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| Itraconazole — a synthetic, highly lipophilic triazole antifungal drug with substantial drug-repurposing interest in oncology. Standard abbreviations include ITZ and ITRA; Sporanox is a major brand name. Its approved pharmacologic function is inhibition of fungal lanosterol 14α-demethylase, disrupting ergosterol synthesis. Its anticancer activity is mechanistically distinct and appears to be multitargeted, involving direct inhibition of NPC1-dependent lysosomal cholesterol export, VDAC1-dependent metabolic signaling, mTOR suppression, inhibition of VEGFR2 maturation/angiogenesis, and inhibition of Hedgehog signaling through SMO. Itraconazole remains an approved antifungal rather than an approved anticancer drug. Primary mechanisms (ranked):
Bioavailability / PK relevance: Itraconazole has nonlinear, formulation-dependent pharmacokinetics and very low aqueous solubility. Conventional capsule absolute oral bioavailability is approximately 55%, is maximal immediately after a full meal, and decreases with reduced gastric acidity or acid-suppressive therapy. Capsule and oral-solution formulations are not pharmacokinetically interchangeable; systemic exposure is generally greater with oral solution at the same dose. After repeated capsule dosing, reported steady-state Cmax values are approximately 0.5, 1.1 and 2.0 µg/mL after 100 mg once daily, 200 mg once daily and 200 mg twice daily, respectively. Itraconazole is approximately 99.8% plasma-protein bound, extensively tissue distributed, metabolized predominantly through CYP3A4, and has an active hydroxy-itraconazole metabolite. Strong CYP3A4, P-glycoprotein and BCRP inhibition produces a major drug–drug interaction burden. In-vitro vs systemic exposure relevance: Several experimentally important anticancer effects occur around the low-micromolar range, which overlaps total plasma concentrations achievable with high-dose clinical regimens, but free circulating itraconazole is far lower because protein binding approaches 99.8%. Tissue accumulation can exceed plasma concentrations, while exposure varies markedly among patients and formulations. Consequently, mechanistic plausibility is relatively strong for NPC1, VDAC1/mTOR and endothelial targets, but translation of individual in-vitro concentration-response findings should not be assumed without pharmacokinetic confirmation. Clinical evidence status: Approved antifungal; oncology repurposing remains investigational. Human anticancer evidence includes phase II studies in basal cell carcinoma and prostate cancer, window-of-opportunity studies in NSCLC, and small combination studies in several malignancies. A recent randomized double-blind placebo-controlled study in 60 patients with advanced epithelial ovarian cancer reported improved response and progression-free outcomes when itraconazole was added to paclitaxel/carboplatin, but this remains a small single-institution study and does not establish an approved oncology indication. A recent perioperative phase II BCC study also showed a modest reduction in tumor diameter together with decreased CD105-associated angiogenesis. Important translational limitations include substantial interpatient PK variability, CYP3A4-mediated oncology drug interactions, a boxed warning concerning congestive heart failure/negative inotropy, and rare serious hepatotoxicity. Itraconazole Mechanistic Pathway Map
TSF legend: P: 0–30 min R: 30 min–3 hr G: >3 hr |
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| A bioenhancer is an agent capable of enhancing bioavailability and efficacy of a drug with which it is co-administered Query Database for BioEnhancers but the bioenhancers mainly show up under the target notes Bioenhancers - piperine and quercetin are considered bio-enhancers - genistein Piperine act by suppressing P-gp and cytochrome P450 enzymes, which counteract the metabolism of rifampicin via these proteins, thus enhancing the oral bioavailability of rifampicin. It also decreases the intestinal production of glucuronic acid, thus allowing more substances to enter the body in active form. It was found to increase the bioavailability of various drugs from 30% to 200%.[25] Table 1: Published research on bioenhancer effect of piperine with various medicines Drug Studied in Reference Antimicrobial agents Rifampicin In vitro Balakrishnan et al, 2001[11] Isoniazid Rabbits Karan et al, 1998 [12] Pefl oxacin Mountain Gaddi goats Madhukar et al, 2008[13] Tetracycline Rats Atal et al, 1980[14] Sulfadiazine Rats and dogs Atal et al, 1980[14] Oxytetracycline Poultry birds Singh et al, 2005[15] Ampicillin Rabbits Janakiraman and Manavalan, 2008[16] Norfl oxacin Rabbits Janakiraman and Manavalan, 2008 [16] Nevirapine Adult males Kasibhatta et al, 2007 [17] Metronidazole In vitro Singh et al, 2010[18] Analgesics Diclofenac sodium Albino mice Pooja et al, 2007[19] Pentazocine Albino mice Pooja et al, 2007[19] Nimesulide Mice Gupta et al, 1998[20] Antiepileptics Carbamazepine In vitro Pattanaik et al, 2009 [21] Phenytoin Human