[en] Brivaracetam (BRV) is a high-affinity synaptic vesicle protein 2A ligand developed for the treatment of uncontrolled partial-onset seizures. The present Phase I open-label two-way crossover study was designed to assess the effect of rifampin on the pharmacokinetics of BRV and its hydroxy (BRV-OH); acid (BRV-AC); and hydroxy acid (BRV OHAC) metabolites. Twenty-six healthy subjects received BRV 150mg single oral dose, either alone or following 5 days of rifampin 600 mg/day. BRV and its metabolites were examined for their plasma profiles and urinary excretion. Pharmacokinetic modeling was developed to estimate the rate constants of the various metabolic routes. Parallel in vitro assays were conducted to characterize the hydrolysis of BRV to BRV-AC as well as to identify any potential effect of rifampin on the hydrolysis reaction. Rifampin did not significantly affect the maximum plasma concentration (Cmax) of BRV but decreased its area under the curve (AUC) by 45%. In addition, rifampin significantly increased the AUC of BRV-OH (+109%), decreased the AUC of BRV-AC (-53%), but had little effect on BRV-OHAC (-10%). In vitro assays showed that the major urinary metabolite BRV-AC (33% of the dose) was likely to be formed by amidase EC 3.5.1.4. In vitro data indicated that the enzyme was not significantly inhibited nor induced by rifampin. Modeling confirmed that all the observed changes in vivo were secondary to the induction of the CYP2C19-mediated hydroxylation of BRV to BRV-OH (3.7-fold increase in the rate constant).
Disciplines :
Pharmacy, pharmacology & toxicology
Author, co-author :
Stockis, Armel
Watanabe, Shikiko
Scheen, André ; Université de Liège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques
Tytgat, Dominique
Gerin, Brigitte
Rosa, Maria
Chanteux, Hugues
Nicolas, Jean-Marie
Language :
English
Title :
Effect of rifampin on the disposition of brivaracetam in human subjects: further insights into brivaracetam hydrolysis.
Publication date :
2016
Journal title :
Drug Metabolism and Disposition: the Biological Fate of Chemicals
ISSN :
0090-9556
eISSN :
1521-009X
Publisher :
American Society for Pharmacology and Experimental Therapeutics, United States - Maryland
Volume :
44
Issue :
6
Pages :
792-799
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
The American Society for Pharmacology and Experimental Therapeutics.
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