ITC commentary on the prediction of digoxin clinical drug-drug interactions from in vitro transporter assays

Clin Pharmacol Ther. 2014 Sep;96(3):298-301. doi: 10.1038/clpt.2014.94.

Abstract

The "P-glycoprotein" IC50 working group reported an 18- to 796-fold interlaboratory range in digoxin transport IC50 (inhibitor concentration achieving 50% of maximal inhibition), raising concerns about the predictability of clinical transporter-based drug-drug interactions (DDIs) from in vitro data. This Commentary describes complexities of digoxin transport, which involve both uptake and efflux processes. We caution against attributing digoxin transport IC50 specifically to P-glycoprotein (P-gp) or extending this composite uptake/efflux IC50 variability to individual transporters. Clinical digoxin interaction studies should be interpreted as evaluation of digoxin safety, not P-gp DDIs.

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily B, Member 1 / drug effects
  • ATP Binding Cassette Transporter, Subfamily B, Member 1 / metabolism
  • Animals
  • Biological Transport
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / metabolism*
  • Cardiovascular Agents / pharmacokinetics
  • Digoxin / adverse effects
  • Digoxin / metabolism*
  • Digoxin / pharmacokinetics
  • Drug Interactions
  • Humans
  • Membrane Transport Proteins / drug effects*
  • Membrane Transport Proteins / metabolism
  • Models, Biological
  • Patient Safety
  • Risk Assessment
  • Risk Factors

Substances

  • ATP Binding Cassette Transporter, Subfamily B, Member 1
  • Cardiovascular Agents
  • Membrane Transport Proteins
  • Digoxin