Skip to main content
British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1994 Jan;37(1):71–74. doi: 10.1111/j.1365-2125.1994.tb04242.x

Disposition of clozapine in man: lack of association with debrisoquine and S-mephenytoin hydroxylation polymorphisms.

M L Dahl 1, A Llerena 1, U Bondesson 1, L Lindström 1, L Bertilsson 1
PMCID: PMC1364713  PMID: 8148222

Abstract

A large interindividual variability has previously been demonstrated in the bioavailability, steady-state plasma concentrations and clearance of clozapine, an atypical neuroleptic drug. To evaluate the importance of genetic factors in the metabolism of clozapine, its disposition after a single oral dose of 10 mg was studied in 15 healthy Caucasian volunteers. Five of the subjects were poor metabolisers (PM) of debrisoquine, five were PM of S-mephenytoin, and the remaining five were extensive metabolisers (EM) of both probe drugs. There was a 10-fold interindividual variation in Cmax and a 14-fold variation in AUC(0, 24) of clozapine among the 15 subjects studied. The mean (s.d.) Cmax was 117 (81) nmol l-1 and the mean AUC(0,24) value was 890 (711) nmol l-1 h. The value of t1/2,z varied 3-fold with a mean (s.d.) of 13.3 (5.0) h. There were no significant differences in the plasma concentrations or any of the pharmacokinetic parameters of clozapine between PM and EM of debrisoquine, or between the two S-mephenytoin hydroxylation phenotypes. We conclude that neither of the major genetic polymorphisms of oxidative drug metabolism contribute to the large interindividual variability in clozapine pharmacokinetics.

