Document Detail


Loperamide and P-glycoprotein inhibition: assessment of the clinical relevance.
MedLine Citation:
PMID:  20604828     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Loperamide is a peripherally acting mu opioid receptor agonist and an avid substrate for P-glycoprotein. This may give rise to drug-drug interactions and increased risk for central adverse effects. The objective of this study was to re-evaluate the predictability of non-clinical data using loperamide as a probe P-glycoprotein substrate. We searched the literature for papers containing data on drug-drug interactions of loperamide-containing products in humans. We also reviewed the internal worldwide safety database of Johnson & Johnson for spontaneous case reports suggestive of a central opioid effect after coadministration of loperamide with a P-glycoprotein inhibitor or substrate.
KEY FINDINGS: Only one of the ten studies in our review supported the finding that inhibition of P-glycoprotein is associated with clinically relevant signs or symptoms of central nervous system (CNS) depression/opioid toxicity of loperamide. None of the 25 spontaneous case reports of interest were suggestive of signs or symptoms of CNS depression/opioid toxicity due to coadministration of loperamide and a P-glycoprotein inhibitor or substrate.
SUMMARY: Based on a review of the literature and a cumulative review of the spontaneous case reports, there is insufficient evidence that an interaction between loperamide and a P-glycoprotein inhibitor or substrate is associated with clinical symptoms of CNS depression/opioid toxicity when loperamide is taken at the recommended dose.
Authors:
Joris Vandenbossche; Maarten Huisman; Yimei Xu; Dawn Sanderson-Bongiovanni; Paul Soons
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Journal of pharmacy and pharmacology     Volume:  62     ISSN:  2042-7158     ISO Abbreviation:  J. Pharm. Pharmacol.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-07-07     Completed Date:  2011-01-14     Revised Date:  2011-09-13    
Medline Journal Info:
Nlm Unique ID:  0376363     Medline TA:  J Pharm Pharmacol     Country:  England    
Other Details:
Languages:  eng     Pagination:  401-12     Citation Subset:  IM    
Affiliation:
Clinical Pharmacology, Johnson & Johnson Pharmaceutical Research & Development, Beerse, Belgium. jvdbossc@its.jnj.com
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MeSH Terms
Descriptor/Qualifier:
Analgesics, Opioid / adverse effects*
Central Nervous System / drug effects*
Drug Interactions*
Humans
Loperamide / adverse effects*
P-Glycoprotein / antagonists & inhibitors*
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/P-Glycoprotein; 53179-11-6/Loperamide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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