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The Effect of Aging on the Relationship between the Cytochrome P450 2C19 Genotype and Omeprazole Pharmacokinetics

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Abstract

Background and objective

The metabolic activity of cytochrome P450 (CYP) 2C19 is genetically determined, and the pharmacokinetics of omeprazole, a substrate for CYP2C19, are dependent on the CYP2C19 genotype. However, a discrepancy between the CYP2C19 genotype and omeprazole pharmacokinetics was reported in patients with liver disease or advanced cancer. The objective of the present study was to evaluate the effect of aging on the relationship between the CYP2C19 genotype and its phenotype.

Methods

Twenty-eight elderly and 23 young Japanese volunteers were enrolled after being genotyped. Each subject received a single intravenous dose of omeprazole (10mg and 20mg for the elderly and the young groups, respectively) and blood samples were obtained up to 6 hours after dose administration to determine the plasma concentrations of omeprazole and its metabolites, 5-hydroxyomeprazole and omeprazole sulfone. Pharmacokinetic parameters were obtained by noncompartmental analysis. Linear regression models were used to examine the joint effects of covariates such as genotype, age, etc., on the pharmacokinetic parameters, and the pharmacokinetic parameters showing statistical significance were compared by ANOVA.

Results

There were significant differences between genotypes in the area under the plasma concentration-time curve of the young group and the elderly group. The number of mutation alleles and age were significant covariates for systemic clearance (CL), but age was the only significant covariate for volume of distribution at steady state (Vss). There were significant age- and genotype-related differences and a significant age × genotype interaction in CL (20.6 ± 11.0/12.7 ± 4.0/3.2 ± 1.0 and 5.4 ± 4.0/3.7 ± 1.4/2.1 ± 0.7 L/h for homozygous extensive metabolisers [EMs]/heterozygous EMs/poor metabolisers [PMs] of the young and the elderly groups, respectively). In Vss, a significant difference was found between the young and the elderly groups (219 ± 115 and 107 ± 44.5 mL/kg, respectively), but not between three genotypes (178 ± 142, 173 ± 79 and 110 ± 51 mL/kg for homozygous EMs, heterozygous EMs and PMs, respectively).

Conclusion

The elderly EMs showed wide variance in the in vivo CYP2C19 activity and were phenotypically closer to the elderly PMs than the young EMs were to the young PMs. Some of the elderly homozygous EMs, as well as heterozygous EMs, have a metabolic activity similar to PMs, and the CYP2C19 genotype may therefore not be as useful as phenotyping in the elderly.

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Acknowledgements

This work was partially supported by the Japanese Research Foundation for Clinical Pharmacology and the Japanese Ministry of Health, Labor and Welfare (H16-tyoju-001; Quality use of drugs for the elderly based on pharmacogenetic information in Japan). The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Department of Clinical Pharmacology, Hirosaki University School of Medicine, 5 Zaife, Hirosaki, Aomori, 036-8562, Japan

    Yukio Ishizawa, Norio Yasui-Furukori, Takenori Takahata &  Tomonori Tateishi

  2. Second Department of Surgery, Hirosaki University School of Medicine, Hirosaki, Japan

    Yukio Ishizawa & Mutsuo Sasaki

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  1. Yukio Ishizawa
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  2. Norio Yasui-Furukori
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  3. Takenori Takahata
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  5. Tomonori Tateishi
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Correspondence to Tomonori Tateishi.

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Ishizawa, Y., Yasui-Furukori, N., Takahata, T. et al. The Effect of Aging on the Relationship between the Cytochrome P450 2C19 Genotype and Omeprazole Pharmacokinetics. Clin Pharmacokinet 44, 1179–1189 (2005). https://doi.org/10.2165/00003088-200544110-00005

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