Acta Med. 2000, 43: 95-101

https://doi.org/10.14712/18059694.2019.120

Influence of CYP3A Metabolizer Status on the Pharmacokinetics and Pharmacodynamics of Amiodarone

Stanislav Mičudaa, Martin Hodačb, Petr Pařízekb, Miloslav Pleskotb, Luděk Šišperaa, Jaroslav Cermanc, Jana Malákovád, Jiřina Martínkováa, Vladimír Pidrmanb

aCharles University in Prague; Faculty of Medicine in Hradec Králové, Department of Pharmacology, Hradec Králové, Czech Republic
bCharles University in Prague; Faculty of Medicine in Hradec Králové, Second Department of Internal Medicine, Hradec Králové, Czech Republic
cCharles University in Prague; Faculty of Medicine in Hradec Králové, Department of Medical Biochemistry, Hradec Králové, Czech Republic
dUniversity Teaching Hospital in Hradec Králové, Institute of Clinical Biochemistry and Diagnostics, Hradec Králové, Czech Republic

Received March 1, 2000
Accepted June 1, 2000

The present work was designed to determine whether the individual differences in pharmacokinetics and pharmacodynamics of amiodarone and its N-desethyl metabolite are related to cytochrome CYP3A metabolizer status. Methods: 12 cardiac patients with inducible ventricular tachyarrhythmias during the baseline electrophysiologic study were enrolled in this study. Urinary 24-hour excretion of 6β-hydroxycortisol (6β-OHC and the ratio of 6β-hydroxycortisol to urinary free cortisol (6β-OHC/UFC) were measured before the first amiodarone administration. Trough plasma concentrations of amiodarone and N-desethylamiodarone (N-DEA) were measured after 79 ± 11 days (2nd period) and after 182 ± 25 days (3rd period). Electrophysiologic effects of amiodarone therapy were established with serial electrophysiologic studies in 9 of these patients at the baseline and after 79 ± 11 days (during the second period). Results: Both the 6β-OHC excretion and 6β-OHC/UFC ratio varied approximately 6-fold between the patients. We found significant inverse correlation between the 6β-OHC excretion and the trough plasma concentrations of amiodarone at the time of the 3rd period (rs = -0.58, p < 0.05). Similarly, there was correlation between the 24-hour urinary 6β-OHC excretion and trough plasma concentrations of amiodarone during the 3rd period (rs = -0.64, p < 0.025). We were unable to detect any association between CYP3A activity and amiodarone pharmacodynamics. Conclusion: This study points toward important information value of CYP3A metabolizer status in the context of therapeutic drug monitoring of amiodarone.

Funding

This research was supported by grant GAUK (No. 57/1997/C) of the Charles University in Prague.

References

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