Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/42005
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Type: Journal article
Title: Effect of CYP2D6 metabolizer status on the disposition of the (+) and (-) enantiomers of perhexiline in patients with myocardial ischaemia
Author: Inglis, S.
Herbert, M.
Davies, B.
Coller, J.
James, H.
Horowitz, J.
Morris, R.
Milne, R.
Somogyi, A.
Sallustio, B.
Citation: Pharmacogenetics and Genomics (Print Edition), 2007; 17(5):305-312
Publisher: Lippincott Williams & Wilkins
Issue Date: 2007
ISSN: 1744-6872
1744-6880
Statement of
Responsibility: 
Sally C. Inglis; Megan K. Herbert; Benjamin J.L. Davies; Janet K. Coller; Heather M. James; John D. Horowitz; Raymond G. Morris; Robert W. Milne; Andrew A. Somogyi; Benedetta C. Sallustio
Abstract: AIMS: This study investigated the effects of increasing doses of rac-perhexiline maleate and CYP2D6 phenotype and genotype on the pharmacokinetics of (+) and (-)-perhexiline. METHODS: In a prospective study, steady-state plasma concentrations of (+) and (-)-perhexiline were quantified in 10 CYP2D6 genotyped patients following dosing with 100 mg/day rac-perhexiline maleate, and following a subsequent dosage increase to 150 or 200 mg/day. In a retrospective study, steady-state plasma concentrations of (+) and (-)-perhexiline were obtained from 111 CYP2D6 phenotyped patients receiving rac-perhexiline maleate. RESULTS: In the prospective study, comprising one poor and nine extensive/intermediate metabolizers, the apparent oral clearance (CL/F) of both enantiomers increased with the number of functional CYP2D6 genes. In the nine extensive/intermediate metabolizers receiving the 100 mg/day dose, the median CL/F of (+)-perhexiline was lower than that of (-)-perhexiline (352.5 versus 440.6 l/day, P<0.01). Following the dosage increase, the median CL/F of both enantiomers decreased by 45.4 and 41.4%, respectively. In the retrospective study, the median (+)-/(-)-perhexiline plasma concentration ratio was lower (P<0.0001) in phenotypic extensive/intermediate (1.41) versus poor metabolizers (2.29). Median CL/F of (+) and (-)-perhexiline was 10.6 and 24.2 l/day (P<0.05), respectively, in poor metabolizers, and 184.1 and 272.0 l/day (P<0.001), respectively, in extensive/intermediate metabolizers. CONCLUSIONS: Perhexiline's pharmacokinetics exhibit significant enantioselectivity in CYP2D6 extensive/intermediate and poor metabolizers, with both enantiomers displaying polymorphic and saturable metabolism via CYP2D6. Clinical use of rac-perhexiline may be improved by developing specific enantiomer target plasma concentration ranges.
Keywords: Humans; Myocardial Ischemia; Perhexiline; Cytochrome P-450 CYP2D6; Cardiovascular Agents; Metabolic Clearance Rate; Sensitivity and Specificity; Retrospective Studies; Prospective Studies; Biological Availability; Genotype; Phenotype; Polymorphism, Genetic; Stereoisomerism
RMID: 0020070644
DOI: 10.1097/FPC.0b013e32800ffba0
Appears in Collections:Pharmacology publications

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