Article date: September 2004
By: Bryan A. Ward, Alan Morocho, Abdullah Kandil, Raymond E. Galinsky, David A. Flockhart, Zeruesenay Desta, in Volume 58, Issue 3, pages 277-287
Aims
To confirm the identity of the major metabolites of domperidone and to characterize the cytochrome P450s (CYPs) involved in their formation.
Methods
Human liver microsomes (HLMs) were used to characterize the kinetics of domperidone metabolism and liquid chromatography‐mass spectrometry to identify the products. Isoform‐specific chemical inhibitors, correlation analysis and expressed human CYP genes were used to identify the CYPs involved in domperidone oxidation.
Results
In HLMs, domperidone underwent hydroxylation to form 5‐hydroxydomperidone (MIII) and N‐dealkylation to form 2,3‐dihydro‐2‐oxo‐1H‐benzimidazole‐1‐propionic acid (MI) and 5‐chloro‐4‐piperidinyl‐1,3‐dihydro‐benzimidazol‐2‐one (MII). The formation of all three metabolites (n = 4 HLMs) followed apparent Michaelis‐Menten kinetics. The mean Km values for MI, MII and MIII formation were 12.4, 11.9, and 12.6 µm, respectively. In a panel of HLMs (n = 10), the rate of domperidone (5 µm and 50 µm) metabolism correlated with the activity of CYP3A (r > 0.94; P < 0.0001). Only ketoconazole (1 µm) (by 87%) and troleandomycin (50 µm) (by 64%) inhibited domperidone (5 µm) metabolism in HLMs. Domperidone (5 and 50 µm) hydroxylation and N‐dealkylation was catalyzed by expressed CYP3A4 at a higher rate than the other CYPs. CYP1A2, 2B6, 2C8 and 2D6 also hydroxylated domperidone
Conclusions
CYP3A‐catalyzed N‐dealkylation and aromatic hydroxylation are the major routes for domperidone metabolism. The drug would be expected to demonstrate highly variable bioavailability due to hepatic, and possibly intestinal first‐pass metabolism after oral administration. Increased risk of adverse effects might be anticipated during concomitant administration with CYP3A inhibitors, as well as decreased efficacy with inducers of this enzyme.
DOI: 10.1111/j.1365-2125.2004.02156.x
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