Does inhibition of P-glycoprotein lead to drug-drug interactions?

Permeability-glycoprotein (Pgp) is a drug transporter responsible for the efflux of xenobiotics out of cells that influence the pharmacokinetics of numerous drugs. However, the role of this transporter in drug-drug interactions is still poorly studied even though a lot of P-glycoprotein substrates and P-glycoprotein inhibitors are identified among drugs of standard usage. On one hand, Pgp is distributed within a lot of organs and tissues implicated in the absorption or excretion of xenobiotics, and drug-drug interactions with this protein may increase the bioavailability of simultaneously administered active drugs. On the other hand, Pgp is linked to the integrity of blood-tissue barriers, such as the blood-brain barrier or placenta, and a partial blockage of Pgp could be responsible for a new drug distribution in the organism with possible increase of drug rates in organs behind these barriers. Therefore, concomitant administration of substrates and Pgp inhibitors would modify drug pharmacokinetics by increasing bioavailability and organ uptake, leading to more adverse drug reactions and toxicities. Consequently, the identification and comprehension of these drug-drug interactions remain important keys to risk assessment.