Skip to main content
British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1995 Nov;40(5):481–485. doi: 10.1111/j.1365-2125.1995.tb05793.x

The effects of selective serotonin reuptake inhibitors and their metabolites on S-mephenytoin 4'-hydroxylase activity in human liver microsomes.

K Kobayashi 1, T Yamamoto 1, K Chiba 1, M Tani 1, T Ishizaki 1, Y Kuroiwa 1
PMCID: PMC1365195  PMID: 8703653

Abstract

The inhibitory effects of four selective serotonin reuptake inhibitors (SSRIs), fluoxetine, sertraline, paroxetine and citalopram, and three metabolites (norfluoxetine, demethylcitalopram and didemethylcitalopram), on S-mephenytoin 4'-hydroxylation activities in human liver microsomes were studied. The 4'-hydroxylation of S-mephenytoin, a representative substrate toward CYP2C19, was competitively inhibited by all the SSRIs and their metabolites studied. The mean Ki values of fluoxetine, norfluoxetine, sertraline, paroxetine, citalopram, demethylcitalopram and didemethylcitalopram were 5.2, 1.1, 2.0, 7.5, 87.3, 55.8 and 7.7 microM, respectively. The findings suggest that some SSRIs and their metabolites with a low Ki value (e.g., fluoxetine, norfluoxetine) may reduce the clearance of drugs metabolized by this isoform of P450, thereby resulting in a possible drug-drug interaction, when administered simultaneously. In addition, SSRIs and their metabolites examined herein may be substrates toward CYP2C19.

