P. Dalen et al., Inhibition of debrisoquine hydroxylation with quinidine in subjects with three or more functional CYP2D6 genes, BR J CL PH, 49(2), 2000, pp. 180-184
Aims To study whether the CYP2D6 capacity in ultrarapid metabolizers of deb
risoquine due to duplication/multiduplication of a functional CYP2D6 gene,
can be 'normalised' by low doses of the CYP2D6 inhibitor quinidine and whet
her this is dose-dependent.
Methods Five ultrarapid metabolizers of debrisoquine with 3, 4 or 13 functi
onal CYP2D6 genes were given single oral doses of 5, 10, 20, 40, 80 and 160
mg quinidine. Four hours after quinidine intake, 10 mg debrisoquine was gi
ven. Urine was collected for 6 h after debrisoquine administration. Debriso
quine and its 4-hydroxymetabolite were analysed by h.p.l.c. and the debriso
quine metabolic ratio (MR) was calculated.
Results Without quinidine the MR in the ultrarapid metabolizers ranged betw
een 0.01 and 0.07. A dose-effect relationship could be established for quin
idine with regard to the inhibitory effect on CYP2D6 activity. To reach an
MR of 1-2, subjects with 3 or 4 functional genes required a quinidine dose
of about 40 mg, while the sister and brother with 13 functional genes requi
red about 80 mg quinidine. After 160 mg quinidine, the MRs, in the subjects
with 3, 3, 4, 13 and 13 functional genes, were 12.6, 10.1, 9.2, 2.4 and 2.
2, respectively.
Conclusions A dose-effect relationship could be established for quinidine i
nhibition of CYP2D6 in ultrarapid metabolizers. The clinical use of low dos
es of quinidine as an inhibitor of CYP2D6 might be considered in ultrarapid
metabolizers taking CYP2D6 metabolized drugs rather than giving increased
doses of the drug. Normalizing the metabolic capacity of CYP2D6, by giving
a low dose of quinidine, may solve the problem of 'treatment resistance' ca
used by ultrarapid metabolism.