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Relationship between dicumarol distribution and the effect of enzyme induction on dicumarol elimination in rats.

Pronounced intersubject differences in the apparent first-order elimination rate constant (kapp) for dicumarol in rats have been found to be due to corresponding differences in the distribution of dicumarol between the liver (the site of dicumarol biotransformation) and the rest of the body. From theoretical considerations and experimental results in animals given only dicumarol, it has been shown that kapp is linearly related to the fraction of drug in the liver (FL). The proportionality constant (k) for these variables was defined as the intrinsic elimination rate constant for dicumarol which should reflect the activity of the enzyme system(s) involved in the elimination of this drug. The purpose of this investigation was to determine the effect of enzyme induction on dicumarol distribution and on the relationship between kapp and FL in rats. It was found that pretreatment with phenobarbital caused a substantial increase in kapp, but that it had no apparent effect on the serum/liver and serum/kidney concentration ratios of dicumarol. The relative weight of the liver was significantly increased by phenobarbital treatment but the weight of the kidneys was not affected. Linear relationships between kapp and FL were found for both the control and the phenobarbital treated groups, but with a significant difference in the slopes of the regression lines. This study illustrates the application of a pharmacokinetic technique which permits a clear and quantitative distinction between the relative contributions of enzyme activity and body distribution to the in vivo elimination kinetics of a drug.

Animals

Synergistic cytotoxicity between menadione and dicumarol vs. murine leukemia L1210.

The water-soluble derivative of vitamin K, menadiol sodium bisulfite (K3), and the related anticoagulant dicumarol, inhibited growth of murine leukemia L1210 in liquid suspension culture. K3, but not dicumarol, cytotoxicity was abrogated by 1 mM cysteine. Isobolographic analysis of the effect of K3-dicumarol combinations, in the concentration ranges between 5 and 75 microM, on L1210 growth, indicated synergy between the two drugs. K3 (10 microM) caused a 3-fold stimulation of KCN-resistant O2 consumption by L1210 cells; addition of 50 microM dicumarol did not enhance KCN-resistant O2 consumption further, suggesting that K3-dicumarol synergy in L1210 was not due to dicumarol-mediated augmentation of K3-semiquinone-free radical formation. We examined the effect of dicumarol addition on L1210 cellular metabolites known to be affected by K3, i.e., glutathione, NADPH and ATP. Dicumarol prevented the elevation of the glutathione pool caused by less than or equal to 18 microM K3. K3-dicumarol combinations depleted the NADPH pool significantly, at concentrations of each which did not affect the NADPH pool. No synergistic effect on the ATP pool was observed. Thus, although the mechanism of K3-dicumarol synergy vs. leukemia remained unclear, it was possible that effects on the glutathione and/or NADPH pools contributed. We also investigated the effect of K3 and dicumarol on 45Ca++ transport by L1210 cells because of their effects on glutathione. Neither drug affected 45Ca++ influx or efflux rate constants. However, equilibrium 45Ca++ uptake was suppressed by K3 at concentrations lower than those which depleted glutathione.

Adenosine Triphosphate

Comparative pharmacokinetics of coumarin anticoagulants XXX: Relationship between total clearance and serum protein binding of dicumarol in rats.

The effect of serum protein binding on the elimination kinetics of dicumarol was studied. The serum free fraction of dicumarol was essentially independent of concentration over a wide concentration range and ranged from 0.00015 to 0.00079 in 10 adult rats. The total clearance of dicumarol in these animals ranged from 3.93 to 14.5 ml/kg/hr. As in previous studies, there was an excellent linear correlation between the elimination rate constant for dicumarol and the fraction of dicumarol in the liver (i.e., the amount of drug in the liver divided by the amount of drug in the body). Consistent with theoretical considerations, there was a positive and apparently linear relationship between the total clearance and the serum free fraction of dicumarol. The individual serum free fraction and the fraction in liver values for dicumarol were strongly correlated. The pharmacokinetic model based on a proportional relationship between the apparent elimination rate constant and the fraction in the liver applies to dicumarol but not to warfarin and has limited utility. On the other hand, the model relating total clearance to the serum free fraction has been found to apply to dicumarol, warfarin, and other extensively plasma protein-bound drugs and can be utilized under clinical conditions.

