I have a question that is not related to the WinNonlin software usage. But I still posted here and hope somebody can help me.
I am investigating the drug-drug interaction of a CYP3A4 inhibitor and compound A. Compound A is primarily metabolized by CYP3A4 inhibitor. One of the metabolites of A is M1. The metabolism of A is not very clear yet.
My results show that the inhibitor could increase the Cmax and AUCs of A. Surprisingly, the inhibitor could also increase the the Cmax and AUCs of M1 and slightly increase the ratio of M1 to A (Cmax and AUCs ratio). I am very confused by these results. What is the possible reasons that the inhibitor increase the exposure of both parent drug and its metabolites?
Unfortunately, we don’t know the metabolism of M1 right now. Besides the reason that you mentioned, is there any other things that can cause this phenomenon?
Furthermore, would you please provied some infomration on how to the measure the systemic clearance (CLsys) of metabolites? I found an abstract in which the authors compared the CLsys of metabolite under normal and CYP inhibited conditions.
Like Nathan I think the most likely explanation is that M1 is metabolized by CYP3A4.
If the inhibitor dose used leads to about complete inhibition of CYP3A4, it is likely that A is metabolized to M1 mainly by another isoform. Note that some phenotyping experiments tend to identify 3A4 as the main mechanism when other isoforms are also relevant.
Could you please provide the reference of the paper evaluating CLsys of metabolites.
I only found an abstract which mentioned the measurement CLsys of metabolites. This is why I asked here if anyone knows more about the measurement. Please see the abstract attached.