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Importance of Drug Enantiomers in Clinical Pharmacology

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Summary

The ordered asymmetry of biological macromolecules allows them to differentiate between the optical isomers of monomeric substrates. Optical isomers of drugs often have greatly different affinities at receptor sites, are metabolised at different rates, and have different affinities for tissue and protein binding sites. Despite this knowledge, many drugs are administered as their racemates. Manipulation of the enantiomeric ratio or the use of only one enantiomer of a drug may allow separation of toxicity and efficacy, and this may lead to a significant increase in therapeutic ratio and a more rational approach to therapeutics.

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References

  • Adams, S.S.; Bough, R.G.; Cliffe, E.E.; Lessel, B. and Mills, R.F.N.: Absorption, distribution and toxicity of ibuprofen. Toxicology and Applied Pharmacology 15: 310–330 (1969).

    PubMed  CAS  Google Scholar 

  • Adams, S.S.; Bresloff, P. and Mason, C.G.: Pharmacological differences between the optical isomers of ibuprofen: Evidence for metabolic inversion of the (−)-isomer. Journal of Pharmacy and Pharmacology 28: 256–257 (1976).

    PubMed  CAS  Google Scholar 

  • Ager, J.H.; Jacobson, A.E. and May, E.L.: Separation of morphine-like effects by optical resolution. Levo isomers as strong analgetics and narcotic antagonists. Journal of Medicinal Chemistry 12: 288–289 (1969).

    PubMed  CAS  Google Scholar 

  • Aggeler, P.M.; O’Reilly, R.A.; Leong, L. and Kowitz, P.E.: Potentiation of anticoagulant effect of warfarin by phenylbutazone. New England Journal of Medicine 276: 496–501 (1967).

    PubMed  CAS  Google Scholar 

  • Albani, F.; Riva, R.; Contin, M. and Baruzzi, A.: Stereoselective binding of propranolol enantiomers to human α1-acid glycoprotein and human plasma. British Journal of Clinical Pharmacology 18: 244–246 (1984).

    PubMed  CAS  Google Scholar 

  • Alebic-Kolbah, T.; Rendic, S.; Fuks, Z.; Sunjic, V. and Kajfez, F.: Enantioselectivity in the binding of drugs to serum proteins. Acta Pharmaceutica Jugoslavia 29: 53–70 (1979).

    CAS  Google Scholar 

  • Allenmark, S.: Recent advances in methods of direct optical resolution. Journal of Biochemical and Biophysical Methods 9: 1–25 (1984).

    PubMed  CAS  Google Scholar 

  • Ames, M.M. and Frank, S.K.: Stereochemical aspects of parachloramphetamine metabolism. Biochemical Pharmacology 31: 5–9 (1982).

    PubMed  CAS  Google Scholar 

  • Anders, M.W.; Cooper, M.J. and Takemori, A.E.: Kinetics of microsomal metabolism and binding of enantiomerically related substrates. Drug Metabolism and Disposition 1: 642–644 (1973).

    PubMed  CAS  Google Scholar 

  • Ariens, E.J.: Stereochemistry, a basis for sophisticated nonsense in pharmacokinetics and clinical pharmacology. European Journal of Clinical Pharmacology 26: 663–668 (1984).

    PubMed  CAS  Google Scholar 

  • Ariens, E.J.; Soudijn, W. and Timmermans, P.B. (Eds): Stereochemistry and Biological Activity of Drugs (Blackwell Scientific Publications, Oxford, London 1983).

    Google Scholar 

  • Bai, S.A.; Walle, U.K.; Wilson, M.J. and Walle, T.: Stereoselective binding of the (−)-enantiomer of propranolol to plasma and extravascular binding sites in the dog. Drug Metabolism and Disposition 11: 394–395 (1983).

    PubMed  CAS  Google Scholar 

  • Bailey, R.R. and Reddy, J.: Potentiation of warfarin action by sulphinpyrazone. Lancet 1: 254 (1980).

    PubMed  CAS  Google Scholar 

  • Banfield, C.; O’Reilly, R.; Chan, E. and Rowland, M.: Phenylbutazone interaction in man: Further stereochemical and metabolic considerations. British Journal of Clinical Pharmacology 16: 669–675 (1983).

    PubMed  CAS  Google Scholar 

  • Barlow, R.B.; Franks, F.M. and Pearson, J.D.M.: The relation between biological activity and the degree of resolution of optical isomers. Journal of Pharmacy and Pharmacology 24: 753–761 (1972).

    PubMed  CAS  Google Scholar 

  • Barrett, A.M. and Cullum, V.A.: The biological properties of the optical isomers of propranolol and their effects on cardiac arrhythmias. British Journal of Pharmacology 34: 43–55 (1968).

    PubMed  CAS  Google Scholar 

  • Bayer, R.; Kalusche, D.; Kaufmann, R. and Mannhold, R.: Inotropic and electrophysiological actions of verapamil and D600 in mammalian myocardium. Naunyn-Schmiedeberg’s Archives of Pharmacology 290: 81–97 (1975).

