{"title":"Transporters and drug secretion into human breast milk.","authors":"Jessica L Beers, Mary F Hebert, Joanne Wang","doi":"10.1080/17425255.2025.2461479","DOIUrl":"10.1080/17425255.2025.2461479","url":null,"abstract":"<p><strong>Introduction: </strong>Medication use is highly prevalent in breastfeeding persons, posing potential risks for drug exposure to nursing infants. Transporters in the lactating mammary gland carry pharmacological and toxicological significance, as they can mediate the active transfer of drugs and nutrients into breastmilk.</p><p><strong>Areas covered: </strong>In this narrative review, we searched and compiled current knowledge on the transport of drugs in the human mammary gland from literature indexed in PubMed (current as of 25 October 2024), and clinical evidence demonstrating active transport of drugs into milk is provided. In vitro and in vivo models of the mammary gland are outlined in brief and known drug transporters at the blood-milk barrier and their potential relevance to drug concentrations in milk are described in detail.</p><p><strong>Expert opinion: </strong>Although clinical data show that membrane transporters mediate the transfer of multiple drugs into breast milk, our ability to predict milk concentrations for these drugs is limited. Improving our understanding of the transporter biology and pharmacology in the mammary gland is crucial for developing models to predict drug concentrations in human milk, which will support clinicians and lactating individuals in making rational decisions to balance the benefits of breastfeeding and the risks of drug exposure to infants.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"409-428"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kimberly Adams, Xinnong Li, Lisa Rohan, Robert Bies
{"title":"PBPK models of the female reproductive tract: current and future analysis.","authors":"Kimberly Adams, Xinnong Li, Lisa Rohan, Robert Bies","doi":"10.1080/17425255.2025.2470794","DOIUrl":"10.1080/17425255.2025.2470794","url":null,"abstract":"<p><strong>Introduction: </strong>Drug delivery via the female reproductive tract (FRT) has garnered increasing attention due to its potential for local and systemic therapies. Physiologically Based Pharmacokinetic (PBPK) models offer a mechanistic approach to understanding drug absorption, distribution, metabolism, and excretion (ADME) within the FRT, which is critical for optimizing treatments for conditions such as vaginal infections, contraception, and hormonal therapies.</p><p><strong>Areas covered: </strong>This review provides a comprehensive analysis of the current state of PBPK modeling for the FRT, focusing on its physiological and anatomical complexities. The paper reviews existing FRT PBPK models and discusses the challenges of simulating drug permeation and ADME processes in reproductive tissues. Data gaps, including tissue-specific physiological parameters and drug permeability, are identified. Methodological advances and biological factors influencing drug disposition in the FRT are explored, including hormonal cycles, interindividual variability, and disease states like polycystic ovary syndrome.</p><p><strong>Expert opinion: </strong>PBPK models for the FRT hold significant promise for improving drug delivery and therapy personalization. However, current limitations in data availability and model validation must be addressed. Future research integrating real-world patient data, advanced imaging techniques, and pharmacodynamic modeling will enhance these models' accuracy and clinical utility, advancing drug development and regulatory processes.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"429-444"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmacogenetic guided drug therapy - how to deal with phenoconversion in polypharmacy.","authors":"Julia Carolin Stingl, Roberto Viviani","doi":"10.1080/17425255.2025.2451440","DOIUrl":"10.1080/17425255.2025.2451440","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of polypharmacy and the increasing availability of pharmacogenetic information in clinical practice have raised the prospect of data-driven clinical decision-making when addressing the issues of drug-drug interactions and genetic polymorphisms in metabolizing enzymes. Inhibition of metabolizing enzymes in drug interactions can lead to genotype-phenotype discrepancies (phenoconversion) that reduce the relevance of individual pharmacogenetic information.