Verapamil effect on phenytoin pharmacokinetics in rats.

Efflux transporter and enzyme overexpression can be induced by certain antiepileptic drugs. Phenytoin (PHT) is at the same time substrate and inducer of CYP2C isoenzymes and efflux carriers. Its inductive effect has been postulated to be concentration and time-dependent. Since verapamil (VPM) is a well known substrate and inhibitor of P-glycoprotein, its administration could modify PHT systemic exposure. The objective of this work was to determine if single doses (40mg/kg) of VPM might change PHT body fate in the same way when given at the beginning or several days after 100mg/kg of PHT daily doses were started. Both drugs were administered intraperitoneally to female Sprague Dawley rats. VPM increased plasma PHT concentrations after one day of treatment, while a decrease in PHT plasma exposure was observed when VPM was added at the fifth day of the antiepileptic treatment. These results suggested that VPM would have different impact on PHT pharmacokinetics, depending on the level of expression of both efflux transporters and enzymes. Before the hepatic cells could acquire a high content of enzymes due to the inductive effect of PHT dosing, VPM decreased the predominant intestinal clearance of PHT. But, once the enzymatic machinery at the hepatocyte became more important than that at the intestine, although ineffective because of the high hepatobiliary efflux transporter overexpression, VPM blockade from the liver resulted in an increased total PHT clearance.