K. Dilger et al., Enzyme induction in the elderly: Effect of rifampin on the pharmacokinetics and pharmacodynamics of propafenone, CLIN PHARM, 67(5), 2000, pp. 512-520
Objective: A clinical study on enzyme induction in elderly subjects mas per
formed by investigation of the effect of rifampin (INN, rifampicin) on prop
afenone disposition. Propafenone was chosen as a model drug because of its
complex metabolism that permits the simultaneous in vivo assessment of indu
ction of phase 1 and phase 2 pathways.
Methods: Six extensive metabolizers of CYP2D6 (age, 70.5 +/- 3.5 years) ing
ested 600 mg rifampin once daily for 9 consecutive days. One day before the
first rifampin dose and on the day of the last rifampin dose, each elderly
individual received a single intravenous infusion of 70 mg unlabeled propa
fenone and received a single oral dose of 300 mg deuterated propafenone 2 h
ours later, Pharmacokinetics and pharmacodynamics of propafenone were compa
red before and during induction.
Results: Maximum QRS prolongation after oral propafenone was decreased sign
ificantly by rifampin (18% +/- 5% versus 6% +/- 3%; P <.01). There were no
substantial differences in pharmacokinetics and pharmacodynamics of intrave
nous propafenone during induction, However, bioavailability of propafenone
dropped from 30% +/- 24% to 4% +/- 3% (P <.05). After oral propafenone was
administered, clearances through N-dealkylation (6 +/- 3 mL/min versus 26 /- 16 mL/min; P <.05) and glucuronidation (178 +/- 75 mL/min versus 739 +/-
533 mL/min; P <.05), but not 5-hydroxylation, were increased by rifampin,
indicating substantial enzyme induction,
Conclusions: Both phase 1 and phase 2 pathways of propafenone metabolism we
re induced by rifampin in elderly subjects, resulting in a clinically relev
ant drug interaction.