Clopidogrel Markedly Increases Plasma Concentrations of CYP2C8 Substrate Pioglitazone.
The glucose-lowering drug pioglitazone undergoes hepatic CYP2C8-mediated biotransformation to its main metabolites. The antiplatelet drug clopidogrel is metabolized to clopidogrel acyl-β-d-glucuronide, which was recently found to be a strong time-dependent inhibitor of CYP2C8 in humans. Therefore, we studied the effect of clopidogrel on the pharmacokinetics of pioglitazone. In a randomized crossover study, 10 healthy volunteers ingested either 300 mg of clopidogrel on day 1, and 75 mg on days 2 and 3, or placebo. Pioglitazone 15 mg was administered 1 hour after placebo and clopidogrel on day 1. Plasma concentrations of pioglitazone, clopidogrel, and their main metabolites were measured up to 72 hours. Clopidogrel increased the area under the plasma concentration-time curve (AUC0-∞) of pioglitazone 2.1-fold [P < 0.001, 90% confidence interval (CI) 1.8-2.6] and prolonged its half-life from 6.7 to 11 hours (P = 0.002). The peak concentration of pioglitazone was unaffected but the concentration at 24 hours was increased 4.5-fold (range 1.6-9.8; P < 0.001, 90% CI 3.17-6.45) by clopidogrel. The M-IV-to-pioglitazone AUC0-∞ ratio was 49% (P < 0.001, 90% CI 0.40-0.59) of that during the control phase, indicating that clopidogrel inhibited the CYP2C8-mediated biotransformation of pioglitazone. Clopidogrel increases the exposure to pioglitazone by inhibiting its CYP2C8-mediated biotransformation. In consequence, use of clopidogrel may increase the risk of fluid retention and other concentration-related adverse effects of pioglitazone.
Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Matti K
MK
Itkonen
Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Aleksi
A
Tornio
Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Mikko
M
Neuvonen
Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Pertti J
PJ
Neuvonen
Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Mikko
M
Niemi
Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland janne.backman@helsinki.fi.
Janne T
JT
Backman
D000284:Administration, Oral; D000328:Adult; D019540:Area Under Curve; D001711:Biotransformation; D000077144:Clopidogrel; D018592:Cross-Over Studies; D065727:Cytochrome P-450 CYP2C8 / Q000235:genetics / Q000378:metabolism*; D065687:Cytochrome P-450 CYP2C8 Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004347:Drug Interactions; D005260:Female; D005387:Finland; D005838:Genotype; D006207:Half-Life; D064368:Healthy Volunteers; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics; D008297:Male; D008657:Metabolic Clearance Rate; D000071184:Pharmacogenomic Variants; D010641:Phenotype; D000077205:Pioglitazone; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics; D018570:Risk Assessment; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics; D055815:Young Adult
D065687:Cytochrome P-450 CYP2C8 Inhibitors; D007004:Hypoglycemic Agents; D010975:Platelet Aggregation Inhibitors; D045162:Thiazolidinediones; D000077144:Clopidogrel; C450259:CYP2C8 protein, human; D065727:Cytochrome P-450 CYP2C8; D013988:Ticlopidine; D000077205:Pioglitazone