1. Clinical Studies on Drug-Drug Interactions Involving Metabolism and Transport: Methodology, Pitfalls, and Interpretation
- Author
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Anne M. Filppula, Mikko Niemi, Aleksi Tornio, Janne T. Backman, Department of Clinical Pharmacology, INDIVIDRUG - Individualized Drug Therapy, Research Programs Unit, Medicum, Clinicum, Mikko Olavi Niemi / Principal Investigator, Janne Backman / Principal Investigator, and HUSLAB
- Subjects
Drug ,PLASMA-CONCENTRATIONS ,Metabolic Clearance Rate ,media_common.quotation_subject ,Pharmacokinetic modeling ,GRAPEFRUIT JUICE ,INHIBITION ,Reviews ,Bioinformatics ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Pharmacokinetics ,Limited sampling ,Medicine ,Humans ,Pharmacology (medical) ,Drug Interactions ,media_common ,Pharmacology ,Clinical Trials as Topic ,business.industry ,Clinical study design ,GENEVA COCKTAIL ,INTERACTION ASSESSMENTS ,CYTOCHROME-P450 ,Membrane Transport Proteins ,MARKEDLY DECREASES ,State of the Art ,3. Good health ,317 Pharmacy ,030220 oncology & carcinogenesis ,Plasma concentration ,ENDOGENOUS BIOMARKERS ,ROSUVASTATIN PHARMACOKINETICS ,TIME-DEPENDENT PHARMACOKINETICS ,3111 Biomedicine ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Drug metabolism ,Pharmacogenetics - Abstract
Many drug-drug interactions (DDIs) are based on alterations of the plasma concentrations of a victim drug due to another drug causing inhibition and/or induction of the metabolism or transporter-mediated disposition of the victim drug. In the worst case, such interactions cause more than tenfold increases or decreases in victim drug exposure, with potentially life-threatening consequences. There has been tremendous progress in the predictability and modeling of DDIs. Accordingly, the combination of modeling approaches and clinical studies is the current mainstay in evaluation of the pharmacokinetic DDI risks of drugs. In this paper, we focus on the methodology of clinical studies on DDIs involving drug metabolism or transport. We specifically present considerations related to general DDI study designs, recommended enzyme and transporter index substrates and inhibitors, pharmacogenetic perspectives, index drug cocktails, endogenous substrates, limited sampling strategies, physiologically-based pharmacokinetic modeling, complex DDIs, methodological pitfalls, and interpretation of DDI information.
- Published
- 2019