Investigation on modulation of human P-gp by multiple doses of Radix Astragali extract granules using fexofenadine as a phenotyping probe

Abstract

EthnopharmacologyHerb–drug interactions may potentially affect drug efficacy and/or the likelihood of adverse drug reactions. Radix Astragali (RA) extract formulation is usually prescribed for long-term use for patients with immunodeficiency, diabetes, nephropathy or cardiovascular diseases. Its use in combination with P-glycoprotein (P-gp) substrates is possible in clinical practice. Currently there is little knowledge about whether concomitant use of RA extract has an influence on disposition of P-gp substrate. Aim of the studyThis study was to investigate whether continuous and multiple doses of RA extract granules had modulatory effects on human P-gp. Material and methodsA randomised, placebo-controlled, two-period crossover pharmacokinetic drug interaction study was conducted in healthy Chinese volunteers. Fexofenadine was used as a P-gp phenotyping probe. Fourteen volunteers received RA extract granules or placebo (4g bid) for 7 days and then received a single oral dose of 120mg fexofenadine. Fexofenadine plasma concentrations were determined by HPLC. Pharmacokinetic parameters were calculated by non-compartmental method and bioequivalence evaluation was performed. ResultsPharamcokinetic parameters in the placebo phase were as follows: T1/2 (3.75±1.47h), Cmax (745.11±137.41μg/L), Tmax (2.25±0.47h), AUC(0−t) (3894.27±923.45μgh/L), AUC(0−∞) (3993.84±912.97μgh/L). Pharamcokinetic parameters in the RA extract phase were as follows: T1/2 (4.00±1.24h), Cmax (709.44±170.03μg/L), Tmax (2.21±0.51h), AUC(0−t) (3832.72±1077.60μgh/L), AUC(0−∞) (3983.53±1019.83μgh/L). The influence of RA extract on fexofenadine Cmax and AUC lacks statistical significance. Fexofenadine in the two phases were bioequivalent. In the placebo phase, T1/2 of fexofenadine in ABCB1 3435T mutation allele carriers was longer compared to ABCB1 3435CC carriers (4.43±1.44h vs. 2.54±0.21h, p<0.05). However, RA extract pretreatment abolished such genotype-related difference due to the lengthened T1/2 in ABCB1 3435CC carriers. There was no association of the C3435T polymorphism with Cmax and AUC(0−t) in subjects with two pretreatments. ConclusionOne-week administration of RA extract granules did not have a statistically significant impact on systematic exposure to fexofenadine, suggesting that RA extract is not a potent modulator of P-gp in vivo. RA extract appears to have ABCB1 C3435T genotype-dependent inhibitory effect on elimination rather than absorption of a P-gp substrate. Further investigations are necessary in patients who receive long-term use of RA extract formulation and combined P-gp substrates, especially in those ABCB1 3435CC carriers.