Monohydroxy Metabolites Research Articles

Gas chromatographic/mass spectrometric analysis of oxo and chain-shortened leukotriene B4 metabolites. Leukotriene B4 metabolism in Ito cells.

Analysis by gas chromatography/mass spectrometry (GC/MS) of derivatized metabolites formed following incubation of leukotriene B4 (LTB4) incubation with Ito cells extends previous knowledge concerning fragmentation mechanisms for derivatized hydroxy-substituted unsaturated fatty acids. LTB4 was metabolized by rat Ito cells, a hepatic perisinusoidal stellate cell, by the delta 10- and delta 14-reductase pathways, resulting in the formation of 10,11-dihydro-LTB4 and 10,11,14,15-tetrahydro-LTB4. Formation of the intermediate metabolites, 12-oxo-10,11-dihydro-LTB4 and 12-oxo-10,11,14,15-tetrahydro-LTB4, was also observed. GC/electron impact (EI) MS analysis of the 12-oxo metabolites, derivatized as the pentafluorobenzyl ester/ trimethylsilyl ether compounds, resulted in unique fragmentations indicative of the oxo substituent and double bond positions. Further metabolism of 10,11-dihydro-LTB4 and 10,11,14,15-tetrahydro-LTB4 by carboxy terminus beta-oxidation resulted in chain-shortened monohydroxy metabolites. Possible intermediates in this metabolism, which resulted in loss of the original C-5 hydroxy substituent from LTB4, were identified as 2,4,6-conjugated triene-containing C-18 metabolites. The absence of a double bond allylic to the trimethylsiloxy ether in derivatized 10,11,14,15-tetrahydro LTB4 metabolites strikingly reduced the abundance of alpha-cleavage ions observed in the EI mass spectra of these compounds, thus suggesting the importance of formation of an allylic stabilized radical in such alpha-cleavage reactions. Lacking a favorable alpha-cleavage reaction, GC/EIMS analysis of 10-hydroxy-2,4,6-octadecatrienoic acid resulted in the formation of m/z 91, which may arise via cyclization of the conjugated triene moiety. In addition, GC/MS analysis of derivatized metabolites containing the 2,4,6 conjugated triene moiety resulted in a unique fragment ion in the electron capture ionization mass spectra that also may arise via cyclization of the conjugated triene with formation of m/z 121.

Effects of felbamate on the pharmacokinetics of the monohydroxy and dihydroxy metabolites of oxcarbazepine

The effects of felbamate on the multiple dose pharmacokinetics of the monohydroxy and dihydroxy metabolites of oxcarbazepine were assessed in a placebo-controlled, randomized, double-blind crossover study in 18 healthy male volunteers. Oxcarbazepine, 1200 mg/day, was administered on an open basis in combination with double-blind placebo or 2400 mg/day felbamate for two 10-day treatment periods separated by a 14-day washout period. Pharmacokinetic parameters of monohydroxyoxcarbazepine and dihydroxyoxcarbazepine were determined from plasma and urine samples obtained on the tenth day of each treatment period. Felbamate had no effect on monohydroxyoxcarbazepine plasma or urine pharmacokinetics compared with placebo, but it significantly increased values for dihydroxyoxcarbazepine maximum concentration and area under the curve from 0 to 12 hours, as well as urinary excretion of free and total dihydroxyoxcarbazepine. The mechanism that may account for the observations is the induction of oxidative metabolism of monohydroxyoxcarbazepine. Despite these changes, the relative amount of dihydroxyoxcarbazepine is small in comparison to monohydroxyoxcarbazepine, and antiepileptic activity is associated with monohydroxyoxcarbazepine rather than dihydroxyoxcarbazepine. Therefore we conclude that felbamate has no clinically relevant effects on the pharmacokinetics of oxcarbazepine in humans.

Oxcarbazepine: preclinical anticonvulsant profile and putative mechanisms of action.

