Preclinical approach for identifying drug interactions

Pharmacokinetic drug interactions may be divided into two categories: induction and inhibition of enzymes involved in the metabolism of a drug. The induction and inhibition of such enzymes result in decreases or increases in the blood concentrations of the drug, causing drug effects to be altered. Cytochrome P450 (P450 or CYP) is an enzyme responsible for the metabolism of a wide variety of drugs, including some anticancer agents. If a drug with a high affinity to bind to a specific form of P450 is given to a patient in combination with other drugs mainly metabolized by this enzyme, the former may potentiate the pharmacological actions of the latter by preventing their metabolism and thus increasing their serum concentration. Alternatively, if a drug inhibits or inactivates essentially all forms of P450 nonspecifically, it may be possible that the pharmacological effects of other drugs used in combination with it will be enhanced. CYP3A4 is one of the major forms of P450 in human liver microsomes. In previous studies using human liver microsomes, docetaxel was determined to be metabolized mainly by this isozyme. Thus it was assumed that inducers and inhibitors of CYP3A4 might affect the pharmacokinetics of docetaxel. In our studies, administration of dexamethasone, a known inducer of CYP3A, to mice resulted in decreases in serum docetaxel concentrations. In contrast, ketoconazole, an inhibitor of CYP3A, is assumed to increase the serum and hepatic concentrations of docetaxel. As an example of a drug which might inhibit the metabolism of other drugs, we found that bis-aceto-ammine-dichloro-cyclohexylamine platinum(IV) (JM216), which is currently being developed as a potential anticancer agent, inhibits essentially all major forms of P450 present in human liver microsomes. Since its inhibition potency is relatively high, careful assessment of the effects of this drug on the metabolism of other drugs appears to be necessary.