Abstract. The role of glucosylceramide synthase (GCS) in regulating ceramide-induced apoptosis has been widely studied. The purpose of this investigation was to evaluate the role of P-glycoprotein (P-gp) in regulating ceramide cytotoxicity by using C 6 -ceramide. To accomplish this, we employed HeLa cells with conditional expression of the multidrug resistance gene 1/P-gp. HeLa cells expressing P-gp (P-gp/on cells) challenged with [14 C]C 6 -ceramide (6 μM), synthesized 4.5-fold the amount of C 6 -glucosylceramide (GC) compared to HeLa cells with suppressed expression of P-gp (P-gp/off cells), whereas the generated levels of C 6 -sphingomyelin were almost equal (33 and 29% of intracellular 14 C, respectively). Tamoxifen, a P-gp antagonist, decreased the C 6 -GC levels from 3.5-1.0% in the P-gp/off and from 17-2.8% of the total lipid 14 C levels in the P-gp/on cells. Tamoxifen did not inhibit cell-free C 6 -GC synthesis in the P-gp/off or P-gp/on homogenates. However, a specific GCS inhibitor, ethylenedioxy-1-phenyl-2-hexadecanoylamino-3-pyrrolidino-1-propanol (ethylenedioxy-P4), blocked synthesis by 90%. In the cytotoxicity assays, the P-gp/off cells were sensitive to C 6 -ceramide and the P-gp/on cells were resistant. Resistance to C 6 -ceramide in the P-gp/on cells was reversed by tamoxifen but not by ethylenedioxy-P4. Experiments in another cervical cancer model showed that multidrug-resistant P-gp-rich KB-V1 cells synthesized 3-fold more C 6 -GC from C 6 -ceramide than the parental, P-gp-poor KB-3-1 cells, and whereas tamoxifen had no effect on the C 6 -GC synthesis in the KB-3-1 cells, it inhibited synthesis by 70% in the KB-V1 cells. This study demonstrates that P-gp potentiates C 6 -ceramide glycosylation and if antagonized augments C 6 -ceramide sensitivity, both features previously ascribed to GCS. We propose that P-gp can be an effective target for enhancing short-chain ceramide cytotoxicity in the treatment of drug-resistant cancer.