volunteers Bano et al, 1987[22] Pentobarbitone Rats Majumdar et al, 1990[23] Other drugs Propranolol In vitro Bano et al, 1991 [24] Theophylline In vitro Bano et al, 1991 [24] Nutrients In vitro Pooja et al, 2007 [19 ***Borneol -Borneol is thought to temporarily open tight junctions between endothelial cells, enhancing drug penetration. It may also downregulate efflux transporters such as P-glycoprotein (P-gp), allowing higher intracellular concentrations of co-administered drugs. -presence of urea (as a carrier) increased the aqueous solubility of capsaicin by 3.6-fold compared to pure capsaicin Quercetin is found in citrus fruits and is a dual inhibitor of cytochrome P 3A4 (CYP3A4) and P-gp. Table 2: Effect of quercetin pretreatment/co-treatment on pharmacokinetic parameters of different drugs Drugs combined Increase in pharmacokinetic parametera Cmax AUC ABA Verapamil Two fold Two fold SH Diltiazem SH SH Not known Paclitaxel SH SH T wo fold Digoxin 413% 170% Not known Tamoxifen SH SH 59% Compared to drug in question alone. Cmax, peak plasma concentration; AUC, area under the curve; ABA, absolute bioavailability; SH, significantly higher. Another flavonoid, genistein belongs to the isoflavone class of flavonoids. It is a well-known phytoestrogen. The presence of genistein (10 mg/kg) caused an increase in AUC (54.7%) and a decrease in the total plasma clearance (35.2%) after oral administration of paclitaxel at a dose of 30 mg/kg in rats.[37] Naringin is the major flavonoid glycoside found in grapefruit and makes grapefruit juice taste bitter. Oral naringin (3.3 and 10 mg/kg) was pretreated 30 min before and after intravenous administration of paclitaxel (3 mg/kg), the AUC was significantly improved (40.8% and 49.1% for naringin doses of 3.3 and 10 mg/kg, respectively).[38 Carum carvi/Cuminum cyminum ( Jeera) Carum carvi seeds are a prized culinary herb. Extracts of its parts increased significantly (25%–300%), the bioavailability of a number of classes of drugs, such as antibiotics, antifungals, antivirals, anticancer, cardiovascular, anti-inflammatory/ antiarthritic, anti-TB, antileprosy, antihistaminic/respiratory disorders, corticosteroids, immunosuppressants, and antiulcers. Such extracts either in the presence or absence of piperine have been found to be highly selective in their bioavailability/bioefficacy-enhancing action.[40] Capmul One of the widely used bioenhancers is Capmul MCM C10, a glyceryl monocaprate, produced from edible fats and oils and is commonly used in lip products. In a study in rats, antibiotic ceftriaxone when given concomitantly with capmul, increased the bioavailability of ceftriaxone by 80%.[41] Nitrile glycoside Nitrite glycoside is a bioenhancer for drugs and nutrients. Novel bioactive nitrile glycosides, niaziridin and niazirin is obtained from the leaves, pods, and bark of Moringa oleifera. [42] An immunoenhancing polysaccharide and niaziminin, having structural requirement to inhibit tumor promoter-induced Epstein–Barr virus activation have been reported from the leaves of Moringa.[43,44] It enhances the bioactivity of commonly used antibiotics, such as rifampicin, tetracycline, and ampicillin, and also facilitate the absorption of drugs, vitamins, and nutrients through the gastrointestinal membrane, thus increasing their bioavailability. [41] Niazirin is another bioactive nitrile glycoside belonging to M. oleifera. [45,46] Process of isolation of nitrite glycoside from M. oleifera has been patented (US 6858588) by Khanuja et al in 2004–2005. [42 Mechanism of Action Of Bioenhancers Bioavailability-enhancing activity of natural compounds from the medicinal plants may be attributed to various mechanisms, such as P-gp inhibition activity by flavone, quercetin, and genistein; [51] inhibition of efflux transporters, such as P-gp and breast cancer resistance protein (BCRP),[52,53] by naringin and sinomenine thus preventing drug resistance; DNA receptor binding, modulation of cell signaling transduction, and inhibition of drug efflux pumps[54-56] ; by stimulating leucine amino peptidase and glycyl–glycine dipeptidase activity, thus modulating the cell membrane dynamics related to passive transport mechanism as seen with piperine [57] ; nonspecific mechanisms, such as increased blood supply to the gastrointestinal tract, decreased hydrochloric acid secretion, preventing breakdown of some drugs[6] ; and inhibition of metabolic enzymes participating in the biotransformation of drugs, thus preventing inactivation and elimination of drugs and thereby, increasing their bioavailability. [57-5] |
| 7992- | itraC, | Cellular pharmacokinetic aspects of reversal effect of itraconazole on P-glycoprotein-mediated resistance of anticancer drugs |
Query results interpretion may depend on "conditions" listed in the research papers. Such Conditions may include : -low or high Dose -format for product, such as nano of lipid formations -different cell line effects -synergies with other products -if effect was for normal or cancerous cells
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