Oxcarbazepine (OCBZ, Trileptal) and its main human monohydroxy metabolite (MHD) protected mice and rats against generalized tonic-clonic seizures induced by electroshock with ED50 values between 13.5 and 20.5 mg/kg p.o. No tolerance toward this anticonvulsant effect was observed when rats were treated with OCBZ or MHD daily for 4 weeks. The therapeutic indices were 4 (OCBZ) and > 6 (MHD) for sedation (observation test, mice and rats) and 8 (MHD) or 10 (OCBZ) for motor impairment (rotorod test, mice). Both compounds were less potent in suppressing chemically induced seizures and did not significantly influence rat kindling development. At doses of 50 mg/kg p.o. and 20 mg/kg i.m. and higher, OCBZ and, to a lesser extent, MHD protected Rhesus monkeys from aluminum-induced chronically recurring partial seizures. In vitro, OCBZ and MHD suppressed sustained high-frequency repetitive firing of sodium-dependent action potentials in mouse neurons in cell culture with equal potency (medium effective concentration 5 x 10(-8) M/L). This effect is probably due in part to a direct effect on sodium channels. Patch-clamp studies on rat dorsal root ganglia cells revealed that up to a concentration of 3 x 10(-4) M, MHD did not significantly interact with L-type calcium currents, whereas OCBZ diminished them by about 30% at the concentration of 3 x 10(-4) M. In biochemical investigations, no brain neurotransmitter or modulator receptor site responsible for the anticonvulsant mechanism of action of OCBZ and MHD was identified.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of food on the disposition of the antiepileptic oxcarbazepine and its major metabolites in healthy volunteers

The effect of food on the pharmacokinetics of the antiepileptic oxcarbazepine (OXC) was investigated in healthy volunteers. Six healthy male volunteers were treated with single peroral doses of 600 mg of oxcarbazepine (Trileptal) after overnight fasting or a fat- and protein-rich breakfast. Mean (+/- SD) areas under the plasma concentration-time curves (AUC) of the major component in plasma, the active monohydroxy metabolite (MHD), which is responsible for the therapeutic effect in man, were 672 (25) mumol L-1 h when given to the fasted volunteers and 780 (31) mumol L-1 h (p = 0.042) when given after a substantial breakfast. Mean (+/- SD) maximum concentrations (Cmax) were 25.5 (4.8) mumol L-1 when given to the fasted volunteers and 31.4 (5.3) mumol L-1 (p = 0.025) when given after breakfast. Thus, the average AUC was increased by 16% and Cmax by 23% when oxcarbazepine was given with food. The times at which Cmax was reached (tmax) as well as the terminal half-lives were not influenced by concomitant intake of food. The tolerability was the same whether oxcarbazepine was given before or after food in healthy volunteers. The slight effect of food on the kinetics of oxcarbazepine should be of little therapeutic consequence.

Lipoxygenation of Docosahexaenoic Acid by the Rat Pineal Body

Based on the inhibitor profile, production rate, and stereochemical purity of the hydroxylated products, it was demonstrated that lipoxygenation in rat brain occurs only in the pineal. Both positional and stereochemical specificities of the hydroxylation were observed only in pineal, clearly indicating that only the pineal is capable of lipoxygenating polyunsaturated fatty acids among the rat brain regions examined. Cerebral cortex also produced hydroxy products; however, they were racemic mixtures, indicating that peroxidation was responsible for their production. Rat pineal homogenate, obtained after the brain was perfused, metabolized [14C]docosahexaenoic acid ([1-14C]22:6n3) to monohydroxy derivatives, primarily by the 12- and, to a lesser extent, by the 15-lipoxygenase (LO) reaction. The resulting metabolites were 14(S)- and 17(S)-hydroxydocosahexaenoic acid (HDoHE), as determined by reversed-phase HPLC, chiral-phase HPLC, thermospray liquid chromatography-mass spectrometry, and gas chromatography-mass spectrometry. Because blood was removed by perfusion of the brain before incubation, it was clear that the observed LO activity was not due to contamination with blood cell components. The production rate of 17-HDoHE from 22:6n3 was higher than that of 15-hydroxyperoxy-5,8,11,13-eicosatetraenoic acid from 20:4n6, whereas 12-LO activity toward these two substrates was comparable. These monohydroxy metabolites were also detected in the pineal body lipid extract using negative ion chemical ionization mass spectrometry. This is the first observation of endogenous production of hydroxylated compounds in pineal. The ratio of endogenous 15-LO to 12-LO products was considerably higher than that of the in vitro production from exogenous substrate. In some cases, 15-LO products were the major LO metabolites present in the lipid extract of pineal body for both 20:4n6 and 22:6n3. Both 12- and 15-LO activities were recovered mainly in the microsomal plus cytosolic fraction. In addition to monohydroxy products, epoxy, hydroxy derivatives were formed from 22:6n3 by the pineal. The major isomer was identified as 12-hydroxy-13,14-epoxy-22:5n3.

