N. Brynne et al., INFLUENCE OF CYP2D6 POLYMORPHISM ON THE PHARMACOKINETICS AND PHARMACODYNAMICS OF TOLTERODINE, Clinical pharmacology and therapeutics, 63(5), 1998, pp. 529-539
Objective: To determine whether cytochrome P450 2D6 (CYP2D6) is involv
ed in the metabolism of tolterodine by investigating potential differe
nces in pharmacokinetics and pharmacodynamics (heart rate, accommodati
on, and salivation) of tolterodine and its Ei-hydroxymethyl metabolite
between poor metabolizers and extensive metabolizers of debrisoquin (
INN, debrisoquine). Methods: Sixteen male subjects (eight extensive me
tabolizers and eight poor metabolizers) received 4 mg tolterodine by m
outh twice a day for 8 days followed by a single intravenous infusion
of 1.8 mg tolterodine for 30 minutes after a washout period, Doses wer
e given as the tartrate salt, The pharmacokinetics of tolterodine and
Ei-hydroxymethyl metabolite were determined, and the pharmacodynamics
were measured, Results: The mean systemic clearance of tolterodine was
significantly lower (p < 0.001) among poor metabolizers (9.0 +/- 2.1
L/hr) compared with extensive metabolizers (44 +/- 13 L/hr), resulting
in a fourfold longer elimination half-life (p < 0.001), The terminal
half-life of the 5-hydroxymethyl metabolite (2.9 +/- 0.4 hours) was sl
ightly longer than that of the parent compound (2.3 +/- 0.6 hours) amo
ng extensive metabolizers. but the 5-hydroxymethyl metabolite was unde
tectable in the serum of poor metabolizers. Only minor differences in
pharmacodynamic effects after tolterodine dosage were observed between
the groups. Tolterodine caused a similar decrease in salivation in bo
th panels. The decrease occurred when the concentration of unbound tol
terodine and 5-hydroxymethyl metabolite among extensive metabolizers w
as comparable with that of tolterodine among poor metabolizers, Conclu
sions: Tolterodine is extensively metabolized by CYP2D6 with high spec
ificity. Despite the effect on pharmacokinetics, the CYP2D6 polymorphi
sm does not appear to be of great importance in the antimuscarinic eff
ect, probably because of the additive action of parent drug and active
metabolite.