Abstract
The purpose of this study was to investigate the possible effects of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, simvastatin, on the pharmacokinetics of diltiazem and its main metabolite, desacetyldiltiazem, in rats. HMG-CoA reductase inhibitors and diltiazem are sometimes prescribed as a combination therapy for the prevention or treatment of cardiovascular diseases. The effect of simvastatin on P-glycoprotein (P-gp) and cytochrome P450 (CYP) 3A4 activity was evaluated. Simvastatin inhibited CYP3A4 enzyme activity in a concentration-dependent manner with a 50% inhibition concentration (IC50) of 3.0 μM. In addition, simvastatin significantly enhanced the cellular accumulation of rhodamine-123 in MCF-7/ADR cells overexpressing P-gp. The pharmacokinetic parameters of diltiazem and desacetyldiltiazem were determined after oral and intravenous administration of diltiazem to rats in the presence and absence of simvastatin (0.3 and 1.0 mg/kg). The areas under the plasma concentration-time curve (AUC) and the peak concentration (Cmax) of diltiazem were significantly (p < 0.05, 1.0 mg/kg) increased by 45.2% and 35.2%, respectively, in the presence of simvastatin compared to control. Consequently, the absolute bioavailability (AB) values of diltiazem in the presence of simvastatin (1.0 mg/kg) were significantly (p < 0.05) higher (44.8%) than that of the control group. Moreover, the relative bioavailability (RB) of diltiazem was 1.21- to 1.45-fold greater than that in the control group. The metabolite-parent AUC ratio (MR) in the presence of simvastatin (1.0 mg/kg) significantly decreased compared to the control group. This result implied that simvastatin effectively inhibited the metabolism of diltiazem.
The increase in diltiazem oral bioavailability might be attributable to enhanced absorption in the small intestine via the inhibition of P-gp and to reduced first-pass metabolism of diltiazem via the inhibition of the CYP3A subfamily in the small intestine and/or in the liver rather than renal elimination of diltiazem by simvastatin.
Abbreviations
- AB (%):
-
absolute bioavailability
- AUC:
-
area under the plasma concentration-time curve
- Cmax:
-
peak plasma concentration
- Ka:
-
absorption rate constant for the diltiazem
- K12:
-
distribution rate constant of the drug from the central compartment to the peripheral compartment
- K21:
-
distribution rate constant from the peripheral compartment to the central compartment
- MR:
-
metabolite-parent ratio
- RB (%):
-
relative bioavailability
- t1/2:
-
terminal half-life
- Tmax:
-
time to peak concentration
References
Baliharová V, Velík J, Fimanová K, Lamka J, Szotáková B, Savlík M, Skálová L. Inhibitory effect of albendazole and its metabolites on cytochromes P450 activities in rat and mouflon in vitro. Pharmacol Rep, 2005, 57, 97–106.
Bogaards JJ, Bertrand M, Jackson P, Oudshoorn MJ, Weaver RJ, van Bladeren PJ, Walther B: Determining the best animal model for human cytochrome P450 activities: a comparison of mouse, rat, rabbit, dog, mi-cropig, monkey and man. Xenobiotica, 2000, 30, 1131–1152.
Bogman K, Peyer AK, Torok M, Kusters E, Drewe J: HMG-CoA reductase inhibitors and P-glycoprotein modulation. Br J Pharmacol, 2001, 132, 1183–1192.
Bottorff MB: Statin safety and drug interactions: clinical implications. Am J Cardiol 2006, 17, 27–31.
Buckley MMT, Grant SM, Goa KL, McTabish D, Sorkin EM: Diltiazem: A reappraisal of its pharmacological properties and therapeutic use. Drugs, 1990, 39, 757–806.
Chaffman M, Brogden RN: Diltiazem: a review of its pharmacological properties and therapeutic efficacy. Drugs 1985, 29, 387–454.
Choi JS, Piao YJ, Han HK: Pharmacokinetic interaction between fluvastatin and diltiazem in rats. Biopharm Drug Dispos, 2006, 27, 437–41.
