Pharmacokinetic interaction between albendazole sulfoxide enantiomers and antiepileptic drugs in patients with neurocysticercosis

Ther Drug Monit. 2002 Jun;24(3):338-45. doi: 10.1097/00007691-200206000-00003.

Abstract

The aim of the present investigation was to determine the interaction between the antiepileptic drugs (AEDs) phenytoin, carbamazepine, and phenobarbital and the enantioselective metabolism of albendazole. Thirty-two adults with a diagnosis of the active form of intraparenchymatous neurocysticercosis and treated with albendazole at the dose of 7.5 mg/kg every 12 hours for 8 days were studied. The patients were divided into four groups based on the combined use of AEDs or not: control group (n = 9), phenytoin group (n = 9 patients treated with 3-4 mg/kg/d sodium phenytoin), carbamazepine group (n = 9 patients treated with 10-20 mg/kg/d carbamazepine), and phenobarbital group (n = 5 patients treated with 1.5-4.5 mg/kg/d phenobarbital). Serial blood collections were carried out on day 8 of albendazole treatment during the last 12-hour dose interval. Plasma concentrations of the (+)- and (-)-albendazole sulfoxide (ASOX) and albendazole sulfone (ASON) metabolites were determined by high-performance liquid chromatography using a chiral phase column and fluorescence detection. The pharmacokinetic parameters were analyzed by analysis of variance followed by the Tukey-Kramer test. The results are reported as means. The following differences (P < 0.05) were observed between the control and the phenytoin, carbamazepine, and phenobarbital groups, respectively: (+)-ASOX area under the concentration-time curve for 0 to 12 hours after treatment (AUC(0-12)) 6.1, 2.1, 3.1, 2.4 microg/h/mL; (+)-ASOX maximum plasma concentration (C(max)) 0.8, 0.3, 0.4, 0.3 microg/mL; (+)-ASOX half-life (t1/2) 8.0, 3.8, 4.1, 4.9 h; (-)-ASOX AUC(0-12) 1.8, 0.4, 0.6, 0.5 microg/h/mL; (-)-ASOX C(max) 0.2, 0.06, 0.1, 0.1 microg/mL; (-)-ASOX (t(1/2)) 4.3, 1.9, 2.2, 2.1 h; ASON AUC(0-12) 0.5, 0.2 microg/h/mL; ASON C(max) 0.8, 0.3, 0.4, 0.3 microg/mL; ASON (t(1/2)) 8.0, 3.8, 4.1 h. The results show that phenytoin, carbamazepine, and phenobarbital induce to approximately the same extent the oxidative metabolism of albendazole in a nonenantioselective manner. Notably, a significant reduction in the plasma concentration of the active ASOX metabolite was observed in patients with neurocysticercosis treated with these AEDs.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Albendazole / administration & dosage
  • Albendazole / analogs & derivatives*
  • Albendazole / blood
  • Albendazole / pharmacokinetics*
  • Albendazole / therapeutic use
  • Anthelmintics / administration & dosage
  • Anthelmintics / blood
  • Anthelmintics / pharmacokinetics*
  • Anthelmintics / therapeutic use
  • Anticonvulsants / pharmacology*
  • Anticonvulsants / therapeutic use
  • Area Under Curve
  • Carbamazepine / pharmacology
  • Chromatography, High Pressure Liquid
  • Drug Administration Schedule
  • Drug Interactions
  • Female
  • Humans
  • Isomerism
  • Male
  • Neurocysticercosis / drug therapy
  • Phenobarbital / pharmacology
  • Phenytoin / pharmacology

Substances

  • Anthelmintics
  • Anticonvulsants
  • Carbamazepine
  • Phenytoin
  • Albendazole
  • albendazole sulfoxide
  • Phenobarbital