    PubMed  CAS  Google Scholar 

  • Bellville, J.W. and Forrest, W.H.: Respiratory and subjective effects of d- and l-pentazocine. Clinical Pharmacology and Therapeutics 9: 142–151 (1968).

    PubMed  CAS  Google Scholar 

  • Berkowitz, B.: Pharmacokinetics and neurochemical effects of pentazocine and its optical isomers; in Braude et al. (Eds) Narcotic Antagonists, Advances in Biochemical Psychopharmacology, Vol. 8, pp. 395–430 (Raven Press, New York 1974).

    Google Scholar 

  • Bjornsson, T.D.; Meffin, P.J. and Blaschke, T.F.: Interaction of clofibrate with warfarin. I. Effect of clofibrate on the disposition of the optical enantiomorphs of warfarin. Journal of Pharmacokinetics and Biopharmaceutics 5: 495–505 (1977).

    PubMed  CAS  Google Scholar 

  • Blaine, E.H.; Fanelli, G.M.; Irvin, J.D.; Tobert, J.A. and Davies, R.O.: Enantiomers of indacrinone: A new approach to producing an isouricemic diuretic. Clinical and Experimental Hypertension — Theory and Practice A 4: 161–176 (1982).

    CAS  Google Scholar 

  • Bopp, R.J.; Nash, J.F.; Ridolfo, A.S. and Shepard, E.R.: Stereoselective inversion of R(−)-benoxaprofen to the S(+)-enantiomer in humans. Drug Metabolism and Disposition 7: 356–359 (1979).

    PubMed  CAS  Google Scholar 

  • Branch, R.A.; Nies, A.S. and Shand, D.G.: The disposition of propranolol. VIII. Drug Metabolism and Disposition 1: 687–690 (1973).

    CAS  Google Scholar 

  • Breckenridge, A.; Orme, M.; Wesseling, H.; Lewis, R.J. and Gibbons, R.: Pharmacokinetics and pharmacodynamics of the enantiomers of warfarin in man. Clinical Pharmacology and Therapeutics 15: 424–430 (1974).

    PubMed  CAS  Google Scholar 

  • Brown, N.A.; Jahnchen, E.; Muller, W.E. and Wollert, U.: Optical studies on the mechanism of the interaction of the enantiomers of the anticoagulant drugs phenprocoumon and warfarin with human serum albumin. Molecular Pharmacology 13: 70–79 (1977).

    PubMed  CAS  Google Scholar 

  • Cahn, R.S.; Ingold, C.K. and Prelog, V.: The specification of asymmetric configuration in organic chemistry. Experientia 12: 81–124 (1956).

    CAS  Google Scholar 

  • Caldwell, J. and Marsh, M.V.: Interrelationships between xenobiotic metabolism and lipid biosynthesis. Biochemical Pharmacology 32: 1667–1672 (1983).

    PubMed  CAS  Google Scholar 

  • Cho, A.K. and Wright, J.: Pathways of metabolism of amphetamine and related compounds. Life Sciences 22: 363–372 (1978).

    PubMed  CAS  Google Scholar 

  • Cotzias, G.C.; Papavasiliou, P.S. and Gellene, R.: Modification of Parkinsonism-chronic treatment with L-dopa. New England Journal of Medicine 280: 337–345 (1969).

    PubMed  CAS  Google Scholar 

  • Cox, P.J.; Farmer, P.B.; Jarman, M.; Jones, M.; Stec, W.J. and Kinas, R.: Observations on the differential metabolism and biological activity of the optical isomers of cyclophosphamide. Biochemical Pharmacology 25: 993–996 (1976).

    PubMed  CAS  Google Scholar 

  • Davis, J.E. and Johns, L.E.: Possible interaction of sulfinpyrazone with coumarins. New England Journal of Medicine 299: 955 (1978).

    PubMed  CAS  Google Scholar 

  • Echizen, H. and Eichelbaum, M.: Pharmacodynamics of verapamil isomers in man. Naunyn-Schmiedeberg’s Archives of Pharmacology 325 (Suppl.): R86 (1984).

    Google Scholar 

  • Eichelbaum, M.; Birkel, P.; Grube, E.; Gutgemann, U. and Somogyi, A.: Effects of verapamil on P-R-intervals in relation to verapamil plasma levels following single i.v. and oral administration and during chronic treatment. Klinische Wochenschrift 58: 919–925 (1980).

    PubMed  CAS  Google Scholar 

  • Eichelbaum, M.; Mikus, G. and Vogelgesang, B.: Pharmacokinetics of (+)-, (−)- and ( ± )-verapamil after intravenous administration. British Journal of Clinical Pharmacology 17: 453–458 (1984).

    PubMed  CAS  Google Scholar 

  • Evans, G.H.; Nies, A.S. and Shand, D.G.: The disposition of propranolol. III. Decreased half-life and volume of distribution as a result of plasma binding in man, monkey, dog and rat. Journal of Pharmacology and Experimental Therapeutics 186: 114–122 (1973).

