Interaction between grapefruit juice and hypnotic drugs: comparison of triazolam and quazepam.
OBJECTIVE
Grapefruit juice (GFJ) inhibits cytochrome P450 (CYP) 3A4 in the gut wall and increases blood concentrations of CYP3A4 substrates by the enhancement of oral bioavailability. The effects of GFJ on two benzodiazepine hypnotics, triazolam (metabolized by CYP3A4) and quazepam (metabolized by CYP3A4 and CYP2C9), were determined in this study.


METHODS
The study consisted of four separate trials in which nine healthy subjects were administered 0.25 mg triazolam or 15 mg quazepam, with or without GFJ. Each trial was performed using an open, randomized, cross-over design with an interval of more than 2 weeks between trials. Blood samples were obtained during the 24-h period immediately following the administration of each dose. Pharmacodynamic effects were determined by the digit symbol substitution test (DSST) and utilizing a visual analog scale.


RESULTS
GFJ increased the plasma concentrations of both triazolam and quazepam and of the active metabolite of quazepam, 2-oxoquazepam. The area under the curve (AUC)(0-24) of triazolam significantly increased by 96% (p<0.05). The AUC(0-24) of quazepam (+38%) and 2-oxoquazepam (+28%) also increased; however, these increases were not significantly different from those of triazolam. GFJ deteriorated the performance of the subjects in the DSST after the triazolam dose (-11 digits at 2 h after the dose, p<0.05), but not after the quazepam dose. Triazolam and quazepam produced similar sedative-like effects, none of which were enhanced by GFJ.


CONCLUSIONS
These results suggest that the effects of GFJ on the pharmacodynamics of triazolam are greater than those on quazepam. These GFJ-related different effects are partly explained by the fact that triazolam is presystemically metabolized by CYP3A4, while quazepam is presystemically metabolized by CYP3A4 and CYP2C9.
Sugimoto
Koh-ichi
K
Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical School, 3311-1 Minamikawachi, Tochigi, 329-0498, Japan.
Araki
Nobutaka
N
Ohmori
Masami
M
Harada
Ken-ichi
K
Cui
Yimin
Y
Tsuruoka
Shuichi
S
Kawaguchi
Atsuhiro
A
Fujimura
Akio
A
D000328:Adult; D000704:Analysis of Variance; D019540:Area Under Curve; D001189:Aryl Hydrocarbon Hydroxylases / Q000378:metabolism; D001569:Benzodiazepines / Q000097:blood / Q000378:metabolism / Q000493:pharmacokinetics*; D001628:Beverages; D002851:Chromatography, High Pressure Liquid; D032083:Citrus paradisi / Q000737:chemistry*; D018592:Cross-Over Studies; D065729:Cytochrome P-450 CYP2C9; D051544:Cytochrome P-450 CYP3A; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D018565:Food-Drug Interactions; D006207:Half-Life; D006801:Humans; D006993:Hypnotics and Sedatives / Q000097:blood / Q000378:metabolism / Q000493:pharmacokinetics*; D008297:Male; D008657:Metabolic Clearance Rate; D013997:Time Factors; D014229:Triazolam / Q000097:blood / Q000378:metabolism / Q000493:pharmacokinetics*
D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D014229:Triazolam; C039103:2-oxoquazepam; D003577:Cytochrome P-450 Enzyme System; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; D001189:Aryl Hydrocarbon Hydroxylases; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human; C025130:quazepam