Isotretinoin and contraception.
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Biomedical subjects
Publications and source records attributed to D J Back.
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Previous in vivo studies have suggested that phenobarbitone increases the first pass clearance of norethindrone in the rat by induction of enzymes both in the gut wall and liver. In the present study phenobarbitone caused an increase in both the production of highly polar ether-extractable metabolites and the conjugation of the steroid as it crossed the wall of the everted gut sac preparation. In addition, there was a marked increase in the uptake of norethindrone into the liver followed by increased phase I metabolism in the isolated perfused liver. As expected for a highly cleared drug, enzyme induction had no measurable effect on the terminal half-life of norethindrone in the perfused liver preparation.
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The effect of the male contraceptive, gossypol, on rat liver microsomal enzymes has been studied in vitro and in vivo. In vitro, gossypol inhibited aminopyrine N-demethylase activity, the concentration causing 50% inhibition being approximately 0.03 mM; the inhibition was non-competitive. Also the metabolism of ethinylestradiol (a drug with a number of metabolic pathways) was inhibited with the main effect being reduced 2- and 16-hydroxylation. In vivo, gossypol, after 4 weeks of daily administration (30 mg/kg/day) caused a significant reduction in microsomal protein, cytochrome P450 and aminopyrine N-demethylase activity. However, despite reduced enzyme activity, the metabolism of tolbutamide (a drug with a single pathway of metabolism and hence a model substrate) was not impaired by either acute or chronic gossypol administration.
The effects of a single dose of two antimalarial drugs chloroquine (CQ) and primaquine (PQ) on the pharmacokinetics of a combined oral contraceptive (O.C.) have been studied in volunteers. Each woman was studied on 3 separate occasions over 3 cycles and plasma concentrations of ethinyloestradiol (EE2) and levonorgestrel were measured by radioimmunoassay following administration of a single dose of O.C. (30 micrograms EE2 + 150 micrograms levonorgestrel) in the absence and presence of the antimalarial drugs (PQ, 45 mg; CQ, 300 mg). Neither CQ or PQ given 1 h before the O.C. had any significant effect on plasma concentrations of EE2 or levonorgestrel or on any pharmacokinetic parameter determined. There is therefore, no evidence that CQ or PQ interfere with the hepatic handling of O.C.'s. This is in contrast to previously reported inhibitory effects of PQ on the metabolism of antipyrine.
The intestinal content, the mucosa and the rest of the intestinal wall of germfree (GF) and conventional ( CVL ) rats were tested for in vitro hydrolysis of [3H]estrone sulfate. In homogenates from GF rat intestine some estrone sulfate hydrolysis was detected in those from the proximal small intestine (PSI) (4.2 +/- 0.1% hydrolyzed after 4 h), but not in those from the distal small intestine (DSI) and the caecum. Estrone sulfate was also hydrolyzed by the homogenates of the mucosa and the rest of the intestinal wall from each of the segments tested (PSI: 12.8 +/- 0.4% (mucosa) and 21.5 +/- 2.1 (wall); DSI: 8.2 +/- 0.9% (mucosa) and 17.3 +/- 1.7% (wall); caecum: 8.8 +/- 1.6% (mucosa) and 17.3 +/- 0.5% (wall) ). In the homogenates of CVL rat intestine, the estrone sulfatase activity in the rest of the intestinal wall did not differ considerably from the values for GF rats, when expressed per mg protein of the homogenate. The mucosa of the CVL rats, however, showed higher rates of hydrolysis than the mucosa of the GF rats. The microbial estrone sulfatase activity in the intestinal content of CVL rats, tested by anaerobic incubation, was high in the caecum (91.7 +/- 6.6% after 4 h), but very low in the PSI (2.2 +/- 0.7%) and DSI (1.3 +/- 0.5%). Serial dilutions of the caecal content also showed higher viable numbers of estrone sulfate hydrolyzing bacteria. These results add further weight to the suggestion that estrone sulfate may be absorbed from the small intestine, but has to be hydrolyzed in the caecum by the gut microflora prior to absorption.
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The metabolism of [3H]ethinyloestradiol (EE2) was investigated in six male subjects who had been phenotyped with respect to sparteine metabolism (three metabolizers and three non-metabolizers). Urinary metabolite profiles of EE2 were virtually identical. Following enzyme hydrolysis of sulphate and glucuronide conjugates the major urinary metabolite was 2-methoxyEE2. The ratio EE2:2-methoxyEE2 was taken as a measure of EE2 2-hydroxylation (metabolizers, 2.4 +/- 0.3; non-metabolizers, 2.5 +/- 0.4). Primaquine (45 mg), previously shown to inhibit antipyrine metabolism, had no effect on EE2 2-hydroxylation. Supporting studies in rats showed that acute administration of primaquine (50 mg/kg) and 1-methylimidazole (50 mg/kg) inhibited antipyrine but not EE2 metabolism. It is concluded that the cytochrome P-450 enzyme responsible for 2-hydroxylation of EE2 is distinct from the enzymes involved in the oxidation of sparteine and antipyrine.
The effects of various drugs on the pharmacokinetics of tolbutamide have been examined in the rat. Phenobarbitone pretreatment caused a significant decrease in half life and area under the curve (AUC) and a significant increase in clearance and volume of distribution (Vd). Acute administration of primaquine significantly increased half life and AUC and decreased clearance. In contrast, the related animoquinolone chloroquine, was without effect. Acute administration of cimetidine produced similar changes to primaquine but of lesser magnitude. Formation of the major metabolite hydroxytolbutamide, was markedly enhanced by phenobarbitone and reduced by primaquine and cimetidine. We conclude that due to its single pathway of metabolism, tolbutamide is a good substrate to use when examining pharmacokinetic interactions involving hepatic enzyme induction and inhibition.