    PubMed  CAS  Google Scholar 

  • Farmer, P.B.; Jarman, M.; Facchinetti, T.; Pankiewicz, K. and Stec, W.J.: The metabolism and antitumor activity of the enantiomers of cis- and trans-4-methylcyclophosphamide. Chemical and Biological Interactions 18: 47–57 (1977).

    CAS  Google Scholar 

  • Fears, R.; Baggaley, K.H.; Alexander, R.; Morgan, B. and Hindley, R.M.: The participation of ethyl 4-benzyloxybenzoate (BRL 10894) and other aryl-substituted acids in glycerolipid metabolism. Journal of Lipid Research 19: 3–11 (1978).

    PubMed  CAS  Google Scholar 

  • Fears, R. and Richards, D.H.: Association between lipid-lowering activity of aryl-substituted carboxylic acids and formation of substituted glycerolipids in rats. Biochemical Society Transactions 9: 572–573 (1981).

    CAS  Google Scholar 

  • Feldman, D.: Naprosyn (naproxen). Monograph and Clinical Practice Handbook (Syntex Laboratories Inc., Palo Alto 1976).

    Google Scholar 

  • Field, M.J.; Fowler, N. and Giebisch, G.H.: Effects of enantiomers of indarinone (MK-196) on cation transport by the loop of Henle and distal tubule studied by microperfusion in vivo. Journal of Pharmacology and Experimental Therapeutics 230: 62–68 (1984).

    PubMed  CAS  Google Scholar 

  • Forrest, W.H.; Beer, E.G.; Bellville, J.W.; Ciliberti, B.J.; Miller, E.V. and Paddock, R.: Analgesic and other effects of the dand l-isomers of pentazocine. Clinical Pharmacology and Therapeutics 10: 468–476 (1969).

    PubMed  CAS  Google Scholar 

  • Gallus, A. and Birkett, D.: Sulphinpyrazone and warfarin: A probable drug interaction. Lancet 1: 535–536 (1980).

    PubMed  CAS  Google Scholar 

  • Gil-Av, E.: Present status of enantiomeric analyses by gas chromatography. Journal of Molecular Evolution 6: 131–145 (1975).

    PubMed  CAS  Google Scholar 

  • Godbillon, J.; Richard, J.; Gerardin, A.; Meinertz, T.; Kasper, W. and Jahnchen, E.: Pharmacokinetics of the enantiomers of acenocoumarol in man. British Journal of Clinical Pharmacology 12: 621–629 (1981).

    PubMed  CAS  Google Scholar 

  • Graham, G.G.: Non-invasive chemical methods of estimating pharmacokinetic parameters. Pharmacology and Therapeutics 18: 333–349 (1982).

    PubMed  CAS  Google Scholar 

  • Haberkorn, A.; Kraft, H.P. and Blaschke, G.: Antimalarial activity in animals of the optical isomers of chloroquine diphosphate. Tropenmedizin Parasitologie 30: 308–312 (1979).

    CAS  Google Scholar 

  • Hendel, J. and Brodthagen, H.: Enterohepatic cycling of methotrexate estimated by use of the D-isomer as a reference marker. European Journal of Clinical Pharmacology 26: 103–107 (1984).

    PubMed  CAS  Google Scholar 

  • Ho, I.K. and Harris, R.A.: Mechanism of action of barbiturates. Annual Review of Pharmacology and Toxicology 21: 83–111 (1981).

    PubMed  CAS  Google Scholar 

  • Horng, J.S.; Smits, S.E. and Wong, D.T.: The binding of the optical isomers of methadone, α-methadol, α-acetylmethadol and their N-demethylated derivatives to the opiate receptors of rat brain. Research Communications in Chemical Pathology and Pharmacology 14: 621–629 (1976).

    PubMed  CAS  Google Scholar 

  • Hutt, A.J. and Caldwell, J.: The metabolic chiral inversion of 2-arylpropionic acids. A novel route with pharmacological consequences. Journal of Pharmacy and Pharmacology 35: 693–704 (1983).

    PubMed  CAS  Google Scholar 

  • Hutt, A.J. and Caldwell, J.: The importance of stereochemistry in the clinical pharmacokinetics of the 2-arylpropionic acid non-steroidal anti-inflammatory drugs. Clinical Pharmacokinetics 9: 371–373 (1984).

    PubMed  CAS  Google Scholar 

  • Irvin, J.D.; Vlasses, P.H.; Huber, P.B.; Feinberg, J.A.; Ferguson, R.K.; Scrogie, J.J. and Davies, R.O.: Different pharmacodynamic effects of the (+) and (−) enantiomers of indacrinone in man. Clinical Pharmacology and Therapeutics 27: 260 (1980).

    Google Scholar 

  • Jackman, G.P.; McLean, A.J.; Lennings, G.L. and Bobik, A.: No stereoselective first-pass hepatic extraction of propranolol. Clinical Pharmacology and Therapeutics 30: 291–296 (1981).

