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Titolo:
Effect of clarithromycin on the pharmacokinetics and pharmacodynamics of pimozide in healthy poor and extensive metabolizers of cytochrome P450 2D6 (CYP2D6)
Autore:
Desta, Z; Kerbusch, T; Flockhart, DA;
Indirizzi:
Georgetown7Univ, Med Ctr, Div Clin Pharmacol, Dept Med, Washington, DC 2000 Georgetown Univ Washington DC USA 20007 ol, Dept Med, Washington, DC 2000 GeorgetownCUniv, Med Ctr, Dept Pharmacol, Div Clin Pharmacol, Washington, D Georgetown Univ Washington DC USA 20057 Div Clin Pharmacol, Washington, D
Titolo Testata:
CLINICAL PHARMACOLOGY & THERAPEUTICS
fascicolo: 1, volume: 65, anno: 1999,
pagine: 10 - 20
SICI:
0009-9236(199901)65:1<10:EOCOTP>2.0.ZU;2-1
Fonte:
ISI
Lingua:
ENG
Soggetto:
TOURETTES-SYNDROME; LIVER-MICROSOMES; DE-POINTES; HALOPERIDOL; CHILDREN; ERYTHROMYCIN; FLUOXETINE; VOLUNTEERS; PARAMETERS; MACROLIDES;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Desta, Z GeorgetownW,niv, Med Ctr, Div Clin Pharmacol, Dept Med, 3900 Reservoir Rd N Georgetown Univ 3900 Reservoir Rd NW Washington DC USA 20007 Rd N
Citazione:
Z. Desta et al., "Effect of clarithromycin on the pharmacokinetics and pharmacodynamics of pimozide in healthy poor and extensive metabolizers of cytochrome P450 2D6 (CYP2D6)", CLIN PHARM, 65(1), 1999, pp. 10-20

Abstract

Background: The use of pimozide is associated with prolongation of the QT interval and fatal ventricular arrhythmia. We recently reported 2 fatal cases in patients taking pimozide and clarithromycin and we have shown that clarithromycin inhibits CYP3A-mediated metabolism of pimozide in vitro, In this study, we examined the effect of clarithromycin on pimozide pharmacokinetics and QT interval changes in a total of 12 healthy subjects (7 men and 5women), documented as extensive metabolizers or poor metabolizers of CYP2D6. Methods: In a randomized, double-blind placebo-controlled crossover design, subjects were given a single 6-mg oral dose of pimozide after 5 days of treatment with clarithromycin (500 mg twice a day) or a placebo pill. Blood samples were obtained before and for 96 hows after pimozide administration,and plasma pimozide and clarithromycin concentrations were measured by HPLC, Electrocardiograms for the analysis of the QTc intervals were recorded immediately before each blood sample. Results: Pimozide significantly lengthened QTc interval in the first 20 hours in both the placebo-treated groups (Delta QTc(max) = 13.3 +/- 5.3 ms; P= .003) and clarithromycin-treated groups (Delta QTc(max) = 15.7 +/- 9.5 ms; P = .005) compared with baseline values. This is consistent with an effect of the parent drug. Clarithromycin caused a significant increase in the peak plasma concentration (P = .015), terminal elimination half-life (P = .003), and area under the plasma concentration-time curve (P = .024) and a decrease in the clearance (P = .029) of pimozide, Mean QTc(max) observed within 20 hours of pimozide administration was significantly greater in the clarithromycin-treated group (23.8 +/- 12.2 ms; P = .0397) than in the placebo-treated group (16.8 +/- 6 ms). There was no significant effect of CYP2D6 or gender on the pharmacokinetics or pharmacodynamics of pimozide,Conclusions: A single 6-mg oral dose of pimozide resulted in measurable QTinterval changes. Clarithromycin inhibited CYP3A-mediated pimozide metabolism and the resulting elevation in plasma concentrations may increase the risk of pimoxide cardiotoxicity.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/01/20 alle ore 07:26:02