</p><p><strong>Areas covered: </strong>The aim of this review is to provide an overview of existing models of phenoconversion, and we discuss how phenoconversion models may be developed to estimate joint drug-interactions and genetic effects. Based on a literature search in PubMed, Google Scholar, and reference lists from review articles, we provide an overview of the current models of phenoconversion. The currently applied phenoconversion models are presented and discussed to predict the effects of drug-drug interactions while accounting for the pharmacogenetic status of patients.</p><p><strong>Expert opinion: </strong>While pharmacogenetic-dose recommendations alone are most relevant for rare and extreme genotypes, phenoconversion may increase the prevalence of these phenotypes. Therefore, in polypharmacy conditions, phenoconversion assessment is especially important for personalized drug therapy.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"399-407"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Considerations for drug-drug interactions between long-acting antiretrovirals and immunosuppressants for solid organ transplantation.","authors":"Corwin Coppinger, Peter L Anderson","doi":"10.1080/17425255.2024.2448970","DOIUrl":"10.1080/17425255.2024.2448970","url":null,"abstract":"","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"343-346"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Efficacy, safety and tolerability of drugs for alopecia: a comprehensive review.","authors":"Jair Alejandro Valdez-Zertuche, Hassiel Aurelio Ramírez-Marín, Antonella Tosti","doi":"10.1080/17425255.2025.2461483","DOIUrl":"10.1080/17425255.2025.2461483","url":null,"abstract":"<p><strong>Introduction: </strong>Alopecia, encompassing non-scarring and scarring types, presents therapeutic challenges requiring individualized approaches based on pathophysiology and treatment responses. A comprehensive literature search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science (2015-2024) focused on randomized controlled trials, meta-analyses, and observational studies.</p><p><strong>Areas covered: </strong>This review evaluates pharmacological strategies for androgenetic alopecia (AGA), alopecia areata (AA), and scarring alopecias, emphasizing efficacy and safety. Treatments for non-scarring alopecia include finasteride, minoxidil, JAK inhibitors, and antiandrogens like spironolactone. JAK inhibitors, such as baricitinib, show promise for AA but require monitoring due to immune suppression risks. Scarring alopecias, including lichen planopilaris and discoid lupus erythematosus, are managed with systemic agents like hydroxychloroquine and corticosteroids, alongside adjunctive topical and laser therapies.</p><p><strong>Expert opinion: </strong>The future of alopecia treatment is poised for transformation, particularly for AA and AGA. Emerging targeted therapies, such as JAK inhibitors for AA, represent significant advancements. Additionally, innovations in regenerative medicine and delivery systems for AGA treatments, alongside nanotechnology and 3D bioprinting, promise enhanced efficacy and personalization. This shift toward mechanism-targeted and individualized therapy is expected to improve outcomes for various alopecia subtypes.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"347-371"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The impact of genetic variability on Alzheimer's therapies: obstacles for pharmacogenetic progress.","authors":"Ramón Cacabelos, Olaia Martínez-Iglesias, Natalia Cacabelos, Jairo Carrera, Daniel Rodríguez, Vinogran Naidoo","doi":"10.1080/17425255.2024.2433626","DOIUrl":"https://doi.org/10.1080/17425255.2024.2433626","url":null,"abstract":"<p><strong>Introduction: </strong>Genetic load influences the therapeutic response to conventional drugs in Alzheimer's disease (AD). Pharmacogenetics (PGx) is the best option to reduce drug-drug interactions and adverse drug reactions in patients undergoing polypharmacy regimens. However, there are important limitations that make it difficult to incorporate pharmacogenetics into routine clinical practice.</p><p><strong>Areas covered: </strong>This article analyzes the pharmacogenetic apparatus made up of pathogenic, mechanistic, metabolic, transporter, and pleiotropic genes responsible for the efficacy and safety of pharmacological treatment, the impact of genetic load on the outcome of multifactorial treatments, and practical aspects for the effective use of PGx.