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Effects of clarithromycin and verapamil on rabeprazole pharmacokinetics between CYP2C19 genotypes

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Abstract

Objective

Rabeprazole as a proton pump inhibitor (PPI) is mainly reduced to rabeprazole thioether via a nonenzymatic pathway, with minor CYP2C19 and CYP3A4 involvement. The aim of this study was to compare possible effects of clarithromycin and verapamil as inhibitors of CYP3A4 on the pharmacokinetics of rabeprazole among CYP2C19 genotypes.

Methods

A three-way randomized, double-blind, placebo-controlled crossover study was performed. Nineteen volunteers, of whom six were homozygous extensive metabolizers (EMs), eight were heterozygous EMs, and five were poor metabolizers (PMs) for CYP2C19, received three 6-day courses of either daily 800 mg clarithromycin, 240 mg verapamil, or placebo in a randomized fashion, with a single oral dose of 20 mg rabeprazole on day 6 in all cases. Plasma concentrations of rabeprazole and rabeprazole thioether were monitored up to 24 h after the dosing.

Results

In the control phase, the AUC0−∞ values for rabeprazole and rabeprazole thioether were 1,005±366 and 412±149 ng.h/ml in homozygous EMs, 1,108±340 and 491±245 ng.h/ml in heterozygous EMs, and 2,697±364 and 2,116±373 ng.h/ml in PMs, respectively. There were significant differences (p<0.001) in the AUC0−∞ of rabeprazole and rabeprazole thioether among three different CYP2C19 genotypes. In the clarithromycin and verapamil phases, no significant differences were found in the pharmacokinetic parameters of rabeprazole compared with those in the control phase irrespective of CYP2C19 genotypes, whereas the AUC0−∞ of rabeprazole thioether was significantly increased 2.8-fold and 2.3-fold in homozygous EMs (p<0.01), 2.0-fold and 2.0-fold in heterozygous EMs (p<0.05), and 1.6-fold and 1.9-fold in PMs (p<0.05), respectively. In each genotype group for CYP2C19, there were no statistical differences in the percent increase in those pharmacokinetic parameters between the clarithromycin and verapamil pretreatment phases.

Conclusion

The pharmacokinetic parameters of rabeprazole were not altered by clarithromycin or verapamil irrespective of the CYP2C19 genotypes. However, this result shows that both clarithromycin and verapamil significantly influence the disposition of rabeprazole by inhibiting the oxidation of the thioether, since the AUC0−∞ of rabeprazole thioether that has no effect on acid secretion increased. Therefore, the pharmacokinetic interactions between rabeprazole and CYP3A4 or P-glycoprotein inhibitors have limited clinical significance.

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Acknowledgement

The authors have no conflicts of interest in relation to this paper. This research was supported in part by a grant from the Japan Society for the Promotion of Science (no. 14922008).

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Authors and Affiliations

  1. Department of Clinical Pharmacology, Hirosaki University School of Medicine, Hirosaki, 036-8562, Japan

    Mikiko Shimizu, Tsukasa Uno, Norio Yasui-Furukori & Tomonori Tateishi

  2. Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan

    Norio Yasui-Furukori

  3. Department of Pharmacy, Hirosaki University Hospital, Hirosaki, Japan

    Kazunobu Sugawara

Authors
  1. Mikiko Shimizu
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  2. Tsukasa Uno
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  3. Norio Yasui-Furukori
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  5. Tomonori Tateishi
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Correspondence to Tsukasa Uno.

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Shimizu, M., Uno, T., Yasui-Furukori, N. et al. Effects of clarithromycin and verapamil on rabeprazole pharmacokinetics between CYP2C19 genotypes. Eur J Clin Pharmacol 62, 597–603 (2006). https://doi.org/10.1007/s00228-006-0152-9

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  • DOI: https://doi.org/10.1007/s00228-006-0152-9

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