Blood cells are considered an important distributional compartment for metformin based on the high blood-to-plasma partition ratio (B/P) in humans (.10 at C min ). However, literature reports of metformin's intrinsic in vitro B/P values are lacking. At present, the extent and rate of metformin cellular partitioning was determined in incubations of fresh human and rat blood with [14 C]metformin for up to 1 week at concentrations spanning steady-state plasma C min , C max , and a concentration associated with lactic acidosis. The results showed that metformin's intrinsic equilibrium B/P was ∼0.8-1.4 in blood, which is ,10% of the reported clinical value. Kinetics of metformin partitioning into human blood cells and repartitioning back into plasma were slow (repartitioning half-life ∼32-39 hours). These data, along with in vivo rapid and efficient renal clearance of plasma metformin (plasma renal extraction ratio ∼90%-100%), explain why the clinical terminal half-life of metformin in plasma (6 hours) is 3-to 4-fold shorter than the half-life in whole blood (18 hours) and erythrocytes (23 hours). The rate constant for metformin repartitioning from blood cells to plasma (∼0.02 h
21) is far slower than the clinical renal elimination rate constant (0.3 h 21 ). Blood distributional rate constants were incorporated into a metformin physiologically-based pharmacokinetic model, which predicted the differential elimination half-life in plasma and blood. The present study demonstrates that the extent of cellular drug partitioning in blood observed in a dynamic in vivo system may be very different from the static in vitro values when repartitioning from blood cells is far slower than clearance of drug in plasma.
IntroductionThe intrinsic rate and extent of blood cell partitioning of drugs can be reliably determined in a static in vitro system due to the absence of confounding processes present in vivo, including absorption, competing distribution to other tissues, and clearance (Hinderling, 1997). Although metformin is a first-line treatment of type 2 diabetes mellitus that has been commonly used for decades (Gong et al., 2012), its in vitro partitioning properties into the cellular component of blood have not been documented in the literature. Instead, erythrocytes are presumed to be an important distributional compartment for metformin based on the markedly longer blood versus plasma half-life in humans (Glucophage, 2009). Early clinical studies described metformin's in vivo blood-toplasma partition ratio (B/P) value as high (B/P . 10 at C min ), and partitioning as slow based on the apparent timedependent B/P, which increased over the duration of the dosing interval (Sirtori et al., 1978; Pentikainen et al., 1979;Tucker et al., 1981). Following oral administration of a single 1.5-g dose in humans, metformin B/P gradually increased from ,1 between 0 and 4 hours to .10 at 24 hours, with the B/P value becoming greater than unity at 4 hours (Tucker et al., 1981). More recent clinical studies demonstrated metformin elim...