The effect of enzyme induction on diazepam metabolism in man.

Abstract

1 The elimination and metabolism of diazepam in man was investigated following the induction of the liver microsomal enzyme system by antipyrine. 2 Seven healthy volunteers were given 1200 mg antipyrine as an inducing agent for a period of 14 days. Before and after the induction period the elimination of diazepam and desmethyldiazepam was measured in the plasma by gaschromatography. As parameters of liver microsomal enzyme activity, antipyrine elimination and gamma‐glutamyl‐ transpeptidase in the plasma, D‐glucaric acid and 6‐beta‐ hydroxycortisol urinary excretion were measured on both occasions. 3 Following the induction period most parameters of microsomal enzyme activity measured were significantly changed indicating an increase of the microsomal enzyme system. The elimination of diazepam was significantly altered having a half‐life of 37 h before and 18 h afterwards combined with a significant increase in total body clearance after the induction period, although the volume of distribution remained unaltered. The formation of the main metabolite N‐ desmethyldiazepam was not changed, but its elimination was increased having a half‐life of 139 or 58 h respectively. 4 The elimination of unchanged diazepam and desmethyldiazepam is significantly increased by the induction of the liver microsomal enzyme system using antipyrine as an inducing agent in healthy volunteers, which might be important under certain clinical conditions.

Delayed post-hypoxic leukoencephalopathy: case report with a review of disease pathophysiology

“…Pharmacokinetic studies have shown that the diazepam metabolite, n-desmethyldiazepam, has a elimination half life of about 139 hours, versus 58 hours for the antipyrene related hepatic microsomal enzyme induction rate; 15 animal studies show that it accumulates to a high degree within central white matter regions, 16 and does not efflux very readily relative to diazepam. It is therefore hypothesized that prolonged retention of diazepam metabolites may play an additional role in the pathogenesis of diazepam related DPHLE, with accumulation of this metabolite likely occurring within central white matter.…”

Pharmacokinetic Interactions with Antiepileptic Drugs

“…The metabolic clearance of diazepam is enhanced by concurrent treatment with antipyrine (Ohnhaus et al, 1979) and rifampicin (Ochs et al, 1981). Dichloralphenazone (Riddell et aI., 1980) and clozapine (Ryan and Matthews, 1970) have been reported to stimulate the metabolism of phenytoin.…”