1. Analyzing Potential Intestinal Transporter Drug-Drug Interactions: Reevaluating Ticagrelor Interaction Studies
- Author
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Liu, Shuaibing, Sodhi, Jasleen K, and Benet, Leslie Z
- Subjects
Pharmacology and Pharmaceutical Sciences ,Biomedical and Clinical Sciences ,Substance Misuse ,Clinical Research ,Digestive Diseases ,Drug Abuse (NIDA only) ,ATP Binding Cassette Transporter ,Subfamily B ,Member 1 ,Citrus paradisi ,Cyclosporine ,Cytochrome P-450 CYP3A ,Cytochrome P-450 CYP3A Inhibitors ,Diltiazem ,Drug Interactions ,Fruit and Vegetable Juices ,Humans ,Intestinal Absorption ,Intestines ,Ketoconazole ,Rifampin ,Ticagrelor ,drug-drug interactions ,mean absorption time ,ticagrelor ,Pharmacology & Pharmacy ,Pharmacology and pharmaceutical sciences - Abstract
PurposePrevious studies evaluating ticagrelor drug-drug interactions have not differentiated intestinal versus systemic mechanisms, which we do here.MethodsUsing recently published methodologies from our laboratory to differentiate metabolic- from transporter-mediated drug-drug interactions, a critical evaluation of five published ticagrelor drug-drug interactions was carried out to investigate the purported clinical significance of enzymes and transporters in ticagrelor disposition.ResultsThe suggested CYP3A4 inhibitors, ketoconazole and diltiazem, displayed unchanged mean absorption time (MAT) and time of maximum concentration (Tmax) values as was expected, i.e., the interactions were mainly mediated by metabolic enzymes. The potential CYP3A4/P-gp inhibitor cyclosporine also showed an unchanged MAT value. Further analysis assuming there was no P-gp effect suggested that the increased AUC and unchanged t1/2 for ticagrelor after cyclosporine administration were attributed to the inhibition of intestinal CYP3A4 rather than P-gp. Rifampin, an inducer of CYP3As after multiple dosing, unexpectedly showed decreased MAT and Tmax values, which cannot be completely explained. In contrast, grapefruit juice, an intestinal CYP3A/P-gp/OATP inhibitor, significantly increased MAT and Tmax values for ticagrelor, which may be due to activation of P-gp or inhibition of OATPs expressed in intestine.ConclusionsThis study provides new insight into the role of transporter pathways in ticagrelor intestinal absorption by examining potential MAT and Tmax changes mediated by drug-drug interactions.
- Published
- 2021