This article is available online at http://dmd.aspetjournals.org
ABSTRACT:Metformin, a commonly used antidiabetic drug, exerts its glucoselowering effect due to metabolic activities at several sites of action (biophases), including liver, intestine, muscle cells, and adipocytes. The relative contribution of the individual biophases to the overall glucose-lowering effect is not known. Thus, the aims of this investigation were to study the influence of mode of drug administration on the kinetics of glucose-lowering action of metformin in diabetic rats and identify the contribution of different sites of action to the overall response. Streptozotocin diabetic rats received metformin in crossover fashion via intraduodenal, intravenous, and intraportal routes as bolus dose or infusion regimens designed to yield similar pharmacokinetic profiles. Metformin plasma concentrations and blood glucose levels were measured following each mode of administration. Despite the similarity in the concentration-time profiles obtained for different routes of metformin administration, intraduodenal administration produced larger response than intraportal metformin infusion, and lowest response was observed following intravenous administration. This finding indicates that a significant "first-pass" pharmacodynamic effect, which occurs in the presystemic sites of action (liver and the gastrointestinal wall), contributes to the overall glucose-lowering response of metformin. We applied a combined pharmacokinetic-pharmacodynamic modeling approach to study the nature of the first-pass pharmacodynamic effect. The observed data were successfully described by a novel integrated indirect response pharmacokinetic-pharmacodynamic model that revealed a correlation between the temporal metformin concentrations that transit the portal vein and through the gut wall rather than with drug concentrations that accumulated in the liver and the intestinal wall.Metformin, a biguanide glucose-lowering agent, is commonly used for management of type 2 diabetes. Despite the wide clinical use of metformin, the mechanism of its action is not fully understood. The glucose-lowering effect of metformin is apparently composed of a combination of several distinct activities in various organs and tissues (Hermann and Melander, 1992;Cusi and DeFronzo, 1998), including: 1) decreased hepatic glucose output due to decreased hepatic gluconeogenesis and increased glycogenesis and lipogenesis (Christiansen and Hellerstein, 1998); 2) reduced rate of intestinal glucose absorption (Wilcock and Bailey, 1991); and 3) increased glucose uptake by muscle cells and adipocytes (Bailey et al., 1996). The multifactorial mechanism of action of metformin and the complex nature of glucose homeostasis in vivo obscures the dose-response relationship of the metabolic effects in individual organs and tissues (Wiernsperger, 1996). As a result, the relative significance of the above-mentioned sites of metformin action (biophases) to produce metabolic effects remains unknown and is still a matter ...