Full text

PDF
71

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baldessarini R. J., Frankenburg F. R. Clozapine. A novel antipsychotic agent. N Engl J Med. 1991 Mar 14;324(11):746–754. doi: 10.1056/NEJM199103143241107. [DOI] [PubMed] [Google Scholar]
  2. Bertilsson L., Lou Y. Q., Du Y. L., Liu Y., Kuang T. Y., Liao X. M., Wang K. Y., Reviriego J., Iselius L., Sjöqvist F. Pronounced differences between native Chinese and Swedish populations in the polymorphic hydroxylations of debrisoquin and S-mephenytoin. Clin Pharmacol Ther. 1992 Apr;51(4):388–397. doi: 10.1038/clpt.1992.38. [DOI] [PubMed] [Google Scholar]
  3. Bondesson U., Lindström L. H. Determination of clozapine and its N-demethylated metabolite in plasma by use of gas chromatography-mass spectrometry with single ion detection. Psychopharmacology (Berl) 1988;95(4):472–475. doi: 10.1007/BF00172957. [DOI] [PubMed] [Google Scholar]
  4. Brøsen K., Sindrup S. H., Skjelbo E., Nielsen K. K., Gram L. F. Role of genetic polymorphism in psychopharmacology--an update. Psychopharmacol Ser. 1993;10:199–211. doi: 10.1007/978-3-642-78010-3_19. [DOI] [PubMed] [Google Scholar]
  5. Cheng Y. F., Lundberg T., Bondesson U., Lindström L., Gabrielsson J. Clinical pharmacokinetics of clozapine in chronic schizophrenic patients. Eur J Clin Pharmacol. 1988;34(5):445–449. doi: 10.1007/BF01046700. [DOI] [PubMed] [Google Scholar]
  6. Choc M. G., Lehr R. G., Hsuan F., Honigfeld G., Smith H. T., Borison R., Volavka J. Multiple-dose pharmacokinetics of clozapine in patients. Pharm Res. 1987 Oct;4(5):402–405. doi: 10.1023/a:1016434312388. [DOI] [PubMed] [Google Scholar]
  7. Dahl-Puustinen M. L., Lidén A., Alm C., Nordin C., Bertilsson L. Disposition of perphenazine is related to polymorphic debrisoquin hydroxylation in human beings. Clin Pharmacol Ther. 1989 Jul;46(1):78–81. doi: 10.1038/clpt.1989.109. [DOI] [PubMed] [Google Scholar]
  8. Dahl M. L., Bertilsson L. Genetically variable metabolism of antidepressants and neuroleptic drugs in man. Pharmacogenetics. 1993 Apr;3(2):61–70. doi: 10.1097/00008571-199304000-00001. [DOI] [PubMed] [Google Scholar]
  9. Dahl M. L., Ekqvist B., Widén J., Bertilsson L. Disposition of the neuroleptic zuclopenthixol cosegregates with the polymorphic hydroxylation of debrisoquine in humans. Acta Psychiatr Scand. 1991 Jul;84(1):99–102. doi: 10.1111/j.1600-0447.1991.tb01428.x. [DOI] [PubMed] [Google Scholar]
  10. Evans D. A., Mahgoub A., Sloan T. P., Idle J. R., Smith R. L. A family and population study of the genetic polymorphism of debrisoquine oxidation in a white British population. J Med Genet. 1980 Apr;17(2):102–105. doi: 10.1136/jmg.17.2.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fischer V., Vogels B., Maurer G., Tynes R. E. The antipsychotic clozapine is metabolized by the polymorphic human microsomal and recombinant cytochrome P450 2D6. J Pharmacol Exp Ther. 1992 Mar;260(3):1355–1360. [PubMed] [Google Scholar]
  12. Fitton A., Heel R. C. Clozapine. A review of its pharmacological properties, and therapeutic use in schizophrenia. Drugs. 1990 Nov;40(5):722–747. doi: 10.2165/00003495-199040050-00007. [DOI] [PubMed] [Google Scholar]
  13. Fonne-Pfister R., Bargetzi M. J., Meyer U. A. MPTP, the neurotoxin inducing Parkinson's disease, is a potent competitive inhibitor of human and rat cytochrome P450 isozymes (P450bufI, P450db1) catalyzing debrisoquine 4-hydroxylation. Biochem Biophys Res Commun. 1987 Nov 13;148(3):1144–1150. doi: 10.1016/s0006-291x(87)80252-8. [DOI] [PubMed] [Google Scholar]
  14. Gauch R., Michaelis W. The metabolism of 8-chloro-11-(4-methyl-1-piperazinyl)-5H-dibenzo(b,e) (1,4)diazepine (clozapine) in mice, dogs and human subjects. Farmaco Prat. 1971 Nov;26(11):667–681. [PubMed] [Google Scholar]
  15. Haring C., Meise U., Humpel C., Saria A., Fleischhacker W. W., Hinterhuber H. Dose-related plasma levels of clozapine: influence of smoking behaviour, sex and age. Psychopharmacology (Berl) 1989;99 (Suppl):S38–S40. doi: 10.1007/BF00442557. [DOI] [PubMed] [Google Scholar]
