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Melperone but not bisoprolol or metoprolol is a clinically relevant inhibitor of CYP2D6: evidence from a therapeutic drug monitoring survey

  • Psychiatry and Preclinical Psychiatric Studies - Original Article
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Abstract

Cytochrome P450 enzymes (CYP) can be inhibited or induced by drugs, resulting in clinically significant drug–drug interactions that can cause unanticipated adverse reactions or therapeutic failures. The objective of the study was to analyze the in vivo inhibitory potential of the beta-blockers bisoprolol and metoprolol as well as the low-potency antipsychotic melperone on CYP2D6. By utilizing a large therapeutic drug monitoring database of 2874 samples, data from patients who had been treated with venlafaxine (VEN) either without (control group) or with a concomitant medication with bisoprolol, metoprolol or melperone were evaluated retrospectively to study the CYP2D6-catalyzed O-demethylation to O-desmethylvenlafaxine (ODVEN). Dose-adjusted serum levels (C/D) of VEN and ODVEN as well as the metabolic ratios (ODVEN/VEN) were computed for the four groups and compared using Kruskal–Wallis test. In total, 381 patients could be included for analysis. No significant difference was found in the median C/D (VEN), C/D (ODVEN) or C/D of the active moiety (VEN + ODVEN) in either the metoprolol (N = 103) or bisoprolol group (N = 101), compared to the control group (N = 108). In contrast, a significantly higher median C/D (VEN) (0.79 ng/ml/mg, range 0.13–5.73 ng/ml/mg) (P < 0.01) was found in the melperone group (N = 69), compared to the control group (0.46 ng/ml/mg, range 0.02–7.39 ng/ml/mg). A significant decrease (P < 0.01) was solely found in the median metabolic ratios of ODVEN/VEN between the melperone group (0.90, range 0.14–15.15), compared to the control group (2.39, range 0.06–15.31). The results of this study provided evidence that melperone but not bisoprolol or metoprolol has a clinically relevant inhibitory potential on CYP2D6.

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Acknowledgments

Christoph Hiemke has received speaker’s or consultancy fees from the following pharmaceutical companies: Astra Zeneca, Janssen-Cilag, Pfizer, Lilly and Servier. He is managing director of the psiac GmbH which provides an internet based drug–drug interaction program for psychopharmacotherapy. He reports no conflict of interest with this publication. Gudrun Hefner has received speaker’s fee from Servier. She reports no conflict of interest with this publication. All other authors declare no conflicts of interest as well. The research study did not receive funds or support from any source.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany

    Gudrun Hefner & Christoph Hiemke

  2. Institute of Clinical Chemistry and Laboratory Medicine, University Medical Centre Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    Gudrun Hefner & Tanja Falter

  3. Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany

    Stefan Unterecker

  4. Department of Pharmaceutics, Faculty of Pharmacy, University of Mansoura, Mansoura, Egypt

    Mohamed E. E. Shams

  5. Department of Pharmacy Practice, Ministry of Health, College of Health Sciences, Muscat, Oman

    Mohamed E. E. Shams

  6. Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany

    Margarete Wolf & Ekkehard Haen

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  1. Gudrun Hefner
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  2. Stefan Unterecker
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  7. Christoph Hiemke
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Correspondence to Gudrun Hefner.

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Hefner, G., Unterecker, S., Shams, M.E.E. et al. Melperone but not bisoprolol or metoprolol is a clinically relevant inhibitor of CYP2D6: evidence from a therapeutic drug monitoring survey. J Neural Transm 122, 1609–1617 (2015). https://doi.org/10.1007/s00702-015-1403-7

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