Cytotoxicity of tacrine and velnacrine metabolites in cultured rat, dog and human hepatocytes.

Clinical trials with tacrine (THA) and its principal (1-OH) metabolite (velnacrine) for the treatment of Alzheimer's disease have been hampered by adverse hepatic events that were undetected in preclinical studies. As part of integrated in vivo/in vitro efforts to characterize the role of metabolites in these events, cultured cells were evaluated for their suitability for further mechanistic studies. The relative cytotoxic potentials of THA, three monohydroxy metabolites of THA (including velnacrine, a racemate), the two velnacrine enantiomers, and several known and suspected dihydroxy velnacrine metabolites were determined. Cytotoxicity was evaluated in 24-hour cultures by morphology and by the Neutral Red Uptake Assay. All test articles were evaluated in primary rat hepatocytes and in a human hepatoma cell line (HepG2). THA and velnacrine were also tested in a rat hepatoma cell line (H4) and in primary dog hepatocytes. The metabolic competency of each cell type was determined. Sensitivity to THA and velnacrine was greatest in H4 cells, followed by primary rat and HepG2 cells; dog cells were least sensitive. In HepG2 cells, THA was clearly more cytotoxic (LC50:54 micrograms/ml) than its monohydroxy metabolites (LC50 values: 84 to 190 micrograms/ml); dihydroxy velnacrine metabolites were the least cytotoxic (LC50 values:251 to 434 micrograms/ml); the relative order was comparable in primary rat hepatocytes. Roles for reactive metabolites and/or altered metabolic capabilities of Alzheimer's patients are suggested.

Identification of in vitro metabolites of 2,4,6,2',4',6'-hexachlorobiphenyl from phenobarbital-treated dog liver microsomes.

We studied in vitro metabolites of 2,4,6,2',4',6'-hexachlorobiphenyl (HCB, IUPAC PCB No. 155) produced by liver microsomes of a phenobarbital (PB)-treated beagle dog. The major metabolites were 3-hydroxy-2,4,6,2',4',6'-HCB (M-1), 4-hydroxy-2,6,2',4',6'-pentachlorobiphenyl (PenCB, M-2) and 3,4-dihydroxy-2,6,2',4',6'-PenCB (M-3). Furthermore, 4-hydroxy-2,3,6,2',4',6'-HCB (M-4), which could be formed via the 3,4-epoxidation and the subsequent NIH-shift of the chlorine from the 4 to the 3 position, was also detected. We found that M-3 is a common secondary metabolite of the two major monohydroxy metabolites, M-1 and M-2. These results indicate that the dog seems to metabolize and eliminate this congener not only by a mechanism involving direct insertion of a hydroxyl group but also via an arene oxide intermediate.

Synthesis and biological activity of putative mono-hydroxylated metabolites of velnacrine

Ten 9-amino-1,2,3,4-tetrahydroacridinediols were prepared as potential mono-hydroxy metabolites of velnacrine. They were tested for acute toxicity as well as for their ability to inhibit acetylcholinesterase in vitro and to reverse scopolamine-induced memory impairment in mice.

Application of 19F-n.m.r. spectroscopy to the identification of dog urinary metabolites of imirestat, a spirohydantoin aldose reductase inhibitor.