  16. Kane J., Honigfeld G., Singer J., Meltzer H. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry. 1988 Sep;45(9):789–796. doi: 10.1001/archpsyc.1988.01800330013001. [DOI] [PubMed] [Google Scholar]
  17. Klein M., Canoll P. D., Musacchio J. M. SKF 525-A and cytochrome P-450 ligands inhibit with high affinity the binding of [3H]dextromethorphan and sigma ligands to guinea pig brain. Life Sci. 1991;48(6):543–550. doi: 10.1016/0024-3205(91)90469-r. [DOI] [PubMed] [Google Scholar]
  18. Lennard M. S., Silas J. H., Smith A. J., Tucker G. T. Determination of debrisoquine and its 4-hydroxy metabolite in biological fluids by gas chromatography with flame-ionization and nitrogen-selective detection. J Chromatogr. 1977 Mar 11;133(1):161–166. doi: 10.1016/s0021-9673(00)89216-x. [DOI] [PubMed] [Google Scholar]
  19. Llerena A., Alm C., Dahl M. L., Ekqvist B., Bertilsson L. Haloperidol disposition is dependent on debrisoquine hydroxylation phenotype. Ther Drug Monit. 1992 Apr;14(2):92–97. doi: 10.1097/00007691-199204000-00003. [DOI] [PubMed] [Google Scholar]
  20. Mahgoub A., Idle J. R., Dring L. G., Lancaster R., Smith R. L. Polymorphic hydroxylation of Debrisoquine in man. Lancet. 1977 Sep 17;2(8038):584–586. doi: 10.1016/s0140-6736(77)91430-1. [DOI] [PubMed] [Google Scholar]
  21. Niznik H. B., Tyndale R. F., Sallee F. R., Gonzalez F. J., Hardwick J. P., Inaba T., Kalow W. The dopamine transporter and cytochrome P45OIID1 (debrisoquine 4-hydroxylase) in brain: resolution and identification of two distinct [3H]GBR-12935 binding proteins. Arch Biochem Biophys. 1990 Feb 1;276(2):424–432. doi: 10.1016/0003-9861(90)90741-g. [DOI] [PubMed] [Google Scholar]
  22. Ross S. B. Is the sigma opiate receptor a proadifen-sensitive subform of cytochrome P-450? Pharmacol Toxicol. 1990 Jul;67(1):93–94. doi: 10.1111/j.1600-0773.1990.tb00791.x. [DOI] [PubMed] [Google Scholar]
  23. Sanz E. J., Villén T., Alm C., Bertilsson L. S-mephenytoin hydroxylation phenotypes in a Swedish population determined after coadministration with debrisoquin. Clin Pharmacol Ther. 1989 May;45(5):495–499. doi: 10.1038/clpt.1989.63. [DOI] [PubMed] [Google Scholar]
  24. Seeman P. Dopamine receptor sequences. Therapeutic levels of neuroleptics occupy D2 receptors, clozapine occupies D4. Neuropsychopharmacology. 1992 Dec;7(4):261–284. [PubMed] [Google Scholar]
  25. Steiner E., Bertilsson L., Säwe J., Bertling I., Sjöqvist F. Polymorphic debrisoquin hydroxylation in 757 Swedish subjects. Clin Pharmacol Ther. 1988 Oct;44(4):431–435. doi: 10.1038/clpt.1988.176. [DOI] [PubMed] [Google Scholar]
  26. Stock B., Spiteller G., Heipertz R. Austausch aromatisch gebundenen Halogens gegen OH- und SCH3- bei der Metabolisierung des Clozapins im menchlichen Körper. Arzneimittelforschung. 1977;27(5):982–990. [PubMed] [Google Scholar]
  27. Thorup M., Fog R. Clozapine treatment of schizophrenic patients. Plasma concentration and coagulation factors. Acta Psychiatr Scand. 1977 Feb;55(2):123–126. doi: 10.1111/j.1600-0447.1977.tb00148.x. [DOI] [PubMed] [Google Scholar]
  28. Walker J. M., Matsumoto R. R., Bowen W. D., Gans D. L., Jones K. D., Walker F. O. Evidence for a role of haloperidol-sensitive sigma-'opiate' receptors in the motor effects of antipsychotic drugs. Neurology. 1988 Jun;38(6):961–965. doi: 10.1212/wnl.38.6.961. [DOI] [PubMed] [Google Scholar]
  29. Zanger U. M., Vilbois F., Hardwick J. P., Meyer U. A. Absence of hepatic cytochrome P450bufI causes genetically deficient debrisoquine oxidation in man. Biochemistry. 1988 Jul 26;27(15):5447–5454. doi: 10.1021/bi00415a010. [DOI] [PubMed] [Google Scholar]
  30. von Bahr C., Movin G., Nordin C., Lidén A., Hammarlund-Udenaes M., Hedberg A., Ring H., Sjöqvist F. Plasma levels of thioridazine and metabolites are influenced by the debrisoquin hydroxylation phenotype. Clin Pharmacol Ther. 1991 Mar;49(3):234–240. doi: 10.1038/clpt.1991.22. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Clinical Pharmacology are provided here courtesy of British Pharmacological Society

RESOURCES