</p><p><strong>Expert opinion: </strong>Over 120 genes are closely associated with AD. There is an accumulation of cerebrovascular (CVn) and neurodegenerative (ADn) genes in AD. <i>APOE-4</i> carriers accumulate more deleterious genetic load related to other CVn and ADn genes, develop the disease earlier, and are at a biological disadvantage compared to <i>APOE-4</i> non-carriers. <i>CYP2D6</i>-PMs and <i>APOE-4</i> carriers are the worst responders to anti-dementia drugs. Some limitations hinder the implementation of PGx in clinical practice, including lack of pharmacogenetic information for many drugs, low number of genes in PGx screening protocols, and educational deficiencies in the medical community regarding PGx and genomic medicine.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"1-28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catia Marzolini, Sara Gibbons, Daniel Seddon, Saye Khoo
{"title":"Drug-drug interactions potential with the HIV-1 capsid inhibitor lenacapavir.","authors":"Catia Marzolini, Sara Gibbons, Daniel Seddon, Saye Khoo","doi":"10.1080/17425255.2024.2415295","DOIUrl":"10.1080/17425255.2024.2415295","url":null,"abstract":"<p><strong>Introduction: </strong>Lenacapavir is the first HIV-1 capsid inhibitor administered subcutaneously twice yearly. While lenacapavir is currently only indicated as salvage therapy, it has the potential to become a foundation of future treatments and to revolutionize HIV prevention.</p><p><strong>Areas covered: </strong>This review summarizes the pharmacology of lenacapavir with particular emphasis placed on its drug-drug interaction (DDI) potential as it is used in treatment-experienced individuals who often present multiple comorbidities and polypharmacy. The effect of lenacapavir on drug metabolizing enzymes and transporters as well as findings of DDI studies are summarized. These data were used to predict DDIs with 1073 comedications. Finally, the management of selected DDIs is discussed. Conferences/workshops abstracts (i.e. CROI, IAS, EACS, HIV Glasgow, PK workshop) were screened using the terms: 'lenacapavir,' 'capsid inhibitor,' 'GS-6207,' and a PubMed search was used to compile data until September 2024.</p><p><strong>Expert opinion: </strong>Lenacapavir has a favorable DDI profile with 80% of evaluated comedications estimated to have no clinically significant DDIs. More studies are needed to address pharmacological gaps including the pharmacokinetics of lenacapavir in special populations, its transfer across the blood-brain barrier or the placenta as well as the possibility to manage DDIs with moderate/strong inducers by reducing lenacapavir dosing interval.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"161-172"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Su-Su Bao, Peng-Fei Tang, Quan Zhou, Chuan-Feng Shao, Zhong-Xiang Xiao, Chen Cheng, Jian-Ping Cai, Yun-Lei Li
{"title":"The relationship between CYP2C9 gene polymorphisms and azilsartan metabolism in vitro.","authors":"Su-Su Bao, Peng-Fei Tang, Quan Zhou, Chuan-Feng Shao, Zhong-Xiang Xiao, Chen Cheng, Jian-Ping Cai, Yun-Lei Li","doi":"10.1080/17425255.2024.2409255","DOIUrl":"10.1080/17425255.2024.2409255","url":null,"abstract":"<p><strong>Background: </strong>The gene polymorphisms of the CYP2C9, as well as the substrate specificity of the enzyme, result in different clearances for different substrates by CYP2C9 variants.</p><p><strong>Research designand methods: </strong>The CYP2C9 wild type and 38 CYP2C9 variants, expressed in insectmicrosomes, were incubated with azilsartan. The resulting metabolite,O-desethyl azilsartan, was determined by HPLC-MS/MS. The enzyme kineticparameters of the 38 variants were calculated and compared with the wild type.Subsequently, we selected CYP2C9*1, *2, and *3 as target proteins for molecular docking with azilsartan to elucidate the mechanisms underlying changes in enzyme function.</p><p><strong>Results: </strong>Compared with CYP2C9*1, three variants (CYP2C9*29, *39, and *49) exhibited markedlyincreased CL<sub>int</sub> values (from 170%-275%, *<i>p</i> < 0.05), whereas 28 variants exhibited significantly decreased CL<sub>int</sub> values (from 3-63%,*<i>p</i> < 0.05). The molecular docking results showed that the binding energy of CYP2C9*2 and *3 was lower than that of the wild type.</p><p><strong>Conclusion: </strong>Thisassessment revealed the effect of CYP2C9 gene polymorphisms on azilsartan metabolism, establishing a theoretical basis for further in-vivo studies and clinical applications. This study will help expand the database of CYP2C9 gene-drug pairs and identify appropriate treatment strategies for azilsartan, contributing to the field of precision medicine.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"95-103"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giovanni Occhipinti, Luis Ortega-Paz, Francesco Franchi, Fabiana Rollini, Davide Capodanno, Salvatore Brugaletta, Dominick J Angiolillo
