Prasugrel, a new thienopyridine antiplatelet drug, weakly inhibits cytochrome P450 2B6 in humans

J Clin Pharmacol. 2008 Jan;48(1):53-9. doi: 10.1177/0091270007309709.

Abstract

Prasugrel, a thienopyridine prodrug, is hydrolyzed in vivo by esterases to a thiolactone followed by a single cytochrome P450 (CYP)-dependent step to an active metabolite that is a potent inhibitor of adenosine diphosphate-induced platelet aggregation. This open-label, multiple-dose, 2-period, fixed-sequence study assessed CYP2B6 inhibition by prasugrel using bupropion as a probe substrate, where its active metabolite, hydroxybupropion, is almost exclusively formed by CYP2B6. Thirty healthy subjects received a single 150-mg oral dose of sustained-release bupropion. After a 7-day washout, a 60-mg prasugrel loading dose, followed by a 10-mg daily maintenance dose for 10 days, was administered. Bupropion (150 mg) was given with prasugrel on day 7 of this phase. Prasugrel weakly inhibited CYP2B6 activity as it increased bupropion Cmax and AUC0-infinity by 14% and 18%, respectively, and decreased hydroxybupropion Cmax and AUC0-infinity by 32% and 23%. These results are consistent with patients receiving prasugrel not requiring dose adjustments when treated with drugs primarily metabolized by CYP2B6.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Area Under Curve
  • Bupropion / analogs & derivatives
  • Bupropion / metabolism
  • Bupropion / pharmacokinetics
  • Chromatography, Liquid
  • Cross-Over Studies
  • Cytochrome P-450 CYP2B6
  • Cytochrome P-450 Enzyme Inhibitors*
  • Cytochrome P-450 Enzyme System / metabolism
  • Delayed-Action Preparations / chemistry
  • Drug Interactions
  • Half-Life
  • Humans
  • Male
  • Middle Aged
  • Molecular Structure
  • Piperazines / chemistry
  • Piperazines / pharmacology*
  • Platelet Aggregation Inhibitors / chemistry
  • Platelet Aggregation Inhibitors / pharmacology*
  • Prasugrel Hydrochloride
  • Prodrugs / chemistry
  • Prodrugs / pharmacology
  • Pyridines / chemistry
  • Pyridines / pharmacology
  • Tandem Mass Spectrometry
  • Thiophenes / chemistry
  • Thiophenes / pharmacology*
  • Time Factors

Substances

  • Cytochrome P-450 Enzyme Inhibitors
  • Delayed-Action Preparations
  • Piperazines
  • Platelet Aggregation Inhibitors
  • Prodrugs
  • Pyridines
  • Thiophenes
  • thienopyridine
  • Bupropion
  • Cytochrome P-450 Enzyme System
  • CYP2B6 protein, human
  • Cytochrome P-450 CYP2B6
  • Prasugrel Hydrochloride
  • radafaxine