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Impact of CYP2C9 and CYP2C19 polymorphisms on tolbutamide kinetics and the insulin and glucose response in healthy volunteers

Kirchheiner, Juliaa; Bauer, Steffena; Meineke, Ingolfb; Rohde, Wolfgangc; Prang, Verenaa; Meisel, Christiana; Roots, Ivora; Brockmöller, Jürgena,b

Original Articles

Tolbutamide is known to be metabolized by cytochrome P450 2C9 (CYP2C9), and the effects of the CYP2C9 amino acid polymorphisms *2 (Arg144Cys) and *3 (Ile359Leu) could be important for drug treatment with tolbutamide and for use of tolbutamide as a CYP2C9 test drug.

Tolbutamide pharmacokinetics and plasma insulin and glucose concentrations were studied in 23 healthy volunteers with all six combinations of the CYP2C9 alleles *1, *2 and *3, including two subjects with the combined CYP2C9*1/ *1 and CYP2C19*2/ *2 genotype. Volunteers received a single oral dose of 500 mg tolbutamide, followed by 75 g oral glucose at 1, 4.5 and 8 h after tolbutamide administration. Pharmacokinetic analysis was performed using a computer program for regression analysis of nonlinear mixed effects models.

The mean oral clearances of tolbutamide were 0.97 (95% confidence interval [CI] 0.89–1.05), 0.86 (95% CI 0.79–0.93), 0.75 (95% CI 0.69–0.81), 0.56 (95% CI 0.51–0.61), 0.45 (95% CI 0.41–0.49) and 0.15 (95% CI 0.14–0.16) l/h in carriers of CYP2C9 genotypes 1/ *1, *1/ *2, *2/ *2, *1/ *3, *2/ *3 and *3/ *3, respectively. Tolbutamide pharmacokinetics in carriers of the functionally deficient CYP2C19*2/*2 genotype were not different from those in the CYP2C19 highly active genotype. Elimination in the six CYP2C9 genotype groups could be expressed as the linear combination of three constants (0.05, 0.04, 0.01 h−1), which were specific to the respective CYP2C9 alleles *1, *2 and *3, thus indicating a co-dominant mode of inheritance. Insulin and glucose concentration–time curves did not change with differing CYP2C9 genotypes.

Tolbutamide was confirmed as a substrate of the genetically polymorphic enzyme CYP2C9. The pronounced differences in pharmacokinetics due to the amino acid variants did not significantly affect plasma insulin and glucose concentrations in healthy volunteers.

aInstitute of Clinical Pharmacology, University Medical Center Charité, Humboldt University, Berlin, bDepartment of Clinical Pharmacology, Georg August University, Göttingen, and 3Department of Endocrinology, University Medical Center Charité, Humboldt University, Berlin, Germany

Correspondence to Prof. Dr Jürgen Brockmöller, Abteilung Klinische Pharmakologie, Universitätsklinikum, Robert-Koch-Str. 40, 37075 Göttingen, Germany Tel: + 49 551 39 5770; fax: + 49 551 39 12767; email:

This study was supported by the German Ministry of Education and Research, BMBF grant no. 01 GG 9845/5.

Received 10 August 2001

Accepted 11 October 2001

© 2002 Lippincott Williams & Wilkins, Inc.