{"title":"Switching from cangrelor to oral P2Y<sub>12</sub> inhibitors: a focused review on drug-drug interactions.","authors":"Giovanni Occhipinti, Luis Ortega-Paz, Francesco Franchi, Fabiana Rollini, Davide Capodanno, Salvatore Brugaletta, Dominick J Angiolillo","doi":"10.1080/17425255.2024.2418033","DOIUrl":"10.1080/17425255.2024.2418033","url":null,"abstract":"<p><strong>Introduction: </strong>Cangrelor, the only intravenous platelet P2Y<sub>12</sub> receptor inhibitor, is characterized by a prompt and potent platelet inhibition, with a rapid offset of action. Large-scale clinical trials have shown that cangrelor reduce peri-procedural thrombotic events among patients undergoing percutaneous coronary interventions and not pre-treated with an oral P2Y<sub>12</sub> receptor inhibitor. However, high P2Y<sub>12</sub> receptor occupancy provided by cangrelor raises concerns for drug-drug interactions (DDIs) when transitioning to oral P2Y<sub>12</sub> inhibitors.</p><p><strong>Areas covered: </strong>An understanding of the pharmacology of cangrelor and oral P2Y<sub>12</sub> inhibitors is essential to define the optimal approach to transition to oral P2Y<sub>12</sub> inhibitors without incurring the risk of DDIs. This review, based on a thorough literature search in major scientific databases (PubMed, Cochrane Library, Web of Science), synthesizes the pharmacology of cangrelor and the oral P2Y<sub>12</sub> receptor inhibitors, providing the rationale for the occurrence of DDIs and strategies to avoid such risk.</p><p><strong>Expert opinion: </strong>The timing of transition from cangrelor to oral P2Y<sub>12</sub> inhibitors plays a crucial role in the occurrence of DDIs, especially with clopidogrel and prasugrel. Currently, no evidence suggests a DDI when transitioning to ticagrelor. Adhering to product labels and guideline recommendations is crucial for optimizing safety and efficacy of cangrelor.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"29-40"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chrystalyn Branch, Jan Parson-Martinez, Theodore James Cory
{"title":"Drug-drug interactions in HIV-infected patients receiving chemotherapy.","authors":"Chrystalyn Branch, Jan Parson-Martinez, Theodore James Cory","doi":"10.1080/17425255.2024.2408004","DOIUrl":"10.1080/17425255.2024.2408004","url":null,"abstract":"<p><strong>Introduction: </strong>Coadministration of antiretrovirals and anti-cancer medications may present many complex clinical scenarios. This is characterized by the potential for drug-drug interactions (DDIs) and the challenges that arise in patient management. In this article, we investigate the potential for DDIs between antiretrovirals, including protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs), integrase strand transfer inhibitors (INSTIs), and anti-cancer medications.</p><p><strong>Areas covered: </strong>PubMed, Google Scholar, and Clinicaltrials.gov were searched for relevant articles in April 2024. Our review highlights PIs and NNRTIs as particularly prone to DDIs with anticancer agents, with implications for efficacy and toxicity of concomitant cancer therapy. We explain the mechanisms for interactions, emphasizing the significance of pharmacokinetic effects and enzyme induction or inhibition. We discuss clinical challenges encountered in the management of patients receiving combined ART and cancer therapy regimens.</p><p><strong>Expert opinion: </strong>Data are lacking for potential DDIs between antiretroviral and anti-cancer agents. While some interactions are documented, others are theoretical and based on the pharmacokinetic properties of the medications. Awareness of these interactions, inter-collaborative care between healthcare providers, and standardized treatment guidelines are all crucial for achieving optimal treatment outcomes and ensuring the well-being of patients with HIV/AIDS and cancer comorbidities.</p>","PeriodicalId":94005,"journal":{"name":"Expert opinion on drug metabolism & toxicology","volume":" ","pages":"15-27"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}