Interaction between grapefruit juice and hypnotic drugs: comparison of triazolam and quazepam |
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Authors: | Koh-ichi Sugimoto Nobutaka Araki Masami Ohmori Ken-ichi Harada Yimin Cui Shuichi Tsuruoka Atsuhiro Kawaguchi Akio Fujimura |
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Institution: | (1) Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical School, 3311-1 Minamikawachi, Tochigi 329-0498, Japan |
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Abstract: | Objective: Grapefruit juice (GFJ) inhibits cytochrome P450 (CYP) 3A4 in the gut wall and increases blood concentrations of CYP3A4 substrates
by the enhancement of oral bioavailability. The effects of GFJ on two benzodiazepine hypnotics, triazolam (metabolized by
CYP3A4) and quazepam (metabolized by CYP3A4 and CYP2C9), were determined in this study.
Methods: The study consisted of four separate trials in which nine healthy subjects were administered 0.25 mg triazolam or 15 mg quazepam,
with or without GFJ. Each trial was performed using an open, randomized, cross-over design with an interval of more than 2
weeks between trials. Blood samples were obtained during the 24-h period immediately following the administration of each
dose. Pharmacodynamic effects were determined by the digit symbol substitution test (DSST) and utilizing a visual analog scale.
Results GFJ increased the plasma concentrations of both triazolam and quazepam and of the active metabolite of quazepam, 2-oxoquazepam.
The area under the curve (AUC)(0–24) of triazolam significantly increased by 96% (p<0.05). The AUC(0–24) of quazepam (+38%) and 2-oxoquazepam (+28%) also increased; however, these increases were not significantly
different from those of triazolam. GFJ deteriorated the performance of the subjects in the DSST after the triazolam dose (−11
digits at 2 h after the dose, p<0.05), but not after the quazepam dose. Triazolam and quazepam produced similar sedative-like effects, none of which were
enhanced by GFJ.
Conclusion These results suggest that the effects of GFJ on the pharmacodynamics of triazolam are greater than those on quazepam. These
GFJ-related different effects are partly explained by the fact that triazolam is presystemically metabolized by CYP3A4, while
quazepam is presystemically metabolized by CYP3A4 and CYP2C9. |
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Keywords: | Grapefruit juice CYP3A4 CYP2C9 Triazolam Quazepam |
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