1. Urine from a dog dosed orally at 20 mg/kg with 14C-imirestat, a spirohydantoin aldose reductase inhibitor, contained 17.7 and 12.5% of the administered radioactivity at 0-48 and 48-72 h respectively. 2. Radio-h.p.l.c. of the 0-48 h urine revealed a complex mixture of metabolites and a small proportion of parent drug (1.6% of dose). Direct 19F-n.m.r. spectroscopy of this urine showed the fluoride ion, numerous metabolites which were predominantly glucuronide conjugates and, as a minor component, the parent drug. 3. After incubation with beta-glucuronidase the 0-48 h urine gave a 19F-n.m.r. spectrum showing fewer signals. This finding is consistent with aromatic ring hydroxylation followed by glucuronidation being the major metabolite pathways. 4. Deconjugated urine was analysed by proton-coupled 19F-n.m.r. and two-dimensional 19F-19F correlated spectroscopy. Results indicate that major components included three monohydroxy metabolites, a diphenol with both phenolic functions in the same ring, and a phenolic metabolite containing only one fluorine atom. 5. Semi-preparative h.p.l.c. of 0-48 h dog urine gave individual glucuronides isolated as mixtures of C-9 epimers. These fractions were hydrolysed and purified a second time by h.p.l.c. to give aglycones which were analysed by multi-nuclear n.m.r. and g.l.c.-mass spectrometry. The 3- and 4-hydroxy derivatives of imirestat were identified, as was the 2-hydroxy product obtained during or following defluorination. The other major aglycone was postulated to be the 3-fluoro-2-hydroxy metabolite. This represents a novel 'NIH-shift' type pathway for the metabolism of fluorobenzenes.

Novel oxidative pathways of sulphapyridine and sulphadiazine by the turtlePseudemys scripta elegans

The sulphonamides sulphapyridine and sulphadiazine show novel hydroxy metabolites in the turtle Pseudemys scripta elegans. In the excreta of the turtles the monohydroxy metabolites 4-hydroxy- and 5-hydroxysulphapyridine and the dihydroxy metabolite 4,5-dihydroxysulphapyridine were detected. Of sulphadiazine only dihydroxy metabolites 4,5- and 4,6-dihydroxysulphadiazine were detected. About 70-90% of the dose of sulphapyridine was recovered, while this figure varied between 48 and 69% for sulphadiazine.

Increased levels of monohydroxy metabolites of arachidonic acid and linoleic acid in LDL and aorta from atherosclerotic rabbits

Lipid peroxidation results in the formation of peroxy and hydroperoxy metabolites of polyunsaturated fatty acids which can directly or indirectly affect many cellular processes. Lipid hydroperoxides are rapidly metabolized to the corresponding monohydroxy products by various cellular peroxidases. We have measured the amounts of monohydroxy metabolites of linoleic acid (18:2) and arachidonic acid (20:4) in lipids derived from aorta and LDL from rabbits fed a diet enriched in cholesterol and peanut oil for either 8 or 15 weeks. Increased amounts of the 9-hydroxy, and, to a lesser extent, the 13-hydroxy metabolite of 18:2 were observed in aorta and LDL from cholesterol-fed rabbits at both 8 and 15 weeks. The amounts of esterified 11-, 12- and 15-hydroxy metabolites of 20:4 in aortae from cholesterol-fed rabbits were similar to controls after 8 weeks, but about 3-fold higher after 15 weeks. These monohydroxy metabolites of 20:4 were also detected in LDL lipids in cholesterol-fed rabbits. The greater amounts of hydroxy-18:2 in the cholesterol-fed group could be explained by an approx. 2-4-fold increase in 18:2 in aorta and LDL. In contrast, the amounts of 20:4 in aortic lipids were lower in cholesterol-fed rabbits than in controls. Thus, the percentage of esterified 20:4 which had been oxidized to its 11, 12, and 15-hydroxylated metabolites was about 5-times higher in the cholesterol-fed group. Our results would be consistent with the hypothesis that increased amounts of peroxidized 18:2 and 20:4 in lipids could be involved in the development of atherosclerotic lesions in cholesterol-fed rabbits.

