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Physiologically Based Pharmacokinetic Modeling to Assess the Impact of CYP2D6‐Mediated Drug‐Drug Interactions on Tramadol and O‐Desmethyltramadol Exposures via Allosteric and Competitive Inhibition

Tramadol is an opioid medication used to treat moderately severe pain. Cytochrome P450 (CYP) 2D6 inhibition could be important for tramadol, as it decreases the formation of its pharmacologically active metabolite, O‐desmethyltramadol, potentially resulting in increased opioid use and misuse. The ob...

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Autores principales: Long, Tao, Cristofoletti, Rodrigo, Cicali, Brian, Michaud, Veronique, Dow, Pamela, Turgeon, Jacques, Schmidt, Stephan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9293201/
https://www.ncbi.nlm.nih.gov/pubmed/34383318
http://dx.doi.org/10.1002/jcph.1951
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author Long, Tao
Cristofoletti, Rodrigo
Cicali, Brian
Michaud, Veronique
Dow, Pamela
Turgeon, Jacques
Schmidt, Stephan
author_facet Long, Tao
Cristofoletti, Rodrigo
Cicali, Brian
Michaud, Veronique
Dow, Pamela
Turgeon, Jacques
Schmidt, Stephan
author_sort Long, Tao
collection PubMed
description Tramadol is an opioid medication used to treat moderately severe pain. Cytochrome P450 (CYP) 2D6 inhibition could be important for tramadol, as it decreases the formation of its pharmacologically active metabolite, O‐desmethyltramadol, potentially resulting in increased opioid use and misuse. The objective of this study was to evaluate the impact of allosteric and competitive CYP2D6 inhibition on tramadol and O‐desmethyltramadol pharmacokinetics using quinidine and metoprolol as prototypical perpetrator drugs. A physiologically based pharmacokinetic model for tramadol and O‐desmethyltramadol was developed and verified in PK‐Sim version 8 and linked to respective models of quinidine and metoprolol to evaluate the impact of allosteric and competitive CYP2D6 inhibition on tramadol and O‐desmethyltramadol exposure. Our results show that there is a differentiated impact of CYP2D6 inhibitors on tramadol and O‐desmethyltramadol based on their mechanisms of inhibition. Following allosteric inhibition by a single dose of quinidine, the exposure of both tramadol (51% increase) and O‐desmethyltramadol (52% decrease) was predicted to be significantly altered after concomitant administration of a single dose of tramadol. Following multiple‐dose administration of tramadol and a single‐dose or multiple‐dose administration of quinidine, the inhibitory effect of quinidine was predicted to be long (≈42 hours) and to alter exposure of tramadol and O‐desmethyltramadol by up to 60%, suggesting that coadministration of quinidine and tramadol should be avoided clinically. In comparison, there is no predicted significant impact of metoprolol on tramadol and O‐desmethyltramadol exposure. In fact, tramadol is predicted to act as a CYP2D6 perpetrator and increase metoprolol exposure, which may necessitate the need for dose separation.
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spelling pubmed-92932012022-07-20 Physiologically Based Pharmacokinetic Modeling to Assess the Impact of CYP2D6‐Mediated Drug‐Drug Interactions on Tramadol and O‐Desmethyltramadol Exposures via Allosteric and Competitive Inhibition Long, Tao Cristofoletti, Rodrigo Cicali, Brian Michaud, Veronique Dow, Pamela Turgeon, Jacques Schmidt, Stephan J Clin Pharmacol Physiologically Based Pharmacokinetic Modeling Tramadol is an opioid medication used to treat moderately severe pain. Cytochrome P450 (CYP) 2D6 inhibition could be important for tramadol, as it decreases the formation of its pharmacologically active metabolite, O‐desmethyltramadol, potentially resulting in increased opioid use and misuse. The objective of this study was to evaluate the impact of allosteric and competitive CYP2D6 inhibition on tramadol and O‐desmethyltramadol pharmacokinetics using quinidine and metoprolol as prototypical perpetrator drugs. A physiologically based pharmacokinetic model for tramadol and O‐desmethyltramadol was developed and verified in PK‐Sim version 8 and linked to respective models of quinidine and metoprolol to evaluate the impact of allosteric and competitive CYP2D6 inhibition on tramadol and O‐desmethyltramadol exposure. Our results show that there is a differentiated impact of CYP2D6 inhibitors on tramadol and O‐desmethyltramadol based on their mechanisms of inhibition. Following allosteric inhibition by a single dose of quinidine, the exposure of both tramadol (51% increase) and O‐desmethyltramadol (52% decrease) was predicted to be significantly altered after concomitant administration of a single dose of tramadol. Following multiple‐dose administration of tramadol and a single‐dose or multiple‐dose administration of quinidine, the inhibitory effect of quinidine was predicted to be long (≈42 hours) and to alter exposure of tramadol and O‐desmethyltramadol by up to 60%, suggesting that coadministration of quinidine and tramadol should be avoided clinically. In comparison, there is no predicted significant impact of metoprolol on tramadol and O‐desmethyltramadol exposure. In fact, tramadol is predicted to act as a CYP2D6 perpetrator and increase metoprolol exposure, which may necessitate the need for dose separation. John Wiley and Sons Inc. 2021-09-20 2022-01 /pmc/articles/PMC9293201/ /pubmed/34383318 http://dx.doi.org/10.1002/jcph.1951 Text en © 2021 The Authors. The Journal of Clinical Pharmacology published by Wiley Periodicals LLC on behalf of American College of Clinical Pharmacology https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Physiologically Based Pharmacokinetic Modeling
Long, Tao
Cristofoletti, Rodrigo
Cicali, Brian
Michaud, Veronique
Dow, Pamela
Turgeon, Jacques
Schmidt, Stephan
Physiologically Based Pharmacokinetic Modeling to Assess the Impact of CYP2D6‐Mediated Drug‐Drug Interactions on Tramadol and O‐Desmethyltramadol Exposures via Allosteric and Competitive Inhibition
title Physiologically Based Pharmacokinetic Modeling to Assess the Impact of CYP2D6‐Mediated Drug‐Drug Interactions on Tramadol and O‐Desmethyltramadol Exposures via Allosteric and Competitive Inhibition
title_full Physiologically Based Pharmacokinetic Modeling to Assess the Impact of CYP2D6‐Mediated Drug‐Drug Interactions on Tramadol and O‐Desmethyltramadol Exposures via Allosteric and Competitive Inhibition
title_fullStr Physiologically Based Pharmacokinetic Modeling to Assess the Impact of CYP2D6‐Mediated Drug‐Drug Interactions on Tramadol and O‐Desmethyltramadol Exposures via Allosteric and Competitive Inhibition
title_full_unstemmed Physiologically Based Pharmacokinetic Modeling to Assess the Impact of CYP2D6‐Mediated Drug‐Drug Interactions on Tramadol and O‐Desmethyltramadol Exposures via Allosteric and Competitive Inhibition
title_short Physiologically Based Pharmacokinetic Modeling to Assess the Impact of CYP2D6‐Mediated Drug‐Drug Interactions on Tramadol and O‐Desmethyltramadol Exposures via Allosteric and Competitive Inhibition
title_sort physiologically based pharmacokinetic modeling to assess the impact of cyp2d6‐mediated drug‐drug interactions on tramadol and o‐desmethyltramadol exposures via allosteric and competitive inhibition
topic Physiologically Based Pharmacokinetic Modeling
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9293201/
https://www.ncbi.nlm.nih.gov/pubmed/34383318
http://dx.doi.org/10.1002/jcph.1951
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