Appropriate phenotyping procedures for drug metabolizing enzymes and transporters in humans and their simultaneous use in the "cocktail" approach

Clin Pharmacol Ther. 2007 Feb;81(2):270-83. doi: 10.1038/sj.clpt.6100050.

Abstract

Phenotyping for drug metabolizing enzymes and transporters is used to assess quantitatively the effect of an intervention (e.g., drug therapy, diet) or a condition (e.g., genetic polymorphism, disease) on their activity. Appropriate selection of test drug and metric is essential to obtain results applicable for other substrates of the respective enzyme/transporter. The following phenotyping metrics are recommended based on the level of validation and on practicability: CYP1A2, paraxanthine/caffeine in plasma 6 h after 150 mg caffeine; CYP2C9, tolbutamide plasma concentration 24 h after 125 mg tolbutamide; CYP2C19, urinary excretion of 4'-OH-mephenytoin 0-12 h after 50 mg mephenytoin; CYP2D6, urinary molar ratio debrisoquine/4-OH-debrisoquine 0-8 h after 10 mg debrisoquine; and CYP3A4, plasma clearance of midazolam after 2 mg midazolam (all drugs given orally).

Publication types

  • Review

MeSH terms

  • ATP-Binding Cassette Transporters / genetics
  • ATP-Binding Cassette Transporters / metabolism*
  • Administration, Oral
  • Caffeine / blood
  • Caffeine / metabolism
  • Caffeine / pharmacokinetics
  • Cytochrome P-450 Enzyme System / drug effects
  • Cytochrome P-450 Enzyme System / genetics
  • Cytochrome P-450 Enzyme System / metabolism*
  • Debrisoquin / blood
  • Debrisoquin / metabolism
  • Debrisoquin / pharmacokinetics
  • Humans
  • Pharmaceutical Preparations / administration & dosage
  • Pharmaceutical Preparations / metabolism*
  • Phenotype
  • Theophylline / blood
  • Theophylline / metabolism
  • Theophylline / pharmacokinetics
  • Tolbutamide / blood
  • Tolbutamide / metabolism
  • Tolbutamide / pharmacokinetics

Substances

  • ATP-Binding Cassette Transporters
  • Pharmaceutical Preparations
  • Caffeine
  • Cytochrome P-450 Enzyme System
  • Tolbutamide
  • Theophylline
  • 1,7-dimethylxanthine
  • Debrisoquin