The pyrazolone drug metamizole is a widely used analgesic. Analysis of liver microsomes from patients treated with metamizole revealed selectively higher expression of cytochromes P450, CYP2B6 and CYP3A4 (3.8- and 2.8-fold, respectively), and 2.9-fold higher bupropion hydroxylase activity compared with untreated subjects. Further investigation of metamizole and various derivatives on different potential target genes in human primary hepatocytes demonstrated time- and concentration-dependent induction by metamizole of CYP2B6 (7.8- and 3.1-fold for mRNA and protein, respectively, at 100 muM) and CYP3A4 (2.4- and 2.9-fold, respectively), whereas other genes (CYP2C9, CYP2C19, CYP2D6, NADPH:cytochrome P450 reductase, ABCB1, constitutive androstane receptor (CAR), pregnane X receptor (PXR)) were not substantially altered. Using reporter gene assays, we show that metamizole is not acting as a direct ligand to either PXR or CAR, suggesting a phenobarbital-like mechanism of induction. These data warrant further studies to elucidate the drug-interaction potential of metamizole, especially in patients with long-term treatment.
"These findings suggest extensive enteral or hepatic first-pass metabolism, which is unexpected in infants, who generally do not yet have fully developed oxidative metabolic capacity of the relevant cytochrome P450 isozyme CYP3A4 . However, both children in our present report were maintained on enzyme-inducing agents (phenobarbital or metamizole ), probably partly explaining the differences in MR observed between sublingual and enteral administration. Because N-desmethyl sildenafil is a 2.5-fold weaker PDE5 inhibitor than the parent compound , the net vasodilating effect is expected to increase with sublingual administration. "
[Show abstract][Hide abstract] ABSTRACT: Introduction
Pulmonary hypertension is a progressive disease of diverse origin with devastating consequences in adults as well as in children. The phosphodiesterase 5 inhibitor sildenafil successfully lowers pulmonary vascular resistance. However, because of its poor enteral absorption, resulting in ineffective plasma concentrations, responses in infants and children are often erratic.
We report the cases of two Caucasian boys, one born at term (case 1) and one aged 2.5 years (case 2), who had structural cardiac and pulmonary defects accompanied by symptomatic pulmonary hypertension. They received sildenafil enterally and sublingually and also intravenously in one of them. Plasma samples were taken at various time points to determine the plasma concentrations of sildenafil and its partially active metabolite. Sildenafil and N-desmethyl sildenafil were quantified using a validated liquid chromatography/mass spectrometry method. Oxygen partial pressure was determined from routine arterial blood gas samples.
In agreement with previous observations in adults, we found that sublingual sildenafil was more extensively absorbed in our two pediatric patients. After sublingual administration, sildenafil plasma concentrations increased by 314% to 361% compared to enteral dosing. Concurrently, the metabolic ratio increased, suggesting not only that the overall absorption was enhanced but also that first-pass metabolism was partially bypassed. In case 2, the free fraction of sildenafil was 0.9%, which is considerably less than in adults (4%), suggesting that, in case 2, higher plasma concentration would have been needed to achieve effects similar to those in adults. Sublingual sildenafil appears to be a promising alternative route of administration in children with poor enteral absorption.
Journal of Medical Case Reports 05/2014; 8(1):171. DOI:10.1186/1752-1947-8-171
"March 2013 | Volume 4 | Article 24 | 1 et al., 2007), metamizole (Saussele et al., 2007; Qin et al., 2012), ritonavir (Kharasch et al., 2008), the insect repellent N,N -diethylm-toluamide (DEET; Das et al., 2008), statins (Feidt et al., 2010), efavirenz (Ngaimisi et al., 2010; Habtewold et al., 2011). Interestingly , in the latter study, gender influenced the inducibility of efavirenz 8-hydroxylation, which was higher in women than in the men (Ngaimisi et al., 2010). "
[Show abstract][Hide abstract] ABSTRACT: Cytochrome P450 2B6 (CYP2B6) belongs to the minor drug metabolizing P450s in human liver. Expression is highly variable both between individuals and within individuals, owing to non-genetic factors, genetic polymorphisms, inducibility, and irreversible inhibition by many compounds. Drugs metabolized mainly by CYP2B6 include artemisinin, bupropion, cyclophosphamide, efavirenz, ketamine, and methadone. is one of the most polymorphic CYP genes in humans and variants have been shown to affect transcriptional regulation, splicing, mRNA and protein expression, and catalytic activity. Some variants appear to affect several functional levels simultaneously, thus, combined in haplotypes, leading to complex interactions between substrate-dependent and -independent mechanisms. The most common functionally deficient allele is [Q172H, K262R], which occurs at frequencies of 15 to over 60% in different populations. The allele leads to lower expression in liver due to erroneous splicing. Recent investigations suggest that the amino acid changes contribute complex substrate-dependent effects at the activity level, although data from recombinant systems used by different researchers are not well in agreement with each other. Another important variant, [I328T], occurs predominantly in Africans (4-12%) and does not express functional protein. A large number of uncharacterized variants are currently emerging from different ethnicities in the course of the 1000 Genomes Project. The polymorphism is clinically relevant for HIV-infected patients treated with the reverse transcriptase inhibitor efavirenz, but it is increasingly being recognized for other drug substrates. This review summarizes recent advances on the functional and clinical significance of CYP2B6 and its genetic polymorphism, with particular emphasis on the comparison of kinetic data obtained with different substrates for variants expressed in different recombinant expression systems.
Frontiers in Genetics 03/2013; 4:24. DOI:10.3389/fgene.2013.00024
"It is expressed in liver, brain, intestine, kidney and lung  . CYP2B6 is inducible by many xenobiotics including, phenobarbital , metamizol , ritonavir , oltipraz  , statins , valproic acid , phenytoin , dehydroepiandrosterone , carbamazepine , endosulfan , nifedipine   etc. Master regulators of CYP2B6 basal and xenobiotic-inducible expression are PXR and CAR xenoreceptors    . In addition, several transcription factors including C/EBP , HNF4  , hepatocyte growth factor (HGF), activating transcription factor 5 (ATF5)  and transcriptional factor early growth response 1 (EGR1)  are important for basal expression and maximal induction of CYP2B6. "
[Show abstract][Hide abstract] ABSTRACT: Retinoic acid receptors (RARs), retinoid X receptors (RXRs) and thyroid hormone receptors (TRs) are nuclear receptors that are crucial transcriptional regulators of many cellular processes such as differentiation, development, apoptosis, carbohydrate and lipid metabolism, homeostasis etc. In addition, RXRs are common heterodimerization partners for several receptors including vitamin D receptor, pregnane X receptor (PXR), constitutive androstane receptor (CAR) etc. In the course of 90s', PXR and CAR were discovered as key xenosensors regulating drug-metabolizing enzymes. Since there exist various cross-talks between cell signaling pathways, this was not surprising that RXRs, RARs and TRs were identified as regulators of human drug-metabolizing cytochromes P450 and cytochromes P450 involved in metabolism of endogenous compounds. Hence, a link between regulation of xenobiotic metabolizing enzymes and regulatory pathways of intermediary metabolism was established. Additionally, several drug-metabolizing enzymes are involved in metabolism of retinoids, rexinoids and thyroid hormones. In the current paper, we summarize the knowledge on the role of RARs, RXRs and TRs in the regulation of drug metabolizing cytochromes P450, and vice versa on the role of P450s in homeostasis of retinoids, rexinoids and thyroid hormone.
Current Drug Metabolism 03/2011; 12(2):71-88. DOI:10.2174/138920011795016881 · 2.98 Impact Factor
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