3'-azido-3'-deoxythymidine drug interactions. Screening for inhibitors in human liver microsomes

Zidovudine is a widely used antiretroviral drug active against human immunodeficiency virus. The drug interactions of this compound, which are primarily eliminated as a glucuronide, have not yet been extensively studied. Because zidovudine is frequently combined with other drugs, complete knowledge of interactions is essential to optimize AIDS therapy. We therefore screened the effect of 55 molecules, representative of 20 different therapeutic classes, on 3'-azido-3'-deoxythymidine (AZT) glucuronidation by human liver microsomes. We demonstrate that many drugs caused more than 15% inhibition of AZT glucuronidation in vitro, whereas major antibiotics (ceftazidine, isoniazid, aminoglycosides, macrolides, and sulfamides), antivirals (2',3'-dideoxycytidine, 2',3'-dideoxyinosine, and acyclovir), flucytosine, metronidazole, acetaminophen, and ranitidine had no effect. For compounds that appeared to inhibit AZT glucuronidation, extrapolation to the clinical situation must take into account both the in vitro apparent Ki values and the usual expected plasma level for the coadministered drug. By considering these parameters, this work indicates that clinically relevant inhibition of AZT glucuronidation may be observed with the following drugs: cefoperazone, penicillin G, amoxicilin, piperacillin, chloramphenicol, vancomycin, miconazole, rifampicin, phenobarbital, carbamazepine, phenytoin, valproic acid, quinidine, phenylbutazone, ketoprofen, probenecid, and propofol. Complementary clinical and pharmacokinetic studies should be performed to validate these assumptions.