S-amlodipine-bisoprolol combination therapy caused elevated transaminases and triglyceride levels in healthy Chinese subjects: a randomized controlled, open-label, multiple-dose pharmacokinetic interaction study

Expert Opin Drug Metab Toxicol. 2019 Sep;15(9):687-695. doi: 10.1080/17425255.2019.1650913. Epub 2019 Aug 7.

Abstract

Introduction: S-amlodipine is main anti-hypertensive active enantiomer of amlodipine. Bisoprolol is a β-blocker particularly suitable for hypertensive patients with sinus tachycardia. We evaluated the pharmacokinetic interaction between S-amlodipine and bisoprolol in healthy Chinese subjects. Areas covered: Thirty-two subjects were randomly divided into two equal groups. Subjects in group A were administered S-amlodipine 5 mg for 10 days followed by S-amlodipine 5 mg plus bisoprolol 5 mg for 7 days. Subjects in group B were administered bisoprolol 5 mg for 7 days, followed by S-amlodipine 5 mg plus bisoprolol 5 mg for 10 days. Blood samples were collected for evaluation of pharmacokinetic interaction. Tolerability was evaluated by interview, vital signs, 12-lead ECGs, physical examination, and clinical laboratory tests. Expert opinion: The geometric mean ratio (90% CI) for amlodipine AUCτ,ss and Css-max during the monotherapy and combination therapy periods were 1.0389 (0.9879, 1.0926) and 1.0213 (0.9556, 1.0915). For bisoprolol, it was 1.0193 (0.9834, 1.0566) and 0.9989 (0.9133, 1.0925). Most adverse events were mild-moderate. There was high incidence of elevated alanine aminotransferase, aspartate aminotransferase, and triglyceride.This study found no pharmacokinetic interaction between S-amlodipine and bisoprolol. Alanine aminotransferase, aspartate aminotransferase, and triglycerides should be closely monitored.

Keywords: Hypertension; amlodipine; bisoprolol; pharmacokinetic interaction; transaminases elevation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-1 Receptor Antagonists / administration & dosage*
  • Adrenergic beta-1 Receptor Antagonists / adverse effects
  • Adrenergic beta-1 Receptor Antagonists / pharmacokinetics
  • Adult
  • Amlodipine / administration & dosage*
  • Amlodipine / adverse effects
  • Amlodipine / pharmacokinetics
  • Antihypertensive Agents / administration & dosage*
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / pharmacokinetics
  • Area Under Curve
  • Asian People
  • Bisoprolol / administration & dosage*
  • Bisoprolol / adverse effects
  • Bisoprolol / pharmacokinetics
  • Drug Interactions
  • Drug Therapy, Combination
  • Humans
  • Middle Aged
  • Stereoisomerism
  • Transaminases / blood
  • Triglycerides / blood
  • Young Adult

Substances

  • Adrenergic beta-1 Receptor Antagonists
  • Antihypertensive Agents
  • Triglycerides
  • Amlodipine
  • Transaminases
  • Bisoprolol