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Clinical relevance of hepatic and renal P-gp/BCRP inhibition of drugs: An International Transporter Consortium perspective

Taskar, Kunal, Yang, Xinning, Neuhoff, Sibylle, Patel, Mitesh, Yoshida, Kenta, Paine, Mary, Brouwer, Kim, Chu, Xiaoyan, Sugiyama, Yuichi, Cook, Jack, Polli, Joseph, Hanna, Imad, Lai, Yurong and Zamek-Gliszczynski, Maciej (2022) Clinical relevance of hepatic and renal P-gp/BCRP inhibition of drugs: An International Transporter Consortium perspective. Clinical pharmacology and therapeutics. ISSN 1532-6535


The role of P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) in drug-drug interactions (DDIs) and limiting drug absorption as well as restricting the brain penetration of drugs with certain physicochemical properties is well known. P-gp/BCRP inhibition by drugs in the gut has been reported to increase the systemic exposure to substrate drugs. A previous International Transporter Consortium (ITC) perspective discussed the feasibility of P-gp/BCRP inhibition at the blood-brain barrier and its implications. This ITC perspective elaborates and discusses specifically the hepatic and renal P-gp/BCRP (referred as systemic) inhibition of drugs and whether there is any consequence for substrate drug disposition. This perspective summarizes the clinical evidence-based recommendations regarding systemic P-gp and BCRP inhibition of drugs with a focus on biliary and active renal excretion pathways. Approaches to assess the clinical relevance of systemic P-gp and BCRP inhibition in liver and kidney included (1) curation of DDIs involving intravenously administered substrates or inhibitors; (2) in vitro-to-in vivo extrapolation of P-gp- mediated DDIs at the systemic level; and (3) curation of drugs with information available about the contribution of biliary excretion and related DDIs. Based on the totality of evidence reported to date, this perspective supports limited clinical DDI risk upon P-gp or BCRP inhibition in liver or kidney.

Item Type: Article
Keywords: P-gp, BCRP, biliary, renal, systemic, drug interaction, in vitro-to-in vivo extrapolation
Date Deposited: 21 Jun 2022 00:45
Last Modified: 21 Jun 2022 00:45


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