Effect of Telmisartan on the Pharmacokinetics of Ebastine

Ebastine의 약동학에 미치는 Telmisartan의 영향

  • Received : 2013.08.07
  • Accepted : 2013.11.27
  • Published : 2013.12.31

Abstract

Purpose: Telmisartan, an angiotensin receptor blocker has been known to be a potent blocker of both CYP2J2 and P-glycoprotein (P-gp) in vitro. This study aims to investigate the drug-drug interactions between telmisartan and ebastine, a CYP2J2 and P-gp substrate in rats. Method: Ebastine (10 mg/kg) was orally given in the presence and absence of telmisartan (4 mg/kg, p.o.). Heparinized blood was serially taken and the plasma concentrations of ebastine and its three metabolites (hydroxyebastine, carebastine and desalkylebastine) were determined using LC-MS/MS, and their pharmacokinetic parameters were compared. Results: Peak concentrations ($C_{max}$) and AUC of ebastine were significantly (p<0.05) increased in the presence of telmisartan by 2.1 and 1.9 times, respectively. While $C_{max}$ of hydroxyebastine was significantly increased by 1.9 times, the half-life of hydroxyebasteine was decreased significantly with telmisartan (p<0.05). There was no change in the pharmacokinetic parameters of carebastine, the active metabolite of ebastine, and desalkylebastine was not detected in plasma. The systemic exposure of ebastine was significantly augmented by telmisartan, indicating that telmisartan may enhance the absorption of ebastine by blocking P-gp. Conclusion: Although telmisartan may also partially contribute to inhibit the biotransformation to hydroxyebastine, the inhibitory action seemed to be overridden by the enhancement of absorption, because the generation of hydroxyebastine was not diminished. In spite of such interactions between telmisartan and ebastine, no clinical consequence could be expected due to no significant change of the active metabolite, carebastine.

Keywords

References

  1. Wiseman LR, Faulds D. Ebastine. a review of its pharmacological properties and clinical efficacy in the treatment of allergic disorders. Drugs 1996; 51: 260-77. https://doi.org/10.2165/00003495-199651020-00006
  2. Llupi J, Gras J, Llenas J. Comparative antiallergic effects of second-generation H1-antihistamines ebastine, cetirizine and loratadine in preclinical models, Arzneimittelforschung 2003; 53: 93-7.
  3. Fujii T, Matsumoto S, Hatoyama T, et al. Studies on the firstpass metabolism of ebastine in rats. Arzneimittelforschung 1997; 47: 949-53.
  4. Yamaguchi T, Hashizume T, Matsuda M, et al. Pharmacokinetics of the H1-receptor antagonist ebastine and its active metabolite carebastine in healthy subjects, Arzneimittelforschung 1994; 44: 59-64.
  5. Liu KH, Kim MG, Lee DJ, et al. Characterization of Ebastine, Hydroxyebastine, and Carebastine Metabolism by Human Liver Microsomes and Expressed Cytochrome P450 Enzymes: Major Roles for CYP2J2 and CYP3A, Drug Metab Dispos 2006; 34: 1793-7. https://doi.org/10.1124/dmd.106.010488
  6. Hashizume T, Imaoka S, Mise M, et al. Involvement of CYP2J2 and CYP4F12 in the Metabolism of Ebastine in Human Intestinal Microsomes. J Pharmacol Exp Ther 2002; 300: 298-304. https://doi.org/10.1124/jpet.300.1.298
  7. Hashizume T, Mise M, Terauchi Y, et al. N-Dealkylation and hydroxylation of ebastine by human liver cytochrone P450. Drug Metab Dispos 1998; 26: 566-71.
  8. Imamura Y, Shimizu K, Yamashita F, et al. Transport Characteristics of Ebastine and Its Metabolites across Human Intestinal Epithelial Caco-2 Cell Monolayers. Biol Pharm Bull 2001: 24: 930-4. https://doi.org/10.1248/bpb.24.930
  9. Glavinas H, Krajcsi P, Cserepes J, et al. The Role of ABC Transporters in Drug Resistance, Metabolism, and Toxicity. Curr Drug Deliv 2004: 1: 27-42. https://doi.org/10.2174/1567201043480036
  10. Thiebaut F, Tsuruo T, Hamada H, et al. Immunohistochemical localization in normal tissues of different epitopes in the multidrug transport protein P170: Evidence for localization in brain capillaries and crossreactivity of one antibody with a muscle protein. J Histochem Cytochem 1989; 37: 159-64. https://doi.org/10.1177/37.2.2463300
  11. Cummins CL, Jacobsen W, Benet LZ. Unmasking the Dynamic Interplay between Intestinal P-Glycoprotein and CYP3A4. J Pharmacol Exp Ther 2002; 300: 1036-45. https://doi.org/10.1124/jpet.300.3.1036
  12. Schinkel AF, Wagenaar E, Deemter LV, et al. Absence of the mdr1a P-Glycoprotein in mice affects tissue distribution and pharmacokinetics of dexamethasone, digoxin, and cyclosporin. J Clin Invest 1995; 96: 1698-705 https://doi.org/10.1172/JCI118214
  13. Stangier J, Schmid J, Turck D, et al. Absorption, Metabolism, and Excretion of Intravenously and Orally Administered [14C]Telmisartan in Healthy Volunteers. J Clin Pharmacol 2000; 40: 1312-22.
  14. Stangier J, Su CPF, Hendriks MGC, et al. The Effect of Telmisartan on the Steady-State Pharmacokinetics of Digoxin in Healthy Male Volunteers. J Clin Pharmacol 2000; 40: 1373-9.
  15. Weiss J, Sauer A, Divac N, et al. Interaction of angiotensin receptor type 1 blockers with ATP-binding cassette transporters. Biopharm Drug Dispos 2010; 31: 150-61. https://doi.org/10.1002/bdd.699
  16. Kamiyama E, Nakai D, Mikkaichi T, et al. Interaction of angiotensin II type 1 receptor blockers with P-gp substrates in Caco-2 cells and hMDR1-expressing membranes. Life Sci 2010; 86: 52-8. https://doi.org/10.1016/j.lfs.2009.11.006
  17. Fenner KS, Troutman MD, Kempshall S, et al. Drug-drug interactions mediated through P-glycoprotein: clinical relevance and in vitroin vivo correlation using digoxin as a probe drug. Clin Pharmacol Ther 2009; 85: 173-81. https://doi.org/10.1038/clpt.2008.195
  18. Ren S, Zeng J, Mei Y, et al. Discovery and characterization of novel, potent, and selective cytochrome P450 2J2 inhibitors. Drug Metab Dispos 2013; 41: 60-71. https://doi.org/10.1124/dmd.112.048264
  19. Yoon H, Osun B. Drug interaction of warfarin with simvastatin/gemfibrozil: high levels of ALT/AST, rhabdomyolysis and acute renal failure. Kor J Clin Pharm 2011; 21: 270-5.
  20. Choi MK, Bang JS, Lee YJ. Patterns of over-the-counter drug use and interactions between over-the counter drugs and prescription drugs in adults visiting a community pharmacy. Kor J Clin Pharm 2013; 23: 49-56.
  21. Kang W, Liu K, Ryu J, et al. Simultaneous determination of ebastine and its three metabolites in plasma using liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life 2004; 813: 75-80. https://doi.org/10.1016/j.jchromb.2004.09.017