RT Journal Article
SR Electronic
T1 Clopidogrel Markedly Increases Plasma Concentrations of CYP2C8 Substrate Pioglitazone
JF Drug Metabolism and Disposition
JO Drug Metab Dispos
FD American Society for Pharmacology and Experimental Therapeutics
SP 1364
OP 1371
DO 10.1124/dmd.116.070375
VO 44
IS 8
A1 Matti K. Itkonen
A1 Aleksi Tornio
A1 Mikko Neuvonen
A1 Pertti J. Neuvonen
A1 Mikko Niemi
A1 Janne T. Backman
YR 2016
UL http://dmd.aspetjournals.org/content/44/8/1364.abstract
AB The glucose-lowering drug pioglitazone undergoes hepatic CYP2C8-mediated biotransformation to its main metabolites. The antiplatelet drug clopidogrel is metabolized to clopidogrel acyl-β-d-glucuronide, which was recently found to be a strong time-dependent inhibitor of CYP2C8 in humans. Therefore, we studied the effect of clopidogrel on the pharmacokinetics of pioglitazone. In a randomized crossover study, 10 healthy volunteers ingested either 300 mg of clopidogrel on day 1, and 75 mg on days 2 and 3, or placebo. Pioglitazone 15 mg was administered 1 hour after placebo and clopidogrel on day 1. Plasma concentrations of pioglitazone, clopidogrel, and their main metabolites were measured up to 72 hours. Clopidogrel increased the area under the plasma concentration-time curve (AUC0–∞) of pioglitazone 2.1-fold [P < 0.001, 90% confidence interval (CI) 1.8–2.6] and prolonged its half-life from 6.7 to 11 hours (P = 0.002). The peak concentration of pioglitazone was unaffected but the concentration at 24 hours was increased 4.5-fold (range 1.6–9.8; P < 0.001, 90% CI 3.17–6.45) by clopidogrel. The M-IV-to-pioglitazone AUC0–∞ ratio was 49% (P < 0.001, 90% CI 0.40–0.59) of that during the control phase, indicating that clopidogrel inhibited the CYP2C8-mediated biotransformation of pioglitazone. Clopidogrel increases the exposure to pioglitazone by inhibiting its CYP2C8-mediated biotransformation. In consequence, use of clopidogrel may increase the risk of fluid retention and other concentration-related adverse effects of pioglitazone.