Increased absorption of digoxin from the human jejunum due to inhibition of intestinal transporter-mediated efflux.
OBJECTIVE
The contribution of transport in the small intestine by the apically located efflux pump P-glycoprotein to variable drug absorption in humans is still poorly understood. We therefore investigated whether inhibition of intestinal P-glycoprotein-mediated efflux by quinidine leads to increased absorption of the P-glycoprotein substrate digoxin.


METHODS
Using a multilumen perfusion catheter, we investigated the impact of P-glycoprotein inhibition on absorption of two compounds: the P-glycoprotein substrate digoxin and the marker for passive transcellular absorption antipyrine. Two 20cm adjacent jejunal segments were isolated with the multilumen perfusion catheter in seven healthy subjects. Unlabelled and deuterated digoxin and antipyrine, respectively, were simultaneously infused into either of the intestinal segments. One of the segments was additionally perfused with the P-glycoprotein inhibitor quinidine. Intestinal perfusates were collected for 3 hours, and drug concentrations were determined in the intestinal perfusates, plasma and urine.


RESULTS
Quinidine did not affect the disposition of antipyrine. In contrast, coadministration of quinidine into one jejunal segment caused a considerable increase in the amount of digoxin absorbed from this segment compared with the absorption from the other quinidine-free segment (22.3 +/- 8.9% vs 55.8 +/- 21.2% of the dose; p < 0.05). Accordingly, the area under the plasma concentration-time curve and the maximum plasma concentration of digoxin were considerably higher when luminal quinidine was coadministered (p < 0.05 and p < 0.001, respectively). Differences in digoxin absorption from the two intestinal segments were also reflected by pronounced differences in urinary digoxin elimination (5.5 +/- 3.3% vs 19.2 +/- 8.1% of the dose; p < 0.01).


CONCLUSIONS
P-glycoprotein inhibition in enterocytes increases systemic exposure of orally administered drugs that are P-glycoprotein substrates. These data highlight the importance of the small intestine as an active barrier against xenobiotics.
Igel
Svitlana
S
Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.
Drescher
Siegfried
S
Mürdter
Thomas
T
Hofmann
Ute
U
Heinkele
Georg
G
Tegude
Heike
H
Glaeser
Hartmut
H
Brenner
Stefanie S
SS
Somogyi
Andrew A
AA
Omari
Taher
T
Schäfer
Christian
C
Eichelbaum
Michel
M
Fromm
Martin F
MF
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000378:metabolism*; D000284:Administration, Oral; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000493:pharmacokinetics; D000983:Antipyrine / Q000008:administration & dosage / Q000493:pharmacokinetics; D019540:Area Under Curve; D001682:Biological Availability; D001693:Biological Transport, Active / Q000187:drug effects; D004077:Digoxin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D020895:Enterocytes / Q000166:cytology / Q000378:metabolism; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics; D004847:Epithelial Cells / Q000166:cytology / Q000378:metabolism; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects; D007583:Jejunum / Q000166:cytology / Q000378:metabolism*; D008297:Male; D021381:Protein Transport / Q000187:drug effects; D011802:Quinidine / Q000008:administration & dosage / Q000493:pharmacokinetics; D015262:Xenobiotics / Q000008:administration & dosage / Q000493:pharmacokinetics
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004791:Enzyme Inhibitors; D015262:Xenobiotics; D004077:Digoxin; D011802:Quinidine; D000983:Antipyrine
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