Animals

Quinoneimines as substrates for quinone reductase (NAD(P)H: (quinone-acceptor)oxidoreductase) and the effect of dicumarol on their cytotoxicity.

Several quinoneimines have been shown to be substrates for partly purified rat liver cytosolic quinone reductase with either NADH or NADPH as cofactor. Km and Vmax values with NADH as cofactor for N-acetyl-p-benzoquinoneimine were 54.9 microM and 278 mumol/min/mg; for 2-amino-1,4-naphthoquinoneimine, 2.8 microM and 38 mumol/min/mg; for N,N-dimethylindoaniline, 1.7 microM and 22 mumol/min/mg; and 2-acetamido-N,N-dimethylindoaniline, 0.4 microM and 9 mumol/min/mg. All the quinoneimines showed substrate inhibition at high concentrations. At 30 microM dicumarol, an inhibitor of quinone reductase, potentiated the acute toxicity of quinoneimines to cultured phenobarbital-induced rat hepatocytes by 0.7- to 2.9-fold. Dicumarol was toxic to cultured non-induced rat hepatocytes and produced little or no increase in quinoneimine toxicity. Dicumarol potentiated the toxicity of 2-methyl-1,4-naphthoquinone (menadione) to cultured non-induced, as well as phenobarbital-induced, hepatocytes. Levels of quinone reductase in both types of hepatocytes were similar. Quinoneimines exhibited strong growth inhibitory properties with Chinese hamster ovary (CHO) cells and A204 human rhabdomyosarcoma cells. Dicumarol, 0.1 mM, potentiated growth inhibition by N,N-dimethylindoaniline and 2-acetamido-N,N-dimethylindoaniline in A204 but not in CHO cells. Growth inhibition by 2-amino-1,4-naphthoquinoneimine was inhibited by dicumarol in both cell lines. Dicumarol potentiated growth inhibition by 2-methyl-1,4-naphthoquinone in A204 and CHO cells. Quinone reductase activity in A204 cells was 48% and in CHO cells 1% of the activity in cultured hepatocytes. The lack of a correlation between the effects of dicumarol on quinoneimine and quinone growth inhibition and levels of cellular quinone reductase suggests that dicumarol has effects in cells in addition to, or other than, inhibition of quinone reductase. It is concluded that quinone reductase may protect cells against quinoneimine toxicity under certain conditions, as with phenobarbital-induced hepatocytes, but does not appear to play a major role in modifying quinoneimine toxicity in non-induced hepatocytes, or growth inhibition in CHO cells or A204 cells.

Animals

Inhibition of mouse glutathione transferases and glutathione peroxidase II by dicumarol and other ligands.

Dicumarol, often used as a specific inhibitor of DT diaphorase (NAD(P)H:(quinone-acceptor) oxidoreductase; EC 1.6.99.2), was found to potently inhibit GSH transferases (EC 2.5.1.18). Dicumarol exhibited an IC50 of 11 microM in inhibiting the conjugation of 1-chloro-2,4-dinitrobenzene (50 microM) by GSH transferase GT-8.7, the major hepatic class mu isoenzyme of CD-1 mice. The activities of GT-8.7 and of the class pi isoenzyme, GT-9.0, toward a carcinogenic substrate, 4-nitroquinoline 1-oxide (100 microM), were inhibited by dicumarol with IC50 values of 14 and 9 microM, respectively. Dicumarol also affected GSH peroxidase II activity, inhibiting the reduction of cumene hydroperoxide by GT-10.6, the predominant class alpha GSH transferase of mouse liver, with an IC50 of 14 microM. GSH peroxidase I (EC 1.11.1.9) and GSH peroxidase II activities were resolved by chromatography of liver and testis cytosols. While inhibiting GSH peroxidase II with IC50 of 9-10 microM, dicumarol did not affect the activity of the selenoenzyme, GSH peroxidase I. Whereas several other non-substrate ligands were more potent inhibitors of 1-chloro-2,4-dinitrobenzene conjugation, dicumarol effectively inhibited GSH transferase and GSH peroxidase II activities in the range of dicumarol concentrations frequently used for detection of DT diaphorase action. These results indicate that physiological consequences resulting from the use of supramicromolar concentrations of dicumarol should not be interpreted in terms of DT diaphorase inhibition alone.

