This study shows that ivabradine exerts a dose-dependent bradycardic effect and that its N-dealkylated metabolite contributes to this bradycardic effect.

ObjectiveSeveral reports indicate that fluvoxamine decreases the clearance of cytochrome P4501A2 (CYP1A2) substrates. This study compared in vitro and in vivo inhibition potencies of fluvoxamine toward CYP1A2 with an approach based on inhibition constants (Ki) determined in vitro and in vivo.MethodsIn vitro inhibition constant values were determined with human liver microsomes and complementary deoxyribonucleic acid‐expressed CYP1A2 (supersomes). Fluvoxamine in vivo inhibition constants (Kiiv) for CYP1A2 were obtained from an investigation of single‐dose theophylline (250 mg) disposition in 9 healthy volunteers receiving steady‐state (9 days) fluvoxamine at 3 doses (0, 25, or 75 mg/d) in a randomized crossover design.ResultsIn vitro Ki values based on total inhibitor concentrations were 177 ±56 nmol/L, 121 ±21 nmol/L, and 52 ±13 nmol/L in human liver microsomes with 1 mg/ml protein and 0.5 mg/ml protein and in supersomes with 0.3 mg/ml protein, respectively. The corresponding in vitro Ki values based on unbound fluvoxamine concentrations were 35 nmol/L, 36 nmol/L, and 36 nmol/L. The ratio of 1‐methyluric acid formation clearances (control/inhibited) in 8 subjects was positively correlated with fluvoxamine concentration (r2 = 0.87; P < .001) with an intercept near 1. Mean values for Kiiv based on total and unbound plasma concentrations at steady state were 25.3 nmol/L (range, 14–39 nmol/L) and 3.6 nmol/L (range, 2.4–5.9 nmol/L), respectively.ConclusionComparison of in vitro and in vivo Ki values based on unbound fluvoxamine concentrations suggests that fluvoxamine inhibition potency is approximately 10 times greater in vivo than in vitro.Clinical Pharmacology & Therapeutics (2001) 70, 415–424; doi: 10.1016/S0009‐9236(01)62844‐3

Fluvoxamine inhibits the metabolism of tacrine. CYP1A2 may be the target of this inhibition. Fluvoxamine may modulate the hepatotoxicity of tacrine, depending on the relative contribution of tacrine and its reactive metabolites to this toxicity.