Full text

PDF
481

Selected References

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

  1. Benfield P., Heel R. C., Lewis S. P. Fluoxetine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs. 1986 Dec;32(6):481–508. doi: 10.2165/00003495-198632060-00002. [DOI] [PubMed] [Google Scholar]
  2. Bertilsson L., Aberg-Wistedt A. The debrisoquine hydroxylation test predicts steady-state plasma levels of desipramine. Br J Clin Pharmacol. 1983 Mar;15(3):388–390. doi: 10.1111/j.1365-2125.1983.tb01518.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bertilsson L., Henthorn T. K., Sanz E., Tybring G., Säwe J., Villén T. Importance of genetic factors in the regulation of diazepam metabolism: relationship to S-mephenytoin, but not debrisoquin, hydroxylation phenotype. Clin Pharmacol Ther. 1989 Apr;45(4):348–355. doi: 10.1038/clpt.1989.40. [DOI] [PubMed] [Google Scholar]
  4. Breyer-Pfaff U., Pfandl B., Nill K., Nusser E., Monney C., Jonzier-Perey M., Baettig D., Baumann P. Enantioselective amitriptyline metabolism in patients phenotyped for two cytochrome P450 isozymes. Clin Pharmacol Ther. 1992 Oct;52(4):350–358. doi: 10.1038/clpt.1992.155. [DOI] [PubMed] [Google Scholar]
  5. Brøsen K., Gram L. F., Kragh-Sørensen P. Extremely slow metabolism of amitriptyline but normal metabolism of imipramine and desipramine in an extensive metabolizer of sparteine, debrisoquine, and mephenytoin. Ther Drug Monit. 1991 Mar;13(2):177–182. doi: 10.1097/00007691-199103000-00015. [DOI] [PubMed] [Google Scholar]
  6. Brøsen K., Klysner R., Gram L. F., Otton S. V., Bech P., Bertilsson L. Steady-state concentrations of imipramine and its metabolites in relation to the sparteine/debrisoquine polymorphism. Eur J Clin Pharmacol. 1986;30(6):679–684. doi: 10.1007/BF00608215. [DOI] [PubMed] [Google Scholar]
  7. Chiba K., Kobayashi K., Manabe K., Tani M., Kamataki T., Ishizaki T. Oxidative metabolism of omeprazole in human liver microsomes: cosegregation with S-mephenytoin 4'-hydroxylation. J Pharmacol Exp Ther. 1993 Jul;266(1):52–59. [PubMed] [Google Scholar]
  8. Chiba K., Manabe K., Kobayashi K., Takayama Y., Tani M., Ishizaki T. Development and preliminary application of a simple assay of S-mephenytoin 4-hydroxylase activity in human liver microsomes. Eur J Clin Pharmacol. 1993;44(6):559–562. doi: 10.1007/BF02440859. [DOI] [PubMed] [Google Scholar]
  9. Chiba K., Saitoh A., Koyama E., Tani M., Hayashi M., Ishizaki T. The role of S-mephenytoin 4'-hydroxylase in imipramine metabolism by human liver microsomes: a two-enzyme kinetic analysis of N-demethylation and 2-hydroxylation. Br J Clin Pharmacol. 1994 Mar;37(3):237–242. doi: 10.1111/j.1365-2125.1994.tb04269.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Crewe H. K., Lennard M. S., Tucker G. T., Woods F. R., Haddock R. E. The effect of selective serotonin re-uptake inhibitors on cytochrome P4502D6 (CYP2D6) activity in human liver microsomes. Br J Clin Pharmacol. 1992 Sep;34(3):262–265. doi: 10.1111/j.1365-2125.1992.tb04134.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. 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]
  12. Eichelbaum M., Spannbrucker N., Steincke B., Dengler H. J. Defective N-oxidation of sparteine in man: a new pharmacogenetic defect. Eur J Clin Pharmacol. 1979 Sep;16(3):183–187. doi: 10.1007/BF00562059. [DOI] [PubMed] [Google Scholar]
  13. 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]
  14. Gugler R., Jensen J. C. Omeprazole inhibits oxidative drug metabolism. Studies with diazepam and phenytoin in vivo and 7-ethoxycoumarin in vitro. Gastroenterology. 1985 Dec;89(6):1235–1241. [PubMed] [Google Scholar]
  15. Hall S. D., Guengerich F. P., Branch R. A., Wilkinson G. R. Characterization and inhibition of mephenytoin 4-hydroxylase activity in human liver microsomes. J Pharmacol Exp Ther. 1987 Jan;240(1):216–222. [PubMed] [Google Scholar]
  16. Inaba T., Jurima M., Mahon W. A., Kalow W. In vitro inhibition studies of two isozymes of human liver cytochrome P-450. Mephenytoin p-hydroxylase and sparteine monooxygenase. Drug Metab Dispos. 1985 Jul-Aug;13(4):443–448. [PubMed] [Google Scholar]