    PubMed  CAS  Google Scholar 

  • Jahnchen, E.; Meinertz, T.; Gilfrich, H-J.; Groth, U. and Martini, A.: The enantiomers of phenprocoumon: Pharmacodynamic and pharmacokinetic studies. Clinical Pharmacology and Therapeutics 20: 342–349 (1976).

    PubMed  CAS  Google Scholar 

  • Jenner, P. and Testa, B.: The influence of stereochemical factors on drug disposition. Drug Metabolism Reviews 2: 117–184 (1973).

    PubMed  CAS  Google Scholar 

  • Judson, B.A.; Horns, W.H. and Goldstein, A.: Side effects of levomethadone and racemic methadone in a maintenance program. Clinical Pharmacology and Therapeutics 20: 445–449 (1976).

    PubMed  CAS  Google Scholar 

  • Kaumann, A.J. and Serur, J.R.: Optical isomers of verapamil on canine heart. Naunyn-Schmiedeberg’s Archives of Pharmacology 291: 347–358 (1975).

    PubMed  CAS  Google Scholar 

  • Kawashima, K.; Levy, A. and Spector, S.: Stereospecific radioimmunoassay for propranolol isomers. Journal of Pharmacology and Experimental Therapeutics 196: 517–523 (1976).

    PubMed  CAS  Google Scholar 

  • Keates, E.U. and Stone, M.D.: The effect of d-timolol on intraocular pressure in patients with ocular hypertension. American Journal of Ophthalmology 98: 73–78 (1984).

    PubMed  CAS  Google Scholar 

  • Kreek, M.J.; Hachey, D.L. and Klein, P.D.: Stereoselective disposition of methadone in man. Life Sciences 24: 925–932 (1979).

    PubMed  CAS  Google Scholar 

  • Larsen, T.A. and Teravainen, H.: Propranolol and essential tremor: Role of the membrane effect. Acta Neurologica Scandinavica 66: 289–294 (1982).

    PubMed  CAS  Google Scholar 

  • Lee, E.J.D.; Williams, K.M.; Graham, G.G.; Day, R.O. and Champion, G.D.: Liquid Chromatographic determination and the plasma concentration profile of optical isomers of ibuprofen in humans. Journal of Pharmaceutical Sciences 73: 1542–1544 (1984).

    PubMed  CAS  Google Scholar 

  • Lee, E.J.D.; Williams, K.; Day, R.; Graham, G. and Champion, D.: Stereoselective disposition of ibuprofen enantiomers in man. British Journal of Clinical Pharmacology 19: 669–674 (1985).

    PubMed  CAS  Google Scholar 

  • Lennard, M.S.; Tucker, G.T.; Silas, J.H.; Freestone, S.; Ramsey, L.E. and Woods, H.F.: Differential stereoselective metabolism of metoprolol in extensive and poor debrisoquine metabolizers. Clinical Pharmacology and Therapeutics 34: 732–737 (1983).

    PubMed  CAS  Google Scholar 

  • Lewis, R.J.; Trager, W.F.; Chan, K.K.; Breckenridge, A.; Orme, M.; Roland, M. and Schary, W.: Warfarin. Stereochemical aspects of its metabolism and the interaction with phenylbutazone. Journal of Clinical Investigation 53: 1607–1617 (1974).

    PubMed  CAS  Google Scholar 

  • Lima, J.L.; Jungbluth, G.L.; Devine, T. and Robertson, L.W.: Stereoselective binding of disopyramide to human plasma protein. Life Sciences 35: 835–839 (1984).

    PubMed  CAS  Google Scholar 

  • Little, J.R.; Latchan, J.P.; Slugg, R.M.; Lesser, R.P. and Stowe, N.T.: Treatment of acute focal cerebral ischaemia with propranolol. Stroke 13: 302–307 (1982).

    PubMed  CAS  Google Scholar 

  • Lochmuller, C.H. and Souter, R.W.: Chromatographie resolution of enantiomers. Selective review. Journal of Chromatography 113: 283–302 (1975).

    CAS  Google Scholar 

  • McMenamy, R.H. and Oncley, J.L.: The specific binding of L-tryptophan to serum albumin. Journal of Biological Chemistry 233: 1436–1447 (1958).

    PubMed  CAS  Google Scholar 

  • Mason, S.: The left hand of nature. New Scientist 1393: 10–14 (1984).

    Google Scholar 

  • May, E.L and Takeda, M.: Optical isomers of miscellaneous strong analgetics. Journal of Medicinal Chemistry 13: 805–807 (1970).

    PubMed  CAS  Google Scholar 

  • Meinertz, T.; Kasper, W.; Kahl, C. and Jahnchen, E.: Anticoagulant activity of the enantiomers of acenocoumarol. British Journal of Clinical Pharmacology 5: 187–188 (1978).