Crespi CL, Miller VP, Penman BW: Microtiter plate assays for inhibition of human, drug-metabolizing cyto-chromes P450. Anal Biochem, 1997, 248, 188–191.
Cummins CL, Jacobsen W, Benet LZ: Unmasking the dynamic interplay between intestinal P-glycoprotein and CYP3A4. J Pharmacol Exp Ther 2002, 300, 1036–1045.
FDA Guidance for industry: In vivo drug metabolism/drug interaction studies-study design, data analysis, and recommendations for dosing and labeling. Available from: URL: https://doi.org/www.fda.gov/cder/guidance/in-dex.htm, [cited November 24, 1999]
Gan LSL, Moseley MA, Khosla B, Augustijns PF, Bradshaw TP, Hendren RW, Thakker DR: CYP3A-like cytochrome P450-mediated metabolism and polarized efflux of cyclosporin A in Caco-2 cells: interaction between the two biochemical barriers to intestinal transport. Drug Metab Dispos, 1996, 24, 344–349.
Goebel KJ, Kolle EU: High performance liquid chroma-tographic determination of diltiazem and four of its metabolites in plasma. J Chromatogr, 1985, 345, 355–363.
Gottesman MM, Pastan I: Biochemistry of multidrug resistance mediated by the multidrug transporter. Annu Rev Biochem, 1993, 62, 385–427.
Han CY, Cho KB, Choi HS, Han HK, Kang KW: Role of FoxO1 activation in MDR1 expression in adriamycin-resistant breast cancer cells. Carcinogenesis, 2008, 29, 1837–1844.
Homsy W, Caille G, du Souich P: The site of absorption in the small intestine determines diltiazem bioavailability in the rabbit. Pharm Res, 1995, 12, 1722–1726.
Homsy W, Lefebvre M, Caille G, du Souich P: Metabolism of diltiazem in hepatic and extrahepatic tissues of rabbits: in vitro studies. Pharm Res, 1995, 12, 609–614.
Hong SP, Chang KS, Choi DH, Choi JS: Effect of ator-vastatin on the pharmacokinetics of diltiazem and its main metabolit, desacetyldiltiazem, in rats. Arch Pharm Res, 2007, 30, 90–95.
Ito K, Kusuhara H, Sugiyama Y: Effects of intestinal CYP3A4 and P-glycoprotein on oral drug absorption theoretical approach. Pharm Res, 1999, 16, 225–231.
Kelly PA, Wang H, Napoli KL, Kahan BD, Strobel HW: Metabolism of cyclosporine by cytochromes P450 3A9 and 3A4. Eur J Drug Metab Pharmacokinet, 1999, 24, 321–328.
Kolars JC, Schmiedlin-Ren P, Dobbins WO, Schuetz J, Wrighton SA, Watkins PB: Heterogeneity of cytochrome P450IIIA expression in rat gut epithelia. Gastroenterol-ogy, 1992, 102, 1186–1198.
Lee YH, Lee MH, Shim CK: Pharmacokinetics of dilti-azem and deacetyldiltiazem in rats. Int J Pharm, 1991, 76, 71–76.
Lefebvre M, Homsy W, Caille G, du Souich P: First-pass metabolism of diltiazem in anesthetized rabbits: role of extrahepatic organs. Pharm Res, 1996, 13, 124–128.
Lennernäs H, Fager G: Pharmacodynamics and pharma-cokinetics of the HMG-CoA reductase inhibitors: similarities and differences. Clin Pharmacokinet, 1997, 32, 403–425.
Lewis DFV: Cytochrome P450. Substrate specificity and metabolism. In: Cytochromes P450. Structure, Function, and Mechanism. Taylor & Francis, Bristol, 1996, 122–123.
Marumo H, Satoh K, Yamamoto A, Kaneta S, Ichihara K: Simvastatin and atorvastatin enhance hypotensive effect of diltiazem in rats. Yakugaku Zasshi, 2001, 121, 761–764.
