Liver enzyme induction and inhibition: implications for anaesthesia.
Recent breakthroughs in molecular biology have enabled a reclassification of drug metabolising enzymes based on their amino acid sequence. This has led to a better understanding of drug metabolism and drug interactions. The majority of these drug metabolising enzymes may be either induced or inhibited by drugs or by extraneous substances including foodstuffs, cigarette smoke and environmental pollutants. Virtually all drugs used in anaesthesia are metabolised by either hepatic phase 1 or phase II enzymes. This review considers the classification of drug metabolising enzymes, explains the mechanisms of enzyme induction and inhibition, and also considers how the action of drugs commonly used by anaesthetists, including opioids and neuromuscular blocking drugs, may be altered by this mechanism.
Sweeney
B P
BP
Department of Anaesthesia, Poole and Royal Bournemouth Hospitals, Bournemouth BH7 7DW, UK. Bpsween@aol.com
Bromilow
J
J
D000701:Analgesics, Opioid / Q000493:pharmacokinetics*; D000777:Anesthetics / Q000493:pharmacokinetics*; D000818:Animals; D001711:Biotransformation; D003577:Cytochrome P-450 Enzyme System / Q000502:physiology*; D004347:Drug Interactions; D004790:Enzyme Induction / Q000502:physiology; D004791:Enzyme Inhibitors / Q000494:pharmacology; D018565:Food-Drug Interactions / Q000502:physiology; D006801:Humans; D008099:Liver / Q000201:enzymology*; D012907:Smoking / Q000378:metabolism
D000701:Analgesics, Opioid; D000777:Anesthetics; D004791:Enzyme Inhibitors; D003577:Cytochrome P-450 Enzyme System