Dicloxacillin induces CYP2C19, CYP2C9 and CYP3A4 in vivo and in vitro. (10th January 2018)

• Record Type: Journal Article
• Authors: Stage, Tore Bjerregaard; Graff, Magnus; Wong, Susan; Rasmussen, Louise Ladebo; Nielsen, Flemming; Pottegård, Anton; Brøsen, Kim; Kroetz, Deanna L.; Khojasteh, S. Cyrus; Damkier, Per
• Is Part Of: British journal of clinical pharmacology. Volume 84:Number 3(2018:Sep.)
• Page Start: 510
• Page End: 519
• Publication Date: 2018-01-10
• Subjects: Pharmacology -- Periodicals; Drugs -- Periodicals; 615.1
• DOI: 10.1111/bcp.13467
• Languages: English
• ISSNs: 0306-5251

Abstract

Abstract : Aim: The aim of this study was to study potential cytochrome P450 (CYP) induction by dicloxacillin. Methods: We performed an open‐label, randomized, two‐phase, five‐drug clinical pharmacokinetic cocktail crossover study in 12 healthy men with and without pretreatment with 1 g dicloxacillin three times daily for 10 days. Plasma and urine were collected over 24 h and the concentration of all five drugs and their primary metabolites was determined using a liquid chromatography coupled to triple quadrupole mass spectrometry method. Cryopreserved primary human hepatocytes were exposed to dicloxacillin for 48 h and changes in gene expression and the activity of CYP3A4, CYP2C9, CYP2B6 and CYP1A2 were investigated. The activation of nuclear receptors by dicloxacillin was assessed using luciferase assays. Results: A total of 10 days of treatment with dicloxacillin resulted in a clinically and statistically significant reduction in the area under the plasma concentration–time curve from 0 to 24 h for omeprazole (CYP2C19) {geometric mean ratio [GMR] [95% confidence interval (CI)]: 0.33 [0.24, 0.45]}, tolbutamide (CYP2C9) [GMR (95% CI): 0.73 (0.65, 0.81)] and midazolam (CYP3A4) [GMR (95% CI): 0.54 (0.41, 0.72)]. Additionally, other relevant pharmacokinetic parameters were affected, indicating the induction of CYP2C‐ and CYP3A4‐mediated metabolism by dicloxacillin. Investigations in primary hepatocytes showed a statistically significant dose‐dependent increase in CYP expression and activity by dicloxacillin, caused by activation of the pregnane X receptor. Conclusions: Dicloxacillin is an inducer of CYP2C‐ and CYP3A‐mediated drug metabolism, and we recommend caution when prescribing dicloxacillin to users of drugs with a narrow therapeutic window.