Clinical trial NCT00504413: Role of CYP2B6, CYP3A4, and MDR1 in the Metabolic Clearance of Methadone
Official title: Role of CYP2B6, CYP3A4, and MDR1 in the Metabolic Clearance of Methadone in Human Subjects
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE1
Conditions: Substance-Related Disorders
Keywords: Metabolic Networks and Pathways
Methadone
Polymorphism, genetic
Cytochrome P-450 Enzyme System
Lead sponsor: University of Washington
Sponsor class: OTHER
First posted: 2007-07-20
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Maximum age (years): 40
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: BASIC_SCIENCE

Brief summary: The purpose of this study is to determine to what extent CYP2B6, CYP3A4, and MDR1 polymorphisms affect the metabolism of methadone.

Detailed description: Methadone maintenance treatment (MMT) has been used to rehabilitate the opiate addict resulting in a higher quality of life for the patient as well as improving social and psychological functioning while reducing the overall cost to society. The maintenance dose of methadone is highly variable between patients, and drug-drug interactions have been observed between methadone and various medications used to treat a variety of diseases. Identification and understanding of the enzymes responsible for the metabolism of methadone could potentially lead to improved strategy in individualizing methadone dosing and reduce the risk of adverse drug interactions.

Several cytochrome P450 enzymes (CYPs) have been identified and hypothesized to be involved in methadone metabolism in vitro, particularly CYP2B6 and CYP3A4. However, the quantitative contribution of CYP2B6 and CYP3A4 in the elimination clearance of methadone in vivo remains undefined. In addition, methadone is a substrate of the efflux transporter, P-glycoprotein (Pgp) at the intestinal mucosa. We are proposing a pilot study in healthy human subjects to investigate the following hypotheses:

1. Pgp limits the gastrointestinal absorption
2. Inter-subject variations in CYP2B6 and CYP3A4 activities explain the variation in methadone clearance in vivo

This will be accomplished by correlating the pharmacokinetics of methadone and the phenotype probes for Pgp (digoxin), CYP2B6 (bupropion) and CYP3A4 (midazolam). We plan to use these data to design a human subject study to assess the utility of MDR1 and CYP genotyping in predicting the methadone maintenance dose in a cohort of MMT patients.

Eligibility criteria: Inclusion Criteria:

* Healthy
* Within 25% of ideal body weight

Exclusion Criteria:

* Pregnant
* A prisoner
* Enemy, non-combatant
* Smoker
* Have a history of liver disease
* Have a history of heart disease
* Have a history of drug abuse
* Currently on prescription medication

Primary outcomes:
measure: Explore if there is a correlation between the areas of the concentration curves of probe substrates for CYP3A4 and/or CYP2B6 and Pgp and the area of the concentration curve of methadone.
timeFrame: two years
Secondary outcomes:
measure: LC-MS assays will be developed to analyze the plasma content of the probe substrates, methadone and their metabolites. Specifically, midazolam, 1-OH midazolam, bupropion, t-butyl-hydroxy bupropion, digoxin, methadone, and EDDP (a methadone metabolite).
timeFrame: two years
measure: Isolate and bank the DNA of the subjects for future genotyping of variant alleles that will be identified in this study to be important in methadone pharmacokinetics.
timeFrame: two years
Other outcomes:
Locations:
city: Seattle
country: United States
facility: University of Washington General Clinical Research Center
state: Washington
Study officials:
affiliation: University of Washington, Medicinal Chemistry Department
name: Rheem A Totah, PhD
role: PRINCIPAL_INVESTIGATOR
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