Inhibitory effect of stiripentol on carbamazepine and saquinavir metabolism in human

Aims To characterize the in vitro and in vivo inhibitory effect of stiripentol, a new anticonvulsant, on the metabolism of carbamazepine and saquinavir, which are substrates of CYP3A4. Methods Human liver microsomes and cDNA-expressed CYP enzymes were used for the in vitro experiments. Pharmacokinetic data from epileptic children and healthy adults were used for the carbamazepine and saquinavir in vivo studies, respectively. Results Carbamazepine biotransformation to its 10,11-epoxide by human liver microsomes (V-max = 10.3 nmol min(-1) nmol(-1) P450, apparent Km = 362 mum), cDNA-expressed CYP3A4 (V-max = 1.17 nmol min(-1) nmol(-1) P450, apparent Km = 119 mum) and CYP2C8 (V-max = 0.669 nmol min(-1) nmol(-1) P450, apparent Km = 757 mum) was inhibited by stiripentol (IC50 14, 5.1, 37 muM and apparent Ki 3.7, 2.5, 35 mum, respectively). Saquinavir biotransformation to its major metabolite M7 by human liver microsomes (V-max = 5.7 nmol min(-1) nmol(-1) P450, apparent Km = 0.79 mum) was inhibited by stiripentol (IC50 163 muM, apparent Ki 86 mum). In epileptic children treated with carbamazepine and stiripentol, the plasma concentration ratio of carbamazepine epoxide/carbamazepine was decreased by 65%. The in vivo apparent Ki for stiripentol ranged from 10.5 to 41.4 mum. The pharmacokinetics of saquinavir was not modified by stiripentol in healthy adults. The 95% confidence intervals for the difference for C-max and AUC of saquinavir between the placebo and stiripentol phase were (-39.8, 39.8) and (-33.2, 112), respectively. Conclusions These results showed that stiripentol was a weak inhibitor of saquinavir metabolism both in vitro and in vivo. In contrast, stiripentol is a potent inhibitor of carbamazepine 10,11-epoxide formation in vitro and in vivo in epileptic patients.