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Experimental Therapeutics

In Vitro and In Vivo Drug-Drug Interaction Study of the Effects of Ivermectin and Oxantel Pamoate on Tribendimidine

Anna Neodo, Jessica D. Schulz, Jörg Huwyler, Jennifer Keiser
Anna Neodo
Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, SwitzerlandUniversity of Basel, Basel, Switzerland
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Jessica D. Schulz
Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, SwitzerlandUniversity of Basel, Basel, Switzerland
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Jörg Huwyler
Department of Pharmaceutical Sciences, Division of Pharmaceutical Technology, University of Basel, Basel, Switzerland
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Jennifer Keiser
Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, SwitzerlandUniversity of Basel, Basel, Switzerland
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DOI: 10.1128/AAC.00762-18
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ABSTRACT

Soil-transmitted helminth (STH) infections still remain a major health problem in poor rural settings. The lack of efficacious drugs against all STH species raises interest in drug combinations. Drug-drug interactions (DDIs) are, however, of major concern, so careful in vitro and in vivo characterization is needed. The combination of tribendimidine with either ivermectin or oxantel pamoate targets a broad range of STHs and thus represents a promising treatment alternative. Drug-drug interactions, however, have not yet been investigated. Therefore, the effects of combinations of ivermectin, oxantel pamoate, and tribendimidine’s active metabolite deacylated amidantel (dADT) on cytochrome P450 (CYP450) metabolism were evaluated, followed by a pharmacokinetic analysis of tribendimidine and ivermectin alone and in combination in healthy rats. Oxantel pamoate is only poorly absorbed and was therefore excluded from pharmacokinetic analysis. No evident effect was observed for tribendimidine-oxantel pamoate at the CYP450 metabolism level, whereas a combination of tribendimidine and ivermectin led to moderately increased CYP2D6 inhibition compared to ivermectin or tribendimidine alone. Coadministration of tribendimidine with ivermectin altered neither the time to maximum concentration of drug in plasma (Tmax) nor the elimination half-lives of dADT, the acetylated derivative of amidantel (adADT), and ivermectin. While the area under the concentration-versus-time curve (AUC) and maximum concentration of drug in plasma (Cmax) values of dADT, adADT, and ivermectin are reduced by coadministration, the change is insufficient to declare that a DDI has been detected. Further studies are necessary to understand the observed interaction of tribendimidine and ivermectin, which is not related to P450 metabolism, and its significance for the situation in humans.

FOOTNOTES

    • Received 16 April 2018.
    • Returned for modification 5 July 2018.
    • Accepted 10 October 2018.
    • Accepted manuscript posted online 15 October 2018.
  • Supplemental material for this article may be found at https://doi.org/10.1128/AAC.00762-18.

  • Copyright © 2018 American Society for Microbiology.

All Rights Reserved.

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In Vitro and In Vivo Drug-Drug Interaction Study of the Effects of Ivermectin and Oxantel Pamoate on Tribendimidine
Anna Neodo, Jessica D. Schulz, Jörg Huwyler, Jennifer Keiser
Antimicrobial Agents and Chemotherapy Dec 2018, 63 (1) e00762-18; DOI: 10.1128/AAC.00762-18

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In Vitro and In Vivo Drug-Drug Interaction Study of the Effects of Ivermectin and Oxantel Pamoate on Tribendimidine
Anna Neodo, Jessica D. Schulz, Jörg Huwyler, Jennifer Keiser
Antimicrobial Agents and Chemotherapy Dec 2018, 63 (1) e00762-18; DOI: 10.1128/AAC.00762-18
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KEYWORDS

CYP450
drug interaction
tribendimidine

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