title: Influence of CYP2D6 and CYP2C19 genetic polymorphism on the pharmacokinetics of tolperisone in healthy volunteers.
abstract: OBJECTIVE
  This is the first study that connects pharmacokinetics of tolperisone with genetic polymorphism of the enzymes involved in its metabolism in human. We aimed to identify the influence of polymorphism of two main enzymes (CYP2D6 and CYP2C19) on pharmacokinetic profile of parent drug.
  
  
  METHODS
  In a single-dose study, 28 healthy Caucasian male volunteers received an oral dose of 150 mg of tolperisone. The subjects were genotyped with respect to CYP2D6 and CYP2C19 enzymes. Plasma was sampled for up to 12 h post dose, followed by quantification of tolperisone by a fully validated HPLC-tandem mass spectrometry (MS/MS) method. The pharmacokinetic parameters were estimated using a non-compartmental method and compared statistically at level p < 0.05 across the genotyped groups.
  
  
  RESULTS
  High variability (exceeded 100%) of main bioavailability parameters (AUCt, AUC(inf), C(max)) was observed in the whole group of subjects. An essential difference in the pharmacokinetics of tolperisone of quick metabolizers whose genotype expressed wild homozygote CYP2D6 *1/*1 with respect to heterozygous *1/*4 and *1/*5 subjects was demonstrated. The mean AUC(inf) was 2.1- and 3.4-fold higher in *1/*4 and *1/*5, respectively, than in *1/*1 subjects. In case of Cmax, the differences were greater and reached maximally 3.8 times (mean values 54.00, 98.85, and 205.20 ng/mL for CYP2D6 *1/*1, *1/*4, and *1/*5, respectively). Values of the parameters for the one subject that expressed *4/*4 genotype were even 8.5 times higher than in subjects with extensive or intermediate phenotype. Although CYP2C19 *1/*2 subjects had higher AUCt, AUC(inf), and Cmax values than *1/*1, no statistically significant differences were observed. Oral clearance (CL/F) significantly decreased by 65.7% in heterozygous *1/*2 relative to homozygous *1/*1 extensive metabolizers.
  
  
  CONCLUSIONS
  In this study, we first demonstrated the effect of CYP2D6 polymorphism on pharmacokinetics of tolperisone in Caucasian subjects. The contribution of CYP2C19 enzyme seems to be less important.
authors.affiliation: Institute of Biotechnology and Antibiotics, Warsaw, Poland. pawlowskam@iba.waw.pl.
authors.forename: M
authors.initials: M
authors.lastname: Pawlowska
authors.affiliation: Institute of Biotechnology and Antibiotics, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Bogiel
authors.affiliation: Institute of Biotechnology and Antibiotics, Warsaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Duda
authors.affiliation: Faculty of Pharmacy, Department of Applied Pharmacy and Bioengineering, Medical University of Warsaw, Warsaw, Poland.
authors.forename: E
authors.initials: E
authors.lastname: Sieradzki
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001682:Biological Availability; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics*; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics*; D005838:Genotype; D064368:Healthy Volunteers; D006579:Heterozygote; D006720:Homozygote; D006801:Humans; D008297:Male; D009125:Muscle Relaxants, Central / Q000493:pharmacokinetics*; D010641:Phenotype; D011110:Polymorphism, Genetic / Q000235:genetics*; D014049:Tolperisone / Q000493:pharmacokinetics*
chemical_list: D009125:Muscle Relaxants, Central; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D019389:Cytochrome P-450 CYP2D6; D014049:Tolperisone