Identification of cannabichromene metabolites by mass spectrometry: Identification of eight new dihydroxy metabolites in the rabbit

Metabolites of cannabichromene (CBC) produced by hepatic microsomal incubates from rabbits and mice were examined by gas chromatography/mass spectrometry (GC/MS) as trimethylsilyl (TMS) and (2H9)TMS derivatives. Most metabolites were hydroxylated compounds whose mass spectra gave very little information on metabolite structure as fragmentation was dominated by formation of the substituted chromenyl ion. This prevented charge localization and diagnostic fragmentation at the site of metabolic attack. This paper describes the identification of these metabolites by GC/MS techniques using both deuterium-exchange reactions and hydrogenation of the metabolites to tetrahydro derivatives; the latter method was used to suppress chromenyl ion formation and to enhance the relative abundance of diagnostic fragment ions. Twenty-one metabolites were identified. Metabolites were found hydroxylated in all positions of both aliphatic chains, with additional compounds formed by epoxidation and reduction of the aliphatic double bond in the methylpentenyl chain. Dihydroxy metabolites were hydoxylated in both the pentyl and methylpentenyl chains in positions common to those hydroxylated in the monohydroxy metabolites.

Pharmacokinetics of urinary metabolites of cannabidiol in the dog

The pharmacokinetics of cannabidiol (CBD) and six of its urinary metabolites was investigated in dogs. CBD was administered intravenously to three dogs, and urine was collected at specified time intervals over a period of 30 h. The apparent terminal half-life of CBD calculated from the slope of the sigma minus plot was significantly shorter (2 h) than the half-life of CBD calculated from plasma data (8 h), and the apparent terminal half-life of the metabolites was similar to that of the CBD calculated from plasma data, indicating that the elimination of these metabolites was formation rate limited. The time course of the metabolite excretion could be divided into two phases: the first phase contained mainly monohydroxy metabolites, and the second phase contained mainly metabolites with a carboxylic acid moiety in their side-chain.

Metabolites of the 1′,2′-dimethylheptyl analogue of delta-8-tetrahydrocannabinol in the mouse and their identification by gas chromatography/mass spectrometry

Metabolism of the 1,2-dimethylheptyl analogue of delta-8-tetrahydrocannabinol (delta-8-DMHP) was studied in vitro using mouse hepatic microsomes and in vivo in mouse liver. Metabolites were extracted with ethyl acetate, concentrated by chromatography on Sephadex LH-20 and examined by low-resolution mass spectrometry as trimethylsilyl (TMS), (2H9)TMS and methyl ester/TMS derivatives. Reduction of metabolites with lithium aluminium deuteride also provided structural information. The electron-impact-induced mass spectrum of the TMS derivative of DMHP differed from that of its unbranched side-chain analogues in that prominent ions were produced by fragmentation of the side-chain at the expense of the retro-Diels-Alder fragmentation that was prominent in the spectra of the latter compounds. This, however, was found to reduce the relative abundance of ions diagnostic of side-chain hydroxy substitution in the spectra of the metabolites. In vitro, the only significant metabolite was 11-hydroxy-delta-8-DMHP. This is in contrast with metabolism of the corresponding delta-8-tetrahydrocannabinol (delta-8-THC, n-C5-side-chain) where a number of other monohydroxy metabolites are produced. Fifteen metabolites were found in vivo, of which nine were identified. Mass spectral information was not sufficient to determine the position of one of the hydroxy groups in the other six metabolites. The major site of hydroxylation was at C-11 and the resulting hydroxy metabolite was oxidized to delta-8-DMHP-11-oic acid. In this respect metabolism paralleled that of delta-8-THC. Dihydroxylation of the double bond also occurred, presumably via the epoxide.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro metabolism of cannabinol in rat, mouse, rabbit, guinea pig, hamster, gerbil and cat

Metabolism of cannabinol (CBN) was studied in hepatic microsomal incubates from mouse, rat, rabbit, guinea pig, cat, hamster and gerbil. Metabolites were extracted with ethyl acetate, concentrated by chromatography on Sephadex LH-20 and identified by GC/MS as TMS derivatives. Six monohydroxy metabolites were identified. These had hydroxy groups at C-11 and at all positions of the pentyl side-chain. Metabolism varied considerably between the species. 11-Hydroxylation was the most prominent route in the majority of species, but in the hamster and cat the major metabolic pathway was 4'-hydroxylation. Metabolites hydroxylated in the pentyl chain were generally more abundant in guinea pig, hamster and cat.

