Transporter-mediated drug interactions clinical implications

Lin JH. Transporter-mediated drug interactions clinical implications and in vitro assessment. Expert Opin Drug Metab Toxicol 2007 3(1) 81—92. 

Transporter-Mediated Drug Interactions Molecular Mechanisms and Clinical Implications... 

IV. CLINICAL IMPLICATIONS OF TRANSPORTER-MEDIATED DRUG INTERACTIONS... 

Several attempts have been made to estimate the dose required in humans in relation to a drug s potency, and to put this into the context of solubility and permeability for an optimal oral drug [2, 3]. A relatively simple example of this is where a 1.0 mg kg-1 dose is required in humans, then 52 pg mL"1 solubility is needed if the permeability is intermediate (20-80%) [3]. This solubility corresponds approximately to 100 pM of a compound with a MW of 400 g mol-1. Most screening activities for permeability determinations in, e.g., Caco-2, are made at a concentration of 10 pM or lower due to solubility restrictions. The first implication of this is that the required potency for these compounds needs to correspond to a dose of <0.1 mg kg-1 in humans if the drug should be considered orally active. Another implication would be the influence of carrier-mediated transport (uptake or efflux), which is more evident at low concentrations. This could result in low permeability coefficients for compounds interacting with efflux transporters at the intestinal membrane and which could either be saturated or of no clinical relevance at higher concentrations or doses. 

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