The effects of lacidipine on the steady/state plasma concentrations of simvastatin in healthy subjects

British Journal of Clinical Pharmacology - Tập 51 Số 2 - Trang 147-152 - 2001
Luigi Ziviani1, Lucio Da Ros1, Lisa Squassante1, Stefano Milleri1, Mauro Cugola1, Laura Iavarone1
1Glaxo Wellcome, Medicine Research Centre, Verona, Italy

Tóm tắt

Aims Lacidipine, a long acting 2, 4‐dihydropyridine calcium channel antagonist is frequently administered with cholesterol lowering agents, particularly in elderly populations. The effects of lacidipine on the pharmacokinetics of simvastatin were investigated, since they share the CYP3A4 pathway for metabolism. Methods The study was an open, randomised, two‐way crossover design, with at least 7 days washout. Eighteen healthy subjects received simvastatin, 40 mg once daily, alone and together with lacidipine, 4 mg once daily, for 8 days. The pharmacokinetics of simvastatin were studied on the eighth day. Analysis was made of total simvastatin acid concentrations (naive simvastatin acid plus that derived from alkaline hydrolysis of the lactone). Results Lacidipine increased the maximum concentration of simvastatin (Cmax) by approximately 70% (P=0.016) and the area under the plasma concentration‐time curve AUC(0,24 h) by approximately 35% (P=0.001). The mean Cmax and AUC(0,24 h) of simvastatin (95% confidence interval) when given alone were 8.76 (6.72–11.41) ng ml−1 and 60.36 (47.15–77.28) ng ml−1 h. During treatment with lacidipine they were, respectively, 14.89 (10.77–20.58) ng ml−1 and 80.96 (64.62–101.44) ng ml−1 h. No significant differences were observed in either time to peak concentration (tmax was 1.0 h for simvastatin alone and 1.5 h for the combination) or in the half‐life (t1/2,z was 8.5 h in both cases). The combination was safe and well tolerated. Conclusions The observed increased exposure to simvastatin 40 mg following coadministration of lacidipine is unlikely to be of clinical relevance.

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Tài liệu tham khảo

10.7326/0003-4819-114-3-224

Lardinois CK, 1988, The effects of antihypertensive agents on serum lipids and lipoproteins, Arch Intern Med, 148, 1280, 10.1001/archinte.1988.00380060044012

10.1097/00005344-199500003-00007

10.1097/00005344-199500003-00006

10.1056/NEJM198801073180111

Copier CL, 1988, Rhabdomyolysis and renal injury with lovastatin use, JAMA, 260, 239, 10.1001/jama.1988.03410020105038

Kliem V, 1996, Comparison of pravastatin and lovastatin in renal transplant patients receiving cyclosporine, Transplant Proc, 28, 3126

10.1159/000187521

10.1002/j.1875-9114.1998.tb03830.x

10.1016/S0009-9236(98)90034-0

10.1016/S0009-9236(98)90130-8

10.1016/S0140-6736(05)78613-X

10.1016/S0009-9236(98)90067-4

Abernethy DR, 1991, Selective inhibition of warfarin metabolism by diltiazem in humans, J Pharmacol Exp Metab, 257, 411

10.1016/S0163-7258(96)00140-4

10.1021/jm00110a012

MilleriS SquassanteL Da RosL.Lacidipine at steady‐state does not affect the pharmacokinetics and pharmacodinamics of warfarin. Proceeding of the 23rd International Congress of Internal Medicine. February 1–6; Manila.1996.

10.1002/bms.1200220102

10.1016/0378-4347(95)00128-6

Meredith PA, 1995, The pharmacokinetics of lacidipine, Rev Contemp Pharmacother, 6, 9

10.1016/0003-9861(91)90551-S

Prueksaritanont T, 1997, In vitro metabolism of simvastatin in humans [SBT] identification of metabolizing enzymes and effect of the drug on hepatic P450s, Drug Metab Dispos, 25, 1191

Roche withdraws Posicor [editorial].Scrip1998; June 102342:20.

10.1016/S0009-9236(96)90167-8

10.1016/S0009-9236(98)90165-5

10.1016/0009-9236(95)90054-3

10.1046/j.1365-2125.1998.00034.x

10.1007/s002280050408

Pierno S, 1995, Potential risk of myopathy by HMGCoA reductase inhibitors: a comparison of pravastatin and simvastatin effects on membrane electrical proprieties of rat skeletal muscle fibers, J Pharmacol Exp Ther, 275, 1490

10.1023/A:1007733311487

10.1097/00004872-199715120-00065

Physicians' Desk Reference.Medical Economics Company Inc1996; Zocor (simvastatin)1775–1779.

10.1016/s0002-9149(96)00742-4

10.1016/s0002-9149(98)00421-4