4-Nitroquinoline-1-oxide

Further characterization of reversal of signs of induced cotton effects of dicumarol derivatives-alpha 1-acid glycoprotein systems by protriptyline.

The interaction of dicumarol derivatives and protriptyline with respect to the binding to alpha 1-acid glycoprotein (AGP) has been investigated by circular dichroism (CD), equilibrium dialysis and ultrafiltration. Investigation of the induced CD spectra of dicumarol derivatives bound to AGP indicated that the conformations of these compounds were different when bound to AGP. Though all the dicumarol derivatives, protriptyline and AGP formed a ternary complex, interaction modes were different, depending upon the substituent groups at position 3 of the dicumarol molecule. On the basis of the protriptyline effect on the CD spectra of all dicumarol derivatives bound to AGP, the compounds were classified in the following way: (1) Dicumarol, ethylidenebis 4-hydroxycoumarin and propylidenebis 4-hydroxycoumarin caused reversal of the sign of ellipticity. This interaction was explained by cooperative binding. (2) Butylidenebis 4-hydroxycoumarin and pentylidenebis 4-hydroxycoumarin generated new band and disappeared ellipticity of the original Cotton effect. This interaction was also explained by the cooperative binding mode. (3) Ethylbiscoumacetate which generated the CD band similar to that of dicumarol in the absence of protriptyline, reversed the sign of the CD spectrum only at 325 nm. The interaction was anticooperative in nature. (4) Benzylidenebis 4-hydroxycoumarin represented type four which had no change in the CD spectrum by the addition of protriptyline. This interaction was explained by the two-state model accompanying the conformational change of AGP. These results suggested that all compounds, except for benzylidenebis 4-hydroxycoumarin, induced negative Cotton effects at 325 nm by taking the same asymmetrical perturbation by the addition of protriptyline and the interaction was carried out according to model 2. An attempt to study the interaction mechanism of two or more drugs with regard to the binding to protein using these models is thought to help in understanding drug-protein interactions.

Binding Sites

Reversal of signs of induced cotton effects of dicumarol-alpha 1-acid glycoprotein systems by phenothiazine neuroleptics through ternary complexation.

The interaction of dicumarol and phenothiazine neuroleptics binding to alpha 1-acid glycoprotein (AGP) was investigated by circular dichroism (CD) and equilibrium dialysis. The induced CD spectra of the dicumarol-AGP complex were affected differently by the different substituents of the phenothiazine molecule. The sign of the induced Cotton effect of dicumarol bound to AGP was reversibly changed with the introduction of the propyldimethylamine substituent at position 10 or chloride group at position 2 of the phenothiazine molecule. Chlorpromazine, which contains both of these substituents reversed the sign of the induced Cotton effect with the highest intensity. The addition of trifluoperazine, fluphenazine, and promethazine containing neither of the two substituents generated a new negative CD band. However, the addition of opromazine, which contains sulfoxide at position 5, decreased the CD intensity of the dicumarol-AGP complex without changing the shape of the CD spectra. Equilibrium dialysis studies revealed that the interaction of dicumarol-AGP with phenothiazine derivatives occurred simultaneously, and the interaction followed a cooperative and anticooperative binding model. Further, among the six phenothiazine derivatives that reversed the signs of the induced Cotton effects of the dicumarol-AGP complex, a linear relationship was observed between coupling constants and the difference in the induced optical ellipticity. The opromazine and dicumarol interaction was competitive for a common binding site on the AGP molecule. Removal of sialic acid did not have any effect on this interaction. These data support the hypothesis that the acidic and the basic drug binding sites overlap each other.

