Interaction of common azole antifungals with P glycoprotein.

Article Details

Citation

Wang EJ, Lew K, Casciano CN, Clement RP, Johnson WW

Interaction of common azole antifungals with P glycoprotein.

Antimicrob Agents Chemother. 2002 Jan;46(1):160-5.

PubMed ID
11751127 [ View in PubMed
]
Abstract

Both eucaryotic and procaryotic cells are resistant to a large number of antibiotics because of the activities of export transporters. The most studied transporter in the mammalian ATP-binding cassette transporter superfamily, P glycoprotein (P-gp), ejects many structurally unrelated amphiphilic and lipophilic xenobiotics. Observed clinical interactions and some in vitro studies suggest that azole antifungals may interact with P-gp. Such an interaction could both affect the disposition and exposure to azole antifungal therapeutics and partially explain the clinical drug interactions observed with some antifungals. Using a whole-cell assay in which the retention of a marker substrate is evaluated and quantified, we studied the abilities of the most widely prescribed orally administered azole antifungals to inhibit the function of this transporter. In a cell line presenting an overexpressed amount of the human P-gp transporter, itraconazole and ketoconazole inhibited P-gp function with 50% inhibitory concentrations (IC(50)s) of approximately 2 and approximately 6 microM, respectively. Cyclosporin A was inhibitory with an IC(50) of 1.4 microM in this system. Uniquely, fluconazole had no effect in this assay, a result consistent with known clinical interactions. The effects of these azole antifungals on ATP consumption by P-gp (representing transport activity) were also assessed, and the K(m) values were congruent with the IC(50)s. Therefore, exposure of tissue to the azole antifungals may be modulated by human P-gp, and the clinical interactions of azole antifungals with other drugs may be due, in part, to inhibition of P-gp transport.

DrugBank Data that Cites this Article

Drug Transporters
DrugTransporterKindOrganismPharmacological ActionActions
ItraconazoleP-glycoprotein 1ProteinHumans
Unknown
Inhibitor
Details
KetoconazoleP-glycoprotein 1ProteinHumans
Unknown
Inhibitor
Details
Binding Properties
DrugTargetPropertyMeasurementpHTemperature (°C)
ItraconazoleP-glycoprotein 1IC 50 (nM)1700N/AN/ADetails
KetoconazoleP-glycoprotein 1IC 50 (nM)5600N/AN/ADetails
Drug Interactions
DrugsInteraction
Digoxin
Ketoconazole
The serum concentration of Digoxin can be increased when it is combined with Ketoconazole.