyline, clomipramine, desipramine, imipramine, and nortriptyline). Enzyme kinetics showed competitive inhibition by neuroleptics (chlorpromazine Ki = 0.5 microM) and antidepressants (clomipramine Ki = 6.8 microM), which are substrates of the polymorphic monooxygenase. Due to the low affinity of codeine for P450 DB1 (Km = 100-200 microM), its bioactivation in extensive metabolizers, and thus its analgesic efficacy, is liable to vary greatly when it is combined with any drug that has a high affinity for the polymorphic isozyme.
Keywords Acetaminophen/pharmacologyAnti-Inflammatory Agents, Non-Steroidal/pharmacologyBenzodiazepines/pharmacologyBiotransformationCodeine/pharmacokineticsCytochrome P-450 CYP2D6Cytochrome P-450 Enzyme System/physiologyDrug InteractionsHumansIn Vitro TechniquesMicrosomes, Liver/metabolismMixed Function Oxygenases/physiologyMorphine/metabolism
PMID: 1425809
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Research group Groupe Desmeules Jules (pharmacologie/toxicologie) (567)
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DAYER, Pierre, DESMEULES, Jules Alexandre, STRIBERNI, Rita. In vitro forecasting of drugs that may interfere with codeine bioactivation. In: European Journal of Drug Metabolism and Pharmacokinetics, 1992, vol. 17, n° 2, p. 115-20. https://archive-ouverte.unige.ch/unige:92730

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