    PubMed  CAS  Google Scholar 

  • Meresaar, U.; Nilsson, M.I.; Holmstrand, J. and Anggard, E.: Single dose pharmacokinetics and bioavailability of methadone in man studied with a stable isotope method. European Journal of Clinical Pharmacology 20: 473–478 (1981).

    PubMed  CAS  Google Scholar 

  • Mills, R.F.N.; Adams, S.S.; Cliffe, E.E.; Dickinson, W. and Nicholson, J.S.: The metabolism of ibuprofen. Xenobiotica 3: 589–598 (1973).

    PubMed  CAS  Google Scholar 

  • Miner, D.J.; Coleman, D.L.; Shepard, A.M.M. and Hardin, T.C.: Determination of moxalactam in human body fluids by liquid Chromatographie and microbiological methods. Antimicrobial Agents and Chemotherapy 20: 252–257 (1981).

    PubMed  CAS  Google Scholar 

  • Muller, W.E. and Wollert, U.: High stereospecificity of the benzodiazepine binding site on human serum albumin. Molecular Pharmacology 11: 52–60 (1975a).

    PubMed  CAS  Google Scholar 

  • Muller, W.E. and Wollert, U.: Benzodiazepines: Specific competitors for the binding of L-tryptophan to human albumin. Naunyn-Schmiedeberg’s Archives of Pharmacology 288: 17–27 (1975b).

    PubMed  CAS  Google Scholar 

  • Murphy, P.J.; Nickander, R.C.; Bellamy, G.M. and Kurtz, W.L.: Effect of l-propoxyphene on plasma levels and analgesic activity of d-propoxyphene in the rat. Journal of Pharmacology and Experimental Therapeutics 199: 415–422 (1976).

    PubMed  CAS  Google Scholar 

  • Nakamura, K.; Hachey, D.L.; Kreek, M.J.; Irving, C.S. and Klein, P.D.: Quantitation of methadone enantiomers in humans using stable isotope-labelled [2H3]-[2H5]- and [2H8] methadone. Journal of Pharmaceutical Sciences 71: 40–43 (1982).

    PubMed  CAS  Google Scholar 

  • Nakamura, Y.; Yamaguchi, T.; Takahashi, S.; Hashimoto, S.; Iwatani, K. and Nakagawa, Y.: Optical isomerization mechanism of R(−)-hydratropic acid derivatives. Proceedings of the 12th Symposium on Drug Metabolism and Action, Kanazawa, Japan (October, 1980).

  • Nies, A.S.; Evans, G.H. and Shand, D.G.: The hemodynamic effects of beta adrenergic blockade on the flow-dependent hepatic clearance of propranolol. Journal of Pharmacology and Experimental Therapeutics 184: 716–720 (1973a).

    PubMed  CAS  Google Scholar 

  • Nies, A.S.; Evans, G.H. and Shand, D.G.: Regional hemodynamic effects of beta adrenergic blockade with propranolol in the unanesthetized primate. American Heart Journal 85: 97–102 (1973b).

    PubMed  CAS  Google Scholar 

  • Nies, A.S.; Shand, D.G. and Wilkinson, G.R.: Altered hepatic blood flow and drug disposition. Clinical Pharmacokinetics 1: 135–155 (1976).

    PubMed  CAS  Google Scholar 

  • Olsen, G.D.; Wendel, H.A.; Livermore, J.D.; Leger, R.M.; Lynn, R.K. and Gerber, N.: Clinical effects and pharmacokinetics of racemic methadone and its optical isomers. Clinical Pharmacology and Therapeutics 21: 147–157 (1977).

    PubMed  CAS  Google Scholar 

  • O’Reilly, R.A.: Studies on the optical enantiomorphs of warfarin in man. Clinical Pharmacology and Therapeutics 16: 348–354 (1974).

    PubMed  Google Scholar 

  • O’Reilly, R.A.: The stereoselective interaction of warfarin and metronidazole in man. New England Journal of Medicine 295: 354–357 (1976).

    PubMed  Google Scholar 

  • O’Reilly, R.A.: Stereoselective interaction of trimethoprim-sul-famethoxazole with the separated enantiomorphs of racemic warfarin in man. New England Journal of Medicine 302: 33–35 (1980).

    PubMed  Google Scholar 

  • O’Reilly, R.A.: Dynamic interaction between disulfiram and separated enantiomorphs of racemic warfarin. Clinical Pharmacology and Therapeutics 29: 332–336 (1981).

    PubMed  Google Scholar 

  • O’Reilly, R.A.: Stereoselective interaction of sulphinpyrazone with racemic warfarin and its separated enantiomorphs in man. Circulation 65: 202–207 (1982a).

    PubMed  Google Scholar 

  • O’Reilly, R.A.: Ticrynafen-racemic warfarin interaction: Hepatotoxic or stereoselective? Clinical Pharmacology and Therapeutics 32: 356–361 (1982b).

    PubMed  Google Scholar 

  • O’Reilly, R.A. and Goulart, D.A.: Comparative interaction of sulfinpyrazone and phenylbutazone with racemic warfarin: Alteration in vivo of free fraction of plasma warfarin. Journal of Pharmacology and Experimental Therapeutics 219: 691–694 (1981).