Antipsychotic Agents

Comparative pharmacokinetics of coumarin anticoagulants XV: relationship between pharmacokinetics of dicumarol and warfarin in rats.

The distribution, elimination, and anticoagulant effect of dicumarol and warfarin were determined in adult males rats following intravenous injection of single doses of these drugs in crossover experiments. The biological half-life of dicumarol ranged from 5 to 28 hr; that of warfarin ranged from 9 to 30 hr. There was a statistically significant correlation between the following pharmacokinetic characteristics of dicumarol and warfarin in individual animals: biological half-life, apparent volume of distribution, total plasma clearance, and concentration in plasma eliciting one-half the maximum anticoagulant effect (effective concentration). The mean ratio of the respective biological half-lives (warfarin/dicumarol) was 1.42, and that of the apparent volumes of distribution was 1.50. The ratio of the effective plasma concentrations (dicumarol/warfarin) was correlated negatively with the half-life of dicumarol and positively with the ratio of the half-life values (warfarin/dicumarol) in individual animals. Additional studies with serum samples from other rats showed pronounced interindividual differences in the serum protein binding of both dicumarol and warfarin and a strong correlation between the protein binding of these two drugs in serum of individual animals. The results of this study, together with the results of previous studies in this series, indicate that serum protein binding is the major determinant of interindividual differences in the pharmacokinetics of dicumarol and warfarin in rats under these experimental conditions.

Animals

Comparative pharmacokinetics of coumarin anticoagulants XXXIII: frequency distribution of dicumarol total clearance in rats.

The total clearance of dicumarol was determined in 172 adult male Sprague-Dawley rats. Clearance values ranged from 1.46 to 27.0 ml/hr/kg. Statistical analysis of a histogram of the total clearance values indicated a trimodal distribution, with modes at 6.28, 14.8, and 23.7 ml/hr/kg. The percentage of animals in each of these components was 60.5, 33.7, and 5.8. A previous study had shown that the total clearance of dicumarol was proportional to the fraction of nonprotein-bound drug in serum (serum free fraction) and that interindividual differences in total clearance of dicumarol in rats were due almost entirely to corresponding differences in the serum free fraction. Therefore, it is likely that the observed trimodal frequency distribution of total clearance values reflects a similar distribution of serum free fraction values of dicumarol. The frequency distribution curve for dicumarol total clearance is very similar to the trimodal frequency distribution curve for warfarin serum free fraction values in rats. This observation is consistent with the previously demonstrated strong correlation of serum free fraction values of dicumarol and warfarin in individual animals.

Animals

Effects of tricyclic drug on induced circular dichroism spectra of dicumarol bound to alpha 1-acid glycoprotein.

Effects of both tricyclic and non-tricyclic drugs on the extrinsic Cotton effects of dicumarol bound to human alpha 1-acid glycoprotein (AGP) have been investigated. Basic tricyclic drugs caused the reversal of the signs of the induced Cotton effects of the circular dichroism (CD) spectra of the dicumarol-AGP system while the basic drugs not possessing tricyclic rings and acidic drugs decreased the observed ellipticities without changing the signs of its CD spectra. There was no reversal of the CD signs of the drugs not containing two hydroxycoumarin rings bound to AGP by basic tricyclic drugs. Raising of pH and temperature, and the addition of guanidine hydrochloride decreased the observed ellipticities of the CD spectra of the dicumarol-AGP system without showing any change in the signs of the Cotton effects. The mutual displacement data showed that protriptyline increased its own binding and that of dicumarol with AGP. The results of CD titration and equilibrium dialysis experiments suggest that dicumarol-AGP and dicumarol-AGP-protriptyline form a 1:1 binary complex and a 1:1:1 ternary complex, respectively.

