P-glycoprotein-based loperamide-cyclosporine drug interaction at the rat blood-brain barrier: prediction from in vitro studies and extrapolation to humans.

We have shown that the rat can quantitatively predict the verapamil-cyclopsorine A (CsA) drug-drug interaction (DDI) at the human blood-brain barrier (BBB). In addition, the potency (EC(50)) of CsA to inhibit rat BBB P-gp can be predicted from in vitro studies in MDRI-transfected cells. To assess if these excellent agreements extend to other substrates, we determined the magnitude of P-gp-based DDI at the rat BBB between loperamide (Lop) or its metabolite, N-desmethyl Lop (dLop), and escalating CsA blood concentrations. The percent increase in the brain:blood Lop concentration ratio was described by the Hill equation, E(max) = 2000%, EC(50) = 7.1 μM and γ = 3.7. The potency (EC(50)) of CsA to inhibit P-gp at the rat BBB was independent of the substrate used (verapamil, Lop, or dLop). Like the verapamil-CsA DDI, the potency (EC(50)) of CsA to inhibit rat BBB P-gp could be predicted from studies in MDRI-transfected cells. When (11)C-Lop was coadministered with a 10 mg/kg iv infusion of CsA (1) yielding ~5.6 uM CsA blood concentration to healthy volunteers, the brain distribution of (11)C-radioactivity was increased by 110%. (1) When corrected for diffusible Lop metabolite(s), this translates into an increase in (11)C-Lop brain distribution of 457%. Based on our rat data, we estimated a similar value at 5.6 μM blood CsA concentration, 588% increase in Lop brain distribution. These data support our conclusion that the rat is a promising model to predict P-gp based DDI at the human BBB.