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Keywords:

  • CYP2C8;
  • CYP3A4;
  • gemfibrozil;
  • interaction;
  • itraconazole;
  • montelukast pharmacokinetics

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• The elimination of montelukast occurs mainly via metabolism and, according to its product information, CYP3A4 and 2C9 are the main metabolizing enzymes in vitro.

• Recent studies, however, suggest that CYP2C8 may have a role in the metabolism of montelukast.

WHAT THIS STUDY ADDS

• The CYP3A4 inhibitor itraconazole markedly reduces the formation of a minor metabolite of montelukast, but has no significant effect on the total elimination of montelukast.

• Montelukast is predominantly metabolized by CYP2C8, and can thus be used as a sensitive CYP2C8 probe drug.

AIM According to product information, montelukast is extensively metabolized by CYP3A4 and CYP2C9. However, CYP2C8 was also recently found to be involved. Our aim was to study the effects of selective CYP2C8 and CYP3A4 inhibitors on the pharmacokinetics of montelukast.

METHODS In a randomized crossover study, 11 healthy subjects ingested gemfibrozil 600 mg, itraconazole 100 mg (first dose 200 mg) or both, or placebo twice daily for 5 days, and on day 3, 10 mg montelukast. Plasma concentrations of montelukast, gemfibrozil, itraconazole and their metabolites were measured up to 72 h.

RESULTS The CYP2C8 inhibitor gemfibrozil increased the AUC(0,∞) of montelukast 4.3-fold and its t1/2 2.1-fold (P < 0.001). Gemfibrozil impaired the formation of the montelukast primary metabolite M6, reduced the AUC and Cmax of the secondary (major) metabolite M4 by more than 90% (P < 0.05) and increased those of M5a and M5b (P < 0.05). The CYP3A4 inhibitor itraconazole had no significant effect on the pharmacokinetic variables of montelukast or its M6 and M4 metabolites, but markedly reduced the AUC and Cmax of M5a and M5b (P < 0.05). The effects of the gemfibrozil-itraconazole combination on the pharmacokinetics of montelukast did not differ from those of gemfibrozil alone.

CONCLUSIONS CYP2C8 is the dominant enzyme in the biotransformation of montelukast in humans, accounting for about 80% of its metabolism. CYP3A4 only mediates the formation of the minor metabolite M5a/b, and is not important in the elimination of montelukast. Montelukast may serve as a safe and useful CYP2C8 probe drug.