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Loperamide and P-glycoprotein inhibition: assessment of the clinical relevance

2010; Oxford University Press; Volume: 62; Issue: 4 Linguagem: Inglês

10.1211/jpp.62.04.0001

2042-7158

Joris Vandenbossche, Maarten T. Huisman, Yimei Xu, Dawn Sanderson-Bongiovanni, P.A. Soons,

Pharmacogenetics and Drug Metabolism

Abstract Objectives Loperamide is a peripherally acting μ opioid receptor agonist and an avid substrate for P-glycoprotein. This may give rise to drug–drug interactions and increased risk for central adverse effects. The objective of this study was to re-evaluate the predictability of non-clinical data using loperamide as a probe P-glycoprotein substrate. We searched the literature for papers containing data on drug–drug interactions of loperamide-containing products in humans. We also reviewed the internal worldwide safety database of Johnson & Johnson for spontaneous case reports suggestive of a central opioid effect after coadministration of loperamide with a P-glycoprotein inhibitor or substrate. Key findings Only one of the ten studies in our review supported the finding that inhibition of P-glycoprotein is associated with clinically relevant signs or symptoms of central nervous system (CNS) depression/opioid toxicity of loperamide. None of the 25 spontaneous case reports of interest were suggestive of signs or symptoms of CNS depression/opioid toxicity due to coadministration of loperamide and a P-glycoprotein inhibitor or substrate. Summary Based on a review of the literature and a cumulative review of the sponta-neous case reports, there is insufficient evidence that an interaction between loperamide and a P-glycoprotein inhibitor or substrate is associated with clinical symptoms of CNS depression/opioid toxicity when loperamide is taken at the recommended dose.