Hydroxyitraconazole, Formed During Intestinal First-Pass Metabolism of Itraconazole, Controls the Time Course of Hepatic CYP3A Inhibition and the Bioavailability of Itraconazole in Rats

• Published in: Drug metabolism and disposition Vol. 36; no. 6; pp. 1097 - 1101
• Main Authors: QUINNEY, Sara K, GALINSKY, Raymond E, JIYAMAPA-SERNA, Vanida A, YONG CHEN, HAMMAN, Mitchell A, HALL, Stephen D, KIMURA, Robert E
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society for Pharmacology and Experimental Therapeutics 01.06.2008
• Subjects: Animals; Antifungal Agents - blood; Antifungal Agents - pharmacokinetics; Biological and medical sciences; Biological Availability; Cytochrome P-450 CYP3A Inhibitors; Intestines - metabolism; Itraconazole - analogs & derivatives; Itraconazole - blood; Itraconazole - metabolism; Itraconazole - pharmacokinetics; Liver - metabolism; Male; Medical sciences; Pharmacology. Drug treatments; Rats; Rats, Sprague-Dawley; Rat; Digestive system; Enzyme; Isozyme; Cytochrome P450; Liver; Rodentia; Gut; Bioavailability; Metabolism; Vertebrata; Antifungal agent; Mammalia; Animal; Triazole derivatives; Inhibitor; Pharmacokinetics; Itraconazole
• ISSN: 0090-9556; 1521-009X
• DOI: 10.1124/dmd.108.020644

Itraconazole (ITZ) is a substrate of CYP3A and both ITZ and hydroxyitraconazole (OH-ITZ), a major metabolite formed by CYP3A, are potent inhibitors of CYP3A. The concentration- and time-dependent changes in the hepatic availability ( F H ) of ITZ were evaluated in rats after oral doses of 5 and 40 mg/kg. Simultaneous blood samples were obtained from the aorta, portal vein, and hepatic vein for 24 h following duodenal ITZ administration, and concentrations of ITZ and OH-ITZ determined by LC/MS. During the absorption phase, the F H of ITZ increased from 0.2 to 1.0, reflecting the time course of hepatic CYP3A inhibition. A counterclockwise hysteresis was observed between ITZ concentrations entering the liver ( C IN,ITZ ) and F H , whereas there was no time delay observed between the change in F H and the OH-ITZ concentrations entering the liver ( C IN,OH-ITZ ). The direct relationship between C IN,OH-ITZ and F H suggested that OH-ITZ was mainly responsible for the inhibition of CYP3A. A positive portal venous-aortic gradient for OH-ITZ was measured after duodenal administration of ITZ, indicating intestinal formation of OH-ITZ. The in vivo Ki for OH-ITZ (38 ± 3 nM) was estimated from C IN,OH-ITZ versus F H of ITZ, and is similar to values obtained from inhibition of midazolam hydroxylation in CYP3A4 supersomes ( Drug Metab Dispos 32:1121–1131, 2004). The data suggest that OH-ITZ, formed by intestinal CYP3A, controls the time course of hepatic CYP3A inhibition and is mainly responsible for the observed increase in F H of ITZ.