Bedaquiline (TMC-207) is a recently
approved drug for the treatment
of multidrug-resistant tuberculosis (MDR-TB). Moreover, there is a
present and growing concern for natural-product-mediated drug interaction,
as these are inadvertently taken by patients as a dietary supplement,
food additive, and medicine. In the present study, we investigated
the impact of 20 plant-based natural products, typically phenolics,
on in vivo oral bedaquiline pharmacokinetics, as previous studies
are lacking. Three natural phenolics were identified that can significantly
enhance the oral exposure of bedaquiline upon coadministration. We
further investigated the possible role of all of the phytochemicals
on in vitro P-glycoprotein (P-gp)
induction and inhibition and CYP3A4 inhibition in a single platform
as bedaquiline is the substrate for both P-gp and
CYP3A4. In conclusion, curcumin, CC-I (3′,5–dihydroxyflavone-7-O-β-d-galacturonide-4′-O-β-d-glucopyranoside), and 6-gingerol should not be
coadministered with bedaquiline to avoid untoward drug interactions
and, subsequently, its dose-dependent adverse effects.