Effects of cytochrome P-450 monooxygenase inducers on mouse hepatic microsomal metabolism of testosterone and alkoxyresorufins

The effects of treatment with phenobarbital, l,4-bis[2-(3,5-dichloropyridyloxy)]benzene (TCPOBOP), pregnenolone-16/ga-carbonitrile (PCN), 3-methylcholanthrene (3-MC) and isosafrole on the hepatic microsomal formation of nine monohydroxy metabolites of testosterone and the O-dealkylation of the ethyl and pentyl ethers of resourfin were evaluated in adult male C57BL/6J and DBA/ 2NCR mice. In both strains, phenobarbital, TCPOBOP and PCN induced testosterone 2β-, 6β-, 15β-and 16/gb-hydroxylases up to 5-fold, while phenobarbital and TCPOBOP increased the rate of dealkylation of pentoxyresorufin by approximately 30-fold. However, phenobarbital and TCPOBOP did not exhibit identical patterns of induction for the testosterone oxidation reactions. Hepatic microsomes from C57BL/6J mice treated with TCPOBOP displayed a depression in 6α-testosterone hydroxylase activity, which was also observed in PCN-treated animals, whereas phenobarbital-treated mice exhibited an elevation in this monooxygenase activity. A dose of TCPOBOP (0.5 μmol/kg) previously demonstrated to represent an ED 50 for mouse aminopyrine N-demethylase activity was also found to approximate the ED 50 for pentoxyresonifin O-dealkylase activity in the C57BL/6J mouse. Isosafrole or 3-MC treatment had little effect on testosterone metabolism or pentoxyresorufin O-dealkylase activity in either strain, while 3-MC induced ethoxyresorufin O-deethylase activity in C57BL/6J but not DBA/2NCR mice. This study confirms that TCPOBOP is a potent cytochrome P-450 inducer which most closely resembles phenobarbital in its mode of action. However, TCPOBOP and phenobarbital do not evoke identical modulations of cytochrome P-450-dependent monooxygenases in mice.

Metabolism studies of the antischistosomal drug praziquantel using tandem mass spectrometry: Distribution of parent drug and ten metabolites obtained from control and schistosome-infected mouse urine

The collisionally activated dissociation spectrum of the antischistosomal drug praziquantel (PZQ) has many structure-specific fragmentations which permit identification of PZQ and seventeen of its hydroxylated metabolites in mouse urine. These fragmentations may also be used to quantify the metabolic pattern of PZQ. In the present study, a triple-quadrupole mass spectrometer system has been used to generate [M + H]+ ions for PZQ and its monohydroxy, dihydroxy and trihydroxy metabolites which yield daughter ions capable of quantifying PZQ and ten of these metabolites. The goal of these experiments was to evaluate the effect of this hepatic infection on drug metabolism. This was accomplished in two steps. First, the amount of unmetabolized, mono- and dihydroxylated PZQ was established from the [M + H]+ ions. Then the specific metabolites at each level of hydroxylation were determined from daughter ion spectra. The product of these two values produces the metabolite pattern. The reproducibility of these assays ranged from good, with a coefficient of variation of 3% for the most abundant metabolite, to poor (43%) for PZQ, which is only 1% of the total elimination pattern. The excretion of unchanged PZQ and two dihydroxylated metabolites was enhanced in animals bearing schistosomiasis compared to control mice, while a third dihydroxylated metabolite was depressed.

