Introduction
Pharmacokinetic outcomes of transporter-mediated drug-drug interactions (TMDDIs) are increasingly being evaluated clinically. The goal of our study was to determine the effects of selective inhibition of multi-drug and toxin extrusion protein 1 (MATE1) using famotidine, on the pharmacokinetics and pharmacodynamics of metformin in healthy volunteers.
Methods
Volunteers received metformin alone or with famotidine in a crossover design. As a positive control, the longitudinal effects of famotidine on the plasma levels of creatinine (an endogenous substrate of MATE1) were quantified in parallel. Famotidine unbound concentrations in plasma reached 1 μM, thus exceeding the in vitro concentrations that inhibit MATE1 (IC50 0.25 μM). Based on current regulatory guidance, these concentrations are expected to inhibit MATE1 clinically (i.e., Cmax,u/IC50 >0.1).
Results
Consistent with MATE1 inhibition, famotidine administration significantly altered creatinine plasma and urine levels in opposing directions (P<0.005). Interestingly, famotidine increased the estimated bioavailability of metformin (Ae∞/Dose, P < 0.005) without affecting its systemic exposure (AUC or Cmax) as a result of a counteracting increase in metformin renal clearance. Moreover, metformin-famotidine co-therapy caused a transient effect on oral glucose tolerance tests (AUCglu,0.5, P < 0.005).
Conclusions
These results suggest that famotidine may improve the bioavailability and enhance the renal clearance of metformin.