A recent clinical study reported that the ingestion of apple juice (AJ) markedly reduced the plasma concentration of atenolol; however, our in vitro study showed that atenolol may not be a substrate of organic anion transporting polypeptide 2B1 (OATP2B1), so this AJ-atenolol interaction cannot be explained by inhibition of OATP2B1. On the other hand, we more recently showed that the solution osmolality influences gastrointestinal (GI) water volume, and this may indirectly affect intestinal drug absorption. In this study, we examined whether the osmolality dependence of water dynamics can account for AJ-atenolol interactions by evaluating the GI water volume and the atenolol aborption in the presence of AJ in rats. Water absorption was highest in purified water, followed by saline and isosmotic mannitol solution, and the lowest in AJ, confirming that water absorption is indeed osmolality-dependent. Interestingly, AJ showed apparent water secretion into the intestinal lumen. The intestinal concentration of FD-4, a nonpermeable compound, after administration in AJ was lower than the initial concentration, whereas that in purified water was greater than the initial concentration. Further, the fraction of atenolol absorbed in intestine was significantly lower in AJ or hyperosmotic mannitol solution (adjusted to the osmolality of AJ) than after administration in purified water. Comparable results were observed in an in vivo pharmacokinetic study in rats. Our results indicate that orally administered AJ has a capacity to modulate luminal water volume depending on the osmolality, and this effect may result in significant AJ-atenolol interactions.

Intestinal water absorption is reportedly influenced by luminal osmolality. In this study, we examined whether differences in the osmolality of the vehicle used for oral administration of drugs influence luminal water volume and drug absorption in the gastrointestinal (GI) tract, by means of in situ rat intestinal closed loop studies using solutions of fluorescein isothiocyanate dextran 4000 (a non-absorbable compound), atenolol (a low-permeability drug), and antipyrine (a high-permeability drug) in various solvents. Determination of the remaining fraction of water revealed the following rank order for water absorption in rat jejunum: purified water > saline > phosphate buffer = isosmotic mannitol solution. The luminal concentration of fluorescein isothiocyanate-dextran 4000 after administration in purified water was significantly increased to 2.5 times the initial dosing concentration. Thus, osmolality-dependent changes in GI water absorption can cause significant changes of drug concentration in the GI fluid, potentially resulting in altered drug absorption characteristics. Indeed, the fraction absorbed of atenolol in jejunum was significantly greater when the drug was administered in purified water than in isosmotic solution. In contrast, no significant change in fraction absorbed of antipyrine was observed. Our results indicate that osmolality-dependent changes in GI water volume may influence drug absorption, especially of low-permeability drugs.

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