    PubMed  Google Scholar 

  • O’Reilly, R.A. and Motley, C.H.: Racemic warfarin and trimethoprim-sulfamethoxazole interaction in humans. Annals of Internal Medicine 91: 34–36 (1979).

    PubMed  Google Scholar 

  • O’Reilly, R.A.; Sahud, M.A. and Robinson, A.J.: Studies on the interaction of warfarin and clofibrate in man. Thrombosis et Diathesis Haemorrhagica 27: 309–318 (1972).

    PubMed  Google Scholar 

  • O’Reilly, R.A.; Trager, W.F.; Motley, C.H. and Howald, W.: Stereoselective interaction of phenylbutazone with [I2C/I3C] warfarin pseudoracemates in man. Journal of Clinical Investigations 65: 746–753 (1980a).

    Google Scholar 

  • O’Reilly, R.A.; Trager, W.F.; Motley, C.H. and Howald, W.: Interaction of secobarbital with warfarin. Clinical Pharmacology and Therapeutics 28: 187–195 (1980b).

    PubMed  Google Scholar 

  • Pasteur, L: Second lecture to the Chemical Society of Paris (1860); in Richardson (Ed.) The Foundations of Stereo Chemistry (American Book Company, New York 1901).

    Google Scholar 

  • Patil, N.; LaPidus, J.B. and Tye, A.: Steric aspects of adrenergic drugs. Journal of Pharmaceutical Sciences 59: 1205–1233 (1970).

    PubMed  CAS  Google Scholar 

  • Patil, N.; Miller, D.D. and Trendelenberg, U.: Molecular geometry and adrenergic drug activity. Pharmacological Reviews 26: 323–392 (1975).

    Google Scholar 

  • Pillai, G.K.; Axelson, J.E.; Kerr, C.R. and McErlane, K.M.: Stereospecific salivary excretion of tocainide enantiomers in man. Research Communications in Chemical Pathology and Pharmacology 43: 209–221 (1984).

    PubMed  CAS  Google Scholar 

  • Raschack, M.: Relationship of antiarrhythmic to inotropic activity and antiarrhythmic qualities of the optical isomers of verapamil. Naunyn-Schmiedeberg’s Archives of Pharmacology 294: 285–291 (1976).

    PubMed  CAS  Google Scholar 

  • Rose, I.A.: Enzyme reaction stereospecificity: A critical review. CRC Critical Reviews in Biochemistry 1: 33–57 (1972).

    PubMed  CAS  Google Scholar 

  • Rubin, A.; Knadler, M.P.; Ho, P.P.K.; Bechtol, L.D. and Wolen, R.L.: Stereoselective inversion of R-fenoprofen to S-fenoprofen in humans. Journal of Pharmaceutical Sciences 74: 82–84 (1985).

    PubMed  CAS  Google Scholar 

  • Saikawa, T. and Arita, M.: Effects of verapamil and its optical isomers on repetitive slow responses induced by electrical depolarization in canine ventricular myocardium. Japan Heart Journal 21: 247–255 (1980).

    CAS  Google Scholar 

  • Sastry, B.V.R.: Stereoisomerism and drug action in the nervous system. Annual Reviews of Pharmacology 13: 253–267 (1973).

    CAS  Google Scholar 

  • Satoh, K.; Yanagisawa, T. and Taira, N.: Coronary vasodilator and cardiac effects of optical isomers of verapamil in the dog. Journal of Cardiovascular Pharmacology 2: 309–318 (1980).

    PubMed  CAS  Google Scholar 

  • Seideman, P.; Ericsson, O.; Groningsson, K. and von Bahr, C.: Effect of pentobarbital on the formation of diastereomeric glucoronides in man: Analysis by high performance liquid chromatography. Acta Pharmacologica et Toxicologica 49: 200–204 (1981).

    PubMed  CAS  Google Scholar 

  • Sellers, E.M. and Koch-Weser, J.: Interaction of warfarin stereoisomers with human albumin. Pharmacological Research Communications 7: 331–335 (1975).

    CAS  Google Scholar 

  • Serlin, M.J. and Breckenridge, A.M.: Drug interactions with warfarin. Drugs 25: 610–620 (1983).

    PubMed  CAS  Google Scholar 

  • Shand, D.G.; Branch, R.A.; Evans, G.H.; Nies, A.S. and Wilkinson, G.R.: The disposition of propranolol. VII. Drug Metabolism and Disposition 1: 679–686 (1973).

    CAS  Google Scholar 

  • Shiotani, S.: Optical resolution of some homobenzomorphan derivatives and their pharmacological properties. Journal of Medicinal Chemistry 22: 1568–1560 (1979).

    Google Scholar 

  • Silber, B. and Riegelman, S.: Stereospecific assay for (−)- and (+)-propranolol in human and dog plasma. Journal of Pharmacology and Experimental Therapeutics 215: 643–648 (1980).