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Steroids are extensively excreted in the bile of rats. There was no significant difference in biliary excretion of steroid following administration of [3H]-estrone sulfate into the proximal small intestine (PSI) of conventional (CVL; 17.8 +/- 62%; mean +/- SD) or germfree (GF; 28.2 +/- 5.3) rats. A similar finding resulted from administration into the distal small intestine (DSI)-CVL, 22.3 +/- 11.8%; GF, 11.4 +/- 3.7%. However, when the drug was given into the caecum, excretion in the bile of CVL rats after 5 h was 59.1% whereas in GF rats it was only 1.7%. When estrone was injected into the PSI and DSI of CVL and GF rats, absorption (as judged by excretion in bile) was more rapid than that seen with estrone sulfate. Five hours after injection into the PSI, biliary excretion was, in CVL 88.2% and in GF 81.7% and after injection into the DSI excretion was, in CVL 84.7% and in GF 83.6%. Absorption of estrone from the caeca of GF rats was apparently reduced (49.0% and 25.3% excreted in the bile of CVL and GF rats respectively). There was no significant difference in bile flow rate between CVL and GF rats. These results give unequivocal evidence of intact absorption of estrone sulfate from the small intestine of the rat. The rate of absorption is however very much reduced compared to the non-sulphated steroid. Estrone sulfate is not absorbed intact in the caecum but is hydrolysed by the gut microflora prior to absorption.
Radioactive pregnanediol-3 alpha-glucuronide at low concentration was found to bind to a number of common laboratory materials. Adsorption was greatest with polypropylene and unsilanised glass tubes. The presence of 0.1% gelatine reduced adsorption, except in polyethylene insert vials. Adsorption of pregnanediol-3 alpha-glucuronide may present a problem in radioimmunoassay studies.
Nine women taking long-term oral contraceptive steroids (Trinordiol) were studied during a cycle while taking cotrimoxazole (1 gm twice daily) and the results were compared to the previous control cycle. During the cotrimoxazole cycle, there was a significant increase in the plasma concentration of ethynylestradiol (EE). In plasma samples taken on 4 successive days 10-12 hours after dosing, the plasma EE concentration rose from 29.3 +/- 5.0 pg/ml to 38.2 +/- 5.8 pg/ml (mean +/- S.E. P less than or equal to 0.02). In samples taken 24 hours after dosing, the increase was from 18.9 +/- 2.5 pg/ml to 27.8 +/- 4.0 pg/ml (P less than or equal to 0.05). Plasma F.S.H. values in these latter samples, decreased from 4.8 +/- 0.6 mIu/ml to 3.4 +/- 0.5 mIu/ml (P less than or equal to 0.01). No significant changes were noted in the plasma concentrations of levonorgestrel or progesterone. The rise in plasma concentration of EE during cotrimoxazole therapy is attributed to an inhibition of the metabolism of EE by cotrimoxazole as has been shown with other drugs. Short courses of cotrimoxazole are unlikely to cause any adverse effects on contraceptive control when given to women taking long-term oral contraceptive steroids.
The aim of this study was to use measurements of urinary steroid glucuronides to confirm the suppression of ovulation of ovulation in women taking oral contraceptives. Urinary concentrations of oestrone-3-glucuronide (E1G) and pregnanediol-3 alpha-glucuronide (Pd-3-G) were measured by radioimmunoassay in early morning urine samples from six normally-menstruating women and six women who were taking combined oral contraceptives. In the normally-menstruating women, E1G concentrations, and the E1G/Pd-3-G ratio, increased 2-3 fold before ovulation. There was no midcycle increase in either measure in women taking oral contraceptives. We suggest that measurement of these steroid metabolites provides a means of assessing the anti-ovulatory effects of oral contraceptives.
The effects of two antimalarial drugs, chloroquine and primaquine on antipyrine kinetics and metabolism have been studied in volunteers. Chloroquine (250 mg) given 2 h before antipyrine (600 mg orally) had no effect on salivary kinetics of antipyrine or on the urinary recovery of metabolites. Primaquine (45 mg) given 2 h before antipyrine (300 mg orally), increased antipyrine half-life (calculated from 0-24 h) from 12.7 +/- 3.2 (mean +/- s.d.) to 25.3 +/- 3.9 h and decreased clearance from 3.01 +/- 0.67 to 1.32 +/- 0.32 1 h-1. There was no change in the apparent volume of distribution. Antipyrine half life changed with time in the presence of primaquine and when calculated between 24 and 48 h had returned to control. After primaquine, the metabolic clearance (calculated from 0-24 h) of antipyrine to its three main metabolites, 3-hydroxymethylantipyrine, 4-hydroxyantipyrine and norantipyrine was significantly reduced. There was no selective effect on a particular metabolic pathway. There was no change in 6 beta-hydroxycortisol excretion (expressed as a ratio of total 17-hydroxy-corticosteroids) in the period 0-48 h following primaquine administration. The inhibition of hepatic metabolism by primaquine but not the structurally related chloroquine may be an example of a structure activity phenomenon and could be of clinical significance.
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