title: Changes in pharmacokinetic profiles of acetaminophen and its glucuronide after pretreatment with combinations of N-acetylcysteine and either glycyrrhizin, silibinin or spironolactone in rat.
abstract: 1. The present study was to investigate the effects of giving N-acetylcysteine (NAC) alone and in combination with either glycyrrhizin (GL), silibinin (SIB) or spironolactone (SL) on the plasma pharmacokinetic (PK) profiles, hepatic exposure, biliary excretion and urinary excretion of acetaminophen (APAP) and its major metabolite, acetaminophen glucuronide (AG). 2. Groups of rats (n = 5) were pretreated with oral doses of either NAC, NAC + GL, NAC + SIB or NAC + SL on five occasions every 12 h. At 1 h, after the last dose, they received APAP (200 mg/kg) by intraperitoneal injection. Blood, bile, liver and urine samples were collected at various times after APAP injection and analyzed for APAP and AG by HPLC. NAC alone and NAC + SIB did not significantly change the PK profiles of APAP and AG. In contrast, NAC + GL decreased the biliary excretion of APAP and AG leading to accumulation of APAP in the liver and systemic circulation whereas NAC + SL [multidrug resistance associated 2 (Mrp2) inducer] increased the biliary excretion of AG and decreased the hepatic exposure to APAP and AG. 3. Our results suggest that Mrp2 inhibitor GL should be discouraged with NAC to treat APAP hepatotoxicity. Such PK drug-drug interactions should be considered in the treatment of APAP-induced liver injury.
authors.affiliation: Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University , Nanjing , China.
authors.forename: Ruijuan
authors.initials: R
authors.lastname: Xu
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.forename: Min
authors.initials: M
authors.lastname: Zang
authors.forename: Xiaoquan
authors.initials: X
authors.lastname: Liu
authors.forename: Jin
authors.initials: J
authors.lastname: Yang
mesh_terms: D000082:Acetaminophen / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics / Q000652:urine; D000111:Acetylcysteine / Q000494:pharmacology*; D000818:Animals; D019695:Glycyrrhizic Acid / Q000494:pharmacology*; D065669:Hepatobiliary Elimination / Q000187:drug effects; D007274:Injections, Intraperitoneal; D008099:Liver / Q000378:metabolism; D008297:Male; D017207:Rats, Sprague-Dawley; D000077385:Silybin; D012838:Silymarin / Q000494:pharmacology*; D013148:Spironolactone / Q000494:pharmacology*; D013997:Time Factors
chemical_list: D012838:Silymarin; D013148:Spironolactone; D000082:Acetaminophen; D000077385:Silybin; D019695:Glycyrrhizic Acid; C037386:acetaminophen glucuronide; D000111:Acetylcysteine