    PubMed  CAS  Google Scholar 

  • Simmonds, R.G.; Woodage, T.J.; Duff, S.M. and Green, J.N.: Stereospecific inversion of R(−)-benoxaprofen in rat and man. European Journal of Drug Metabolism and Pharmacokinetics 5: 169–172 (1980).

    PubMed  CAS  Google Scholar 

  • Smith, D.F. (Ed.): CRC Handbook of Stereoisomers: Drugs in Psychopharmacology (CRC Press Inc., Boca Raton, Florida 1984).

    Google Scholar 

  • Smits, S.E. and Myers, M.B.: Some comparative effects of racemic methadone and its optical isomers in rodents. Research Communications in Chemical Pathology and Pharmacology 7: 651–662 (1974).

    PubMed  CAS  Google Scholar 

  • Steen, P.A. and Michenfelder, J.D.: Cerebral protection with barbiturates. Stroke 9: 140–142 (1978).

    PubMed  CAS  Google Scholar 

  • Stoltenborg, J.K.; Puglisi, C.V.; Rubio, F. and Vane, F.M.: High performance liquid Chromatographic determination of stereoselective disposition of carprofen in humans. Journal of Pharmaceutical Sciences 70: 1207–1212 (1981).

    PubMed  CAS  Google Scholar 

  • Tamassia, V.; Jannuzzo, M.G.; Moro, E.; Stegnjaich, S.. and Groppi, W.: Pharmacokinetics of the enantiomers of indoprofen in man. International Journal of Clinical Pharmacology Research 4: 223–230 (1984).

    PubMed  CAS  Google Scholar 

  • Tobert, J.A.; Cirillo, V.J.; Hitzenberger, G.; James, I.; Pyror, J. et al.: Enhancement of uricosuric properties of indacrinone by manipulation of the enantiomeric ratio. Clinical Pharmacology and Therapeutics 29: 344–350 (1981).

    PubMed  CAS  Google Scholar 

  • Tocco, D.J.; Hooke, K.F.; Deluna, F.A. and Duncan, A.E.W.: Stereospecific binding of timolol, a beta-adrenergic blocking agent. Drug Metabolism and Disposition 4: 323–329 (1976).

    PubMed  CAS  Google Scholar 

  • Toon, S. and Trager, W.F.: Stereochemical aspects of drug-protein binding: The warfarin sulfinpyrazone interaction. 2nd World Conference on Clinical Pharmacology and Therapeutics, Washington DC (August, 1983).

  • Toon, S. and Trager, W.F.: Pharmacokinetic implications of stereoselective changes in plasma-protein binding: Warfarin-sulfinpyrazone. Journal of Pharmaceutical Sciences 73: 1671–1673 (1984).

    PubMed  CAS  Google Scholar 

  • Valdivieso, L.; Blaschke, T. and Giacomini, K.: Disopyramide enantiomers bind stereoselectively to human plasma protein. 2nd World Conference on Clinical Pharmacology and Therapeutics, Washington DC (August, 1983).

  • Verebely, K.; Volavka, J.; Mulé, S. and Resnick, R.: Methadone in man: Pharmacokinetic and excretion studies in acute and chronic treatment. Clinical Pharmacology and Therapeutics 18: 180–190 (1975).

    PubMed  CAS  Google Scholar 

  • Veronich, K.; White, G. and Kapoor, A.: Effects of phenylbutazone, tolbutamide and clofibric acid on binding of racemic warfarin and its enantiomers to human serum albumin. Journal of Pharmaceutical Sciences 68: 1515–1518 (1979).

    PubMed  CAS  Google Scholar 

  • Vlasses, P.H.; Irvin, J.D.; Huber, P.B.; Lee, R.B.; Ferguson, R.K. et al.: Pharmacology of enantiomers and (−) p-OH metabolite of indacrinone. Clinical Pharmacology and Therapeutics 29: 798–807 (1981).

    PubMed  CAS  Google Scholar 

  • Vlasses, P.H.; Rotmensch, H.H.; Swanson, B.N.; Irvin, J.D.; Johnson, C.L. and Ferguson, R.K.: Indacrinone: Natriuretic and uricosuric effects of various ratios of its enantiomers in healthy men. Pharmacotherapy 4: 272–283 (1984).

    PubMed  CAS  Google Scholar 

  • Vogelgesang, B.; Echizen, H.; Schmidt, E. and Eichelbaum, M.: Stereoselective first-pass metabolism of highly cleared drugs: Studies of the bioavailability of L- and D-verapamil examined with a stable isotope technique. British Journal of Clinical Pharmacology 18: 733–740 (1984).

    PubMed  CAS  Google Scholar 

  • Von Bahr, C.; Hermansson, J. and Tawara, K.: Plasma levels of (+) and (−)-propranolol and 4-hydroxypropranolol after administration of racemic ( ± )-propranolol in man. British Journal of Clinical Pharmacology 14: 79–82 (1982a).