Mason RP: A rationale for combined therapy with a calcium channel blocker and a statin: evaluation of basic and clinical evidence. Curr Drug Targets Cardiovasc Haematol Disord, 2005, 5, 489–501.
McKinnon R, McManus M: Localization of cytochromes P450 in human tissues: Implications for chemical toxic-ity. Pathology, 1996, 28, 148–155.
Mousa O, Brater DC, Sunblad KJ, Hall SD: The interaction of diltiazem with simvastatin. Clin Pharmacol Ther, 2000, 67, 267–274.
Narita H, Otsuka M, Yabana H, Nagao T: Hypotensive response of spontaneously hypertensive rats to centrally administered diltiazem and its metabolites: in relevance to the hypotensive action by oral administration. J Phar-macobiodyn, 1986, 9, 547–553.
Pichard L, Gillet G, Fabre I, Dalet-Beluche I, Bonfils C, Thenot JP, Maurel P: Identification of the rabbit and human cytochromes P-450IIIA as the major enzymes involved in the N-demethylation of diltiazem. Drug Metab Dispos, 1990, 18, 711–719.
Prueksaritanont T, Gorham LM, Ma B: In vitro metabolism of simvastatin in humans: identification of metabolizing enzymes and effect of the drug on hepatic P450s. Drug Metab Dispos, 1997, 25, 1191–1199.
Tubic-Grozdanis M, Hilfinger JM, Amidon GL, Kim JS, Kijek P, Staubach P, Langguth P: Pharmacokinetics of the CYP3A substrate simvastatin following administration of delayed versus immediate release oral dosage forms. Pharm Res, 2008, 25, 1591–600.
Wacher VH, Silverman JA, Zhang Y, Benet LZ: Role of P-glycoprotein and cytochrome P450 3A in limiting oral absorption of peptides and peptidomimetics. J Pharm Sci, 1998, 87, 1322–1330.
Wacher VJ, Salphati L, Benet LZ: Active secretion and enterocytic drug metabolism barriers to drug absorption. Adv Drug Deliv Rev, 2001, 46, 89–102.
Watkins PB: Drug metabolism by cytochromes P450 in the liver and small bowel. Gastroenterol Clin North Am 1992, 21, 511–526.
Watkins PB, Wrighton SA, Schuetz EG, Molowa DT, Guzelian PS: Identification of glucocorticoid-inducible cytochromes P-450 in the intestinal mucosa of rats and man. J Clin Invest, 1987, 80, 1029–1036.
Weir MR: Diltiazem: ten years of clinical experience in the treatment of hypertension. J Clin Pharmacol, 1995, 35, 220–232.
Yeung PK, Feng JDZ, Buckley SJ: Pharmacokinetics and hypotensive effect of diltiazem in rabbits: Comparison of diltiazem with its major metabolites. J Pharm Pharmacol, 1998, 50, 1247–1253.
Yeung PK, Prescott C, Haddad C, Montague TJ, McGregor C, Quilliam MA, Xei M et al.: Pharmacoki-netics and metabolism of diltiazem in healthy males and females following a single oral dose. Eur J Drug Metab Pharmacokinet, 1993, 18, 199–206.
Yusa K, Tsuruo T: Reversal mechanism of multidrug resistance by verapamil: direct binding of verapamil to P-glycoprotein on specific sites and transport of verapamil outward across the plasma membrane of K562/ADM cells. Cancer Res, 1989, 49, 5002–5006.
Zhang Q, Dunbar D, Ostrowska A, Zeisloft S, Yang J, Kaminsky L: Characterization of human small intestinal cytochromes P-450. Drug Metab Dispos, 1992, 27, 804–809.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Choi, DH., Choi, JS., Li, C. et al. Effects of simvastatin on the pharmacokinetics of diltiazem and its main metabolite, desacetyldiltiazem, after oral and intravenous administration in rats: possible role of P-glycoprotein and CYP3A4 inhibition by simvastatin. Pharmacol. Rep 63, 1574–1582 (2011). https://doi.org/10.1016/S1734-1140(11)70724-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1016/S1734-1140(11)70724-1