Application of an Inter-Species Extrapolation Method for the Prediction of Drug Interactions between Propolis and Duloxetine in Humans

Abstract

Duloxetine (DLX) is a potent drug investigated for the treatment of depression and urinary incontinence. DLX is extensively metabolized in the liver by two P450 isozymes, CYP2D6 and CYP1A2. Propolis (PPL) is one of the popular functional foods known to have effects on activities of CYPs, including CYP1A2. Due to the high probability of using DLX and PPL simultaneously, the present study was designed to investigate the potent effect of PPL on pharmacokinetics (PKs) of DLX after co-administration in humans. A PK study was first conducted in 18 rats (n = 6/group), in which the plasma concentration of DLX and its major metabolite 4-hydroxy duloxetine (4-HD) with or without administration of PPL was recorded. Population PKs and potential effects of PPL were then analyzed using NONMEM software. Lastly, these results were extrapolated from rats to humans using the allometric scaling and the liver blood flow method. PPL (15,000 mg/day) exerts a statistically significant increase in DLX exposures at steady state, with a 20.2% and 24.6% increase in DLX C m a x , s s and the same 28.0% increase in DLX A U C s s when DLX (40 or 60 mg) was administered once or twice daily, respectively. In conclusion, safety issues are required to be attended to when individuals simultaneously use DLX and PPL at high doses, and the possibility of interactions between DLX and PPL might be noted.

What We Know About Propolis, and Its Potential Role in Obesity and Diabetes

“…Propolis has interactions with some drugs which are duloxetine, warfarin, praziquantel, donepezil, levodopa, metformin, anticancer drugs, and finally antimicrobial drugs. Duloxetine and warfarin are affected negatively by the propolis but the other drugs are affected positively by the propolis or combining two of them together gave better consequences for the treatment [72][73][74]. Raw, water-soluble propolis combined with chemotherapeutic agents has been shown in studies to potentially reduce post-chemotherapeutic reactions, maximize enhanced immunity, and increase treatment efficacy without causing drug interactions [75].…”