    Google Scholar 

  • Von Bahr, C.; Hermansson, J. and Lind, M.: Oxidation of (R)-and (S)-propranolol in human and dog liver microsomes. Species differences in stereoselectivity. Journal of Pharmacology and Experimental Therapeutics 222: 458–462 (1982b).

    Google Scholar 

  • Wade, D.N.; Mearrick, P.T. and Morris, J.L.: Active transport of L-dopa in the intestine. Nature 242: 463–465 (1973).

    PubMed  CAS  Google Scholar 

  • Walle, T. and Walle, U.K.: Stereoselective oral bioavailability of ( ± )-propranolol in the dog. A GCMS study using a stable isotope technique. Research Communications in Chemical Pathology and Pharmacology 23: 453–464 (1979).

    PubMed  CAS  Google Scholar 

  • Walle, U.K.; Walle, T.; Bai, S.A. and Oranoff, L.S.: Stereoselective binding of propranolol to human plasma, α1acid glycoprotein and albumin. Clinical Pharmacology and Therapeutics 34: 718–722 (1983).

    PubMed  CAS  Google Scholar 

  • Wanwimolruk, S.: Protein binding of non-steroidal anti-inflammatory drugs: Basic and clinical aspects (Ph.D. Thesis, Flinders University of South Australia, 1983).

    Google Scholar 

  • Wilkinson, G.R. and Shand, D.G.: A physiological approach to hepatic drug clearance. Clinical Pharmacology and Therapeutics 18: 377–390 (1975).

    PubMed  CAS  Google Scholar 

  • Williams, K.M.: Kinetics of misonidazole enantiomers. Clinical Pharmacology and Therapeutics 36: 817–823 (1984).

    PubMed  CAS  Google Scholar 

  • Williams, K.M. and Day, R.O.: Stereoselective disposition — basis for variability in response to NSAID’s. Agents and Actions (Suppl.) (In press, 1985).

    Google Scholar 

  • Williams, K.M. and Smith, G.G.: A critical evaluation of the application of amino acid racemization to geochronology and geothermometry. Origins of Life 8: 91–144 (1977).

    PubMed  CAS  Google Scholar 

  • Williams, K.; Begg, E.; Wade, D. and O’Shea, K.: Effects of phenytoin, phenobarbital and ascorbic acid on misonidazole elimination. Clinical Pharmacology and Therapeutics 33: 314–321 (1983).

    PubMed  CAS  Google Scholar 

  • Wingard, L.B. and Levy, G.: Comparative pharmacokinetics of coumarin anticoagulants. XXXVI: Predicted steady state patterns of prothrombin complex activity produced by equieffective doses of R(+)- and S(−)-warfarin in humans. Journal of Pharmaceutical Sciences 66: 1790–1791 (1977).

    PubMed  Google Scholar 

  • Wingard, L.B.; O’Reilly, R.A. and Levy, G.: Pharmacokinetics of warfarin enantiomers: A search for intrasubject correlations. Clinical Pharmacology and Therapeutics 23: 212–217 (1978).

    PubMed  CAS  Google Scholar 

  • Wise, R.; Wills, P.J. and Bedford, K.A.: Epimers of moxalactam: In vitro comparison of activity and stability. Antimicrobial Agents and Chemotherapy 20: 30–32 (1981).

    PubMed  CAS  Google Scholar 

  • Workman, P.: Effects of pretreatment with phenobarbitone and phenytoin on the pharmacokinetics and toxicity of misonidazole in mice. British Journal of Cancer 40: 335–353 (1979).

    PubMed  CAS  Google Scholar 

  • Yacobi, A. and Levy, G.: Comparative pharmacokinetics of coumarin anticoagulants. XIV: Relationship between protein binding, distribution and elimination kinetics of warfarin in rats. Journal of Pharmaceutical Sciences 64: 1660–1664 (1975).

    PubMed  CAS  Google Scholar 

  • Yacobi, A. and Levy, G.: Protein binding of warfarin enantiomers in serum of humans and rats. Journal of Pharmacokinetics and Biopharmaceutics 5: 123–131 (1977).

    PubMed  CAS  Google Scholar 

  • Yacobi, A.; Udall, J.A. and Levy, G.: Serum protein binding as a determinant of warfarin body clearance and anticoagulant effect. Clinical Pharmacology and Therapeutics 19: 552–558 (1976).

    PubMed  CAS  Google Scholar 

  • Zacchei, A.G.; Dobrinska, M.R.; Wishousky, T.I.; Kwan, K.C. and White, S.D.: Stereoselectivity in the disposition and metabolism of the uricosuric-diuretic agent, indacrinone, in rhesus monkeys. Drug Metabolism and Disposition 10: 20–27 (1982).

    PubMed  CAS  Google Scholar 

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Williams, K., Lee, E. Importance of Drug Enantiomers in Clinical Pharmacology. Drugs 30, 333–354 (1985). https://doi.org/10.2165/00003495-198530040-00003

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