A method based on catalytic hydrogenation for the identification of monohydroxy metabolites of isomeric tetrahydrocannabinols

AbstractIdentification of isomeric monohydroxy metabolites of 6a,10a‐trans‐tetrahydrocannabinols (THCs) by gas chromatography/mass spectrometry as their trimethylsilyl derivatives is aided by catalytic hydrogenation to hydroxyhexahydrocannabinols (hydroxy‐HHCs) in cases where the metabolites themselves give similar spectra. This method gives common products from a range of hydroxy metabolites of isomeric‐THCs which can be compared with reference compounds synthesized from available hydroxy‐THCs from the Δ8 and Δ9‐series. Sufficient of these compounds are available to enable hydroxy‐HHCs to be prepared with hydroxy groups in most positions accessible to metabolic enzymes. This technique provides a simple alternative to a laborious synthesis of each new metabolite for confirmatory purposes and enables all metabolites in a metabolic experiment to be identified in a single sample. Catalytic hydrogenation was achieved using rhodium on alumina in methanol; this gave rapid, quantitative hydrogenation of underivatized metabolites without the elimination of the hydroxy groups inherent with hydrogenation with other common catalysts. The method was validated by an examination of the metabolites of Δ11 THC in rats and comparison of the results with published work.

Metabolic Characteristics of Oxcarbazepine (®Trileptal) and their Beneficial Implications for Enzyme Induction and Drug Interactions

Hepatic oxygenases of the cytochrome P-450 family play a major role in the clearance of various anti-epileptic drugs. These enzymes are susceptible both to induction and to inhibition. Phenytoin, carbamazepine (CBZ), primidone, and phenobarbitone, for instance, are potent enzyme inducers. Other drugs, such as chloramphenicol, propoxyphene, verapamil, and viloxazine, inhibit cytochrome P-450. Pharmacokinetic behaviour is thus often altered, especially in combined medication, so that the dosage has to be re-adjusted if an optimum therapeutic outcome is to be ensured. Oxcarbazepine (OXC) is a keto analogue of CBZ. In the human liver the keto group is readily reduced, and the resulting monohydroxy metabolite is cleared by glucuronidation. The two enzymes mediating these reactions, i.e. aldo-keto reductase and UDP-glucuronyltransferase, do not depend on cytochrome P-450. The monohydroxy metabolite is the major active substance in plasma. Its elimination is not enhanced by OXC. Moreover, OXC seems to have little effect on cytochrome P-450. Aldo-keto reductases and glucuronyltransferases are in general less sensitive to induction and inhibition than are P-450 dependent enzymes. On the whole, OXC possesses very little potential for metabolic drug interactions, and thus differs favourably from other anti-epileptic drugs.

Metabolic characteristics of oxcarbazepine (®trileptal) and their beneficial implications for enzyme induction and drug interactions.

Hepatic oxygenases of the cytochrome P-450 family play a major role in the clearance of various anti-epileptic drugs. These enzymes are susceptible both to induction and to inhibition. Phenytoin, carbamazepine (CBZ), primidone, and phenobarbitone, for instance, are potent enzyme inducers. Other drugs, such as chloramphenicol, propoxyphene, verapamil, and viloxazine, inhibit cytochrome P-450. Pharmacokinetic behaviour is thus often altered, especially in combined medication, so that the dosage has to be re-adjusted if an optimum therapeutic outcome is to be ensured.Oxcarbazepine (OXC) is a keto analogue of CBZ. In the human liver the keto group is readily reduced, and the resulting monohydroxy metabolite is cleared by glucuronidation. The two enzymes mediating these reactions, i.e. aldo-keto reductase and UDP-glucuronyltransferase, do not depend on cytochrome P-450. The monohydroxy metabolite is the major active substance in plasma. Its elimination is not enhanced by OXC. Moreover, OXC seems to have little effect on cytochrome P-450. Aldo-keto reductases and glucuronyltransferases are in general less sensitive to induction and inhibition than are P-450 dependent enzymes. On the whole, OXC possesses very little potential for metabolic drug interactions, and thus differs favourably from other anti-epileptic drugs.