Bergamottin contribution to the grapefruit juice-felodipine interaction and disposition in humans.
OBJECTIVE
Our objectives were to evaluate the contribution of bergamottin to the grapefruit juice-felodipine interaction and to characterize bergamottin disposition.


METHODS
In this study 250 mL grapefruit juice; 2-, 6-, or 12-mg capsules of bergamottin plus water; or water was administered with 5 mg extended-release felodipine to 11 volunteers in a partially randomized, 5-way crossover study. Plasma concentrations of felodipine, its primary metabolite (dehydrofelodipine), bergamottin, and 6',7'-dihydroxybergamottin were determined.


RESULTS
Grapefruit juice (containing 1.7 mg bergamottin) increased peak plasma concentration (C max ) and area under the plasma concentration-time curve (AUC) of felodipine by 89% (P < .025) and 54% (P < .025), respectively, compared with water. With 2 mg bergamottin, felodipine C max increased by 33% (P < .05). The increase by bergamottin was markedly variable among individuals (range, -33% to 125%). With 6 mg bergamottin, felodipine C max was enhanced by 35% (P < .025), and with 12 mg bergamottin, felodipine C max increased by 40% (P < .05) and AUC increased by 37% (P < .05) compared with water. Bergamottin measured in plasma after administration of 6 and 12 mg produced C max values of 2.1 and 5.9 ng/mL, respectively, and times to reach C max of 0.8 and 1.1 hours, respectively. The bergamottin metabolite 6',7'-dihydroxybergamottin was detected in plasma of some subjects after bergamottin administration.


CONCLUSIONS
Bergamottin enhanced the oral bioavailability of felodipine and may cause a clinically relevant drug interaction in susceptible individuals. Grapefruit juice-drug interactions likely also involve other furanocoumarins, possibly acting in combination by additive or synergistic mechanisms. Bergamottin has systemic availability and is metabolized in vivo to 6',7'-dihydroxybergamottin.
Goosen
Theunis C
TC
Department of Pharmacology, North-West University, Potchefstroom. theunis.goosen@pfizer.com
Cillié
Doré
D
Bailey
David G
DG
Yu
Chongwoo
C
He
Kan
K
Hollenberg
Paul F
PF
Woster
Patrick M
PM
Cohen
Lucinda
L
Williams
J Andrew
JA
Rheeders
Malie
M
Dijkstra
H Paul
HP
D000328:Adult; D019540:Area Under Curve; D001682:Biological Availability; D001711:Biotransformation; D002121:Calcium Channel Blockers / Q000493:pharmacokinetics / Q000494:pharmacology*; D002214:Capsules; D002851:Chromatography, High Pressure Liquid; D002957:Citrus / Q000737:chemistry*; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D015736:Felodipine / Q000493:pharmacokinetics / Q000494:pharmacology*; D005260:Female; D018565:Food-Drug Interactions; D011564:Furocoumarins / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008297:Male; D013056:Spectrophotometry, Ultraviolet
D002121:Calcium Channel Blockers; D002214:Capsules; D003692:Delayed-Action Preparations; D011564:Furocoumarins; C068337:bergamottin; D015736:Felodipine