  17. Kaye C. M., Haddock R. E., Langley P. F., Mellows G., Tasker T. C., Zussman B. D., Greb W. H. A review of the metabolism and pharmacokinetics of paroxetine in man. Acta Psychiatr Scand Suppl. 1989;350:60–75. doi: 10.1111/j.1600-0447.1989.tb07176.x. [DOI] [PubMed] [Google Scholar]
  18. Koyama E., Sohn D. R., Shin S. G., Chiba K., Shin J. G., Kim Y. H., Echizen H., Ishizaki T. Metabolic disposition of imipramine in oriental subjects: relation to metoprolol alpha-hydroxylation and S-mephenytoin 4'-hydroxylation phenotypes. J Pharmacol Exp Ther. 1994 Nov;271(2):860–867. [PubMed] [Google Scholar]
  19. Lemberger L., Rowe H., Bosomworth J. C., Tenbarge J. B., Bergstrom R. F. The effect of fluoxetine on the pharmacokinetics and psychomotor responses of diazepam. Clin Pharmacol Ther. 1988 Apr;43(4):412–419. doi: 10.1038/clpt.1988.52. [DOI] [PubMed] [Google Scholar]
  20. Mellström B., Bertilsson L., Säwe J., Schulz H. U., Sjöqvist F. E- and Z-10-hydroxylation of nortriptyline: relationship to polymorphic debrisoquine hydroxylation. Clin Pharmacol Ther. 1981 Aug;30(2):189–193. doi: 10.1038/clpt.1981.147. [DOI] [PubMed] [Google Scholar]
  21. Milne R. J., Goa K. L. Citalopram. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depressive illness. Drugs. 1991 Mar;41(3):450–477. doi: 10.2165/00003495-199141030-00008. [DOI] [PubMed] [Google Scholar]
  22. Murdoch D., McTavish D. Sertraline. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive-compulsive disorder. Drugs. 1992 Oct;44(4):604–624. doi: 10.2165/00003495-199244040-00007. [DOI] [PubMed] [Google Scholar]
  23. Oyehaug E., Ostensen E. T., Salvesen B. High-performance liquid chromatographic determination of citalopram and four of its metabolites in plasma and urine samples from psychiatric patients. J Chromatogr. 1984 Jun 8;308:199–208. [PubMed] [Google Scholar]
  24. Sindrup S. H., Brøsen K., Gram L. F., Hallas J., Skjelbo E., Allen A., Allen G. D., Cooper S. M., Mellows G., Tasker T. C. The relationship between paroxetine and the sparteine oxidation polymorphism. Clin Pharmacol Ther. 1992 Mar;51(3):278–287. doi: 10.1038/clpt.1992.23. [DOI] [PubMed] [Google Scholar]
  25. Sindrup S. H., Brøsen K., Hansen M. G., Aaes-Jørgensen T., Overø K. F., Gram L. F. Pharmacokinetics of citalopram in relation to the sparteine and the mephenytoin oxidation polymorphisms. Ther Drug Monit. 1993 Feb;15(1):11–17. doi: 10.1097/00007691-199302000-00002. [DOI] [PubMed] [Google Scholar]
  26. Skjelbo E., Brøsen K., Hallas J., Gram L. F. The mephenytoin oxidation polymorphism is partially responsible for the N-demethylation of imipramine. Clin Pharmacol Ther. 1991 Jan;49(1):18–23. doi: 10.1038/clpt.1991.4. [DOI] [PubMed] [Google Scholar]
  27. Skjelbo E., Brøsen K. Inhibitors of imipramine metabolism by human liver microsomes. Br J Clin Pharmacol. 1992 Sep;34(3):256–261. doi: 10.1111/j.1365-2125.1992.tb04133.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Sohn D. R., Kusaka M., Ishizaki T., Shin S. G., Jang I. J., Shin J. G., Chiba K. Incidence of S-mephenytoin hydroxylation deficiency in a Korean population and the interphenotypic differences in diazepam pharmacokinetics. Clin Pharmacol Ther. 1992 Aug;52(2):160–169. doi: 10.1038/clpt.1992.125. [DOI] [PubMed] [Google Scholar]
  29. Stevens J. C., Wrighton S. A. Interaction of the enantiomers of fluoxetine and norfluoxetine with human liver cytochromes P450. J Pharmacol Exp Ther. 1993 Aug;266(2):964–971. [PubMed] [Google Scholar]
  30. Warrington S. J. Clinical implications of the pharmacology of sertraline. Int Clin Psychopharmacol. 1991 Dec;6 (Suppl 2):11–21. doi: 10.1097/00004850-199112002-00004. [DOI] [PubMed] [Google Scholar]
  31. Yasumori T., Li Q. H., Yamazoe Y., Ueda M., Tsuzuki T., Kato R. Lack of low Km diazepam N-demethylase in livers of poor metabolizers for S-mephenytoin 4'-hydroxylation. Pharmacogenetics. 1994 Dec;4(6):323–331. doi: 10.1097/00008571-199412000-00005. [DOI] [PubMed] [Google Scholar]
  32. Yasumori T., Murayama N., Yamazoe Y., Kato R. Polymorphism in hydroxylation of mephenytoin and hexobarbital stereoisomers in relation to hepatic P-450 human-2. Clin Pharmacol Ther. 1990 Mar;47(3):313–322. doi: 10.1038/clpt.1990.34. [DOI] [PubMed] [Google Scholar]

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

RESOURCES