Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/43491
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Type: Journal article
Title: Increased absorption of digoxin from the human jejunum due to inhibition of intestinal transporter-mediated efflux
Author: Igel, S.
Drescher, S.
Murdter, T.
Hofmann, U.
Heinkele, G.
Tegude, H.
Glaeser, H.
Brenner, S.
Somogyi, A.
Omari, T.
Schafer, C.
Eichelbaum, M.
Fromm, M.
Citation: Clinical Pharmacokinetics, 2007; 46(9):777-785
Publisher: Adis International Ltd
Issue Date: 2007
ISSN: 0312-5963
0312-5963
Statement of
Responsibility: 
Svitlana Igel, Siegfried Drescher, Thomas Murdter, Ute Hofmann, Georg Heinkele, Heike Tegude, Hartmut Glaeser, Stefanie Brenner, Andrew A Somogyi, Taher Omari, Christian Schafer, Michel Eichelbaum, and Martin Fromm
Abstract: <h4>Background and objectives</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.
Keywords: Enterocytes
Jejunum
Epithelial Cells
Humans
Quinidine
Antipyrine
Digoxin
Anti-Inflammatory Agents, Non-Steroidal
Xenobiotics
Enzyme Inhibitors
Administration, Oral
Area Under Curve
Biological Transport, Active
Protein Transport
Biological Availability
Intestinal Absorption
Adult
Male
ATP Binding Cassette Transporter, Subfamily B, Member 1
Description: Copyright © 2007 Adis Data Information BV. All rights reserved.
DOI: 10.2165/00003088-200746090-00005
Published version: http://adisonline.com/pharmacokinetics/Fulltext/2007/46090/Increased_Absorption_of_Digoxin_from_the_Human.5.aspx
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