Antidepressive Agents, Tricyclic

Determination of dicumarol metabolites in bile of rats.

After intravenous administration of dicumarol-14C to rats, the bile excreted over the next 24 hr contained from 32 to 46% of the administered radioactivity. At least three primary metabolites and a small amount of unchanged dicumarol were present in the bile. Over 91% of the primary metabolites was converted to dicumarol and 7-hydroxydicumarol by hydrolysis with beta-glucuronidase. Some primary metabolites were hydrolyzed simply by acidification to pH 3 or by treatment under the acidic conditions utilized in the enzymatic hydrolysis. The three primary metabolites contain carboxylic acid groups, as indicated by their electrophoretic mobility-pH profiles, and some are simple glucuronides of dicumarol and 7-hydroxydicumarol. The possibility that others are derivatives of these compounds in which a coumarin lactone ring is opened cannot be ruled out. When the metabolites released by either acidification or enzymatic hydrolysis were chromatographed in n-butanol-3 M ammonia, artifacts were produced, presumably as a result of decomposition of 7-hydroxydicumarol. The question is raised whether a previously reported metabolite (B055) is an artifact.

Animals

Comparative pharmacokinetics of coumarin anticoagulants XXXI: Effect of plasma protein binding on distribution kinetics of dicumarol in rats.

The purpose of this investigation was to determine, with respect to dicumarol, the effect of plasma protein binding on the pharmacokinetic parameters used conventionally to describe the distribution kinetics of a drug on the basis of the time course of its plasma concentration. After rapid intravenous injection, plasma dicumarol concentrations in adult male Sprague-Dawley rats declined triexponentially, with the terminal exponential phase starting at about 4 hr. The free fraction f, of dicumarol in the serum of individual animals ranged from 0.000150 to 0.000790. The parameters of the equation Ct = Pe-pit + Ae-alphat + Be-betat for plasma concentration Ct at time t were obtained by nonlinear least-squares computer fitting of the experimental data and varied appreciably between animals. Of these parameters, only beta showed a significant correlation with f. These observations indicate that the distribution kinetics of this very extensively plasma protein-bound drug, as reflected by the time course of its plasma concentration after intravenous injection, are apparently not affected by intersubject differences in plasma protein binding. There is a remarkable similarity in the valves of P, A, B, pi, and alpha for dicumarol and warfarin, even though the serum free fraction of these drugs differs considerably.

Animals

Comparative pharmacokinetics of coumarin anticoagulants. XLII: Effect of phenobarbital on systemic availability of orally administered dicumarol in rats with ligated bile ducts.

The purpose of this investigation was to determine if the previously demonstrated inhibitory effect of phenobarbital treatment on the systemic availability of orally administered dicumarol in rats is related to the known effect of phenobarbital on bile output. It was found that phenobarbital had no apparent effect on the systemic availability of an aqueous dicumarol suspension in rats with ligated bile ducts. Compared to results obtained previously on normal rats, bile duct-ligated rats absorbed and eliminated dicumarol much more slowly and absorbed much less of the anticoagulant. On the other hand, the relative inductive effect of phenobarbital treatment on dicumarol elimination was similar in normal and in bile duct-ligated animals. The latter exhibited substantial serum transaminase elevations, indicative of liver damage presumably secondary to cholestasis. These results demonstrate that a drug-drug interaction can depend markedly on the pathophysiological status of the animals.

Animals

Studies on drug-milk freeze-dried formulations. I: Bioavailability of sulfamethizole and dicumarol formulations.

In this study, solid dispersion formulations of dicumarol (3,3'-methylenebis[4-hydroxycoumarin]) and sulfamethizole (N'-(5-methyl-1,3, 4-thiadiazol-2-yl)sulfanilamide) in defatted milk were prepared by freeze-drying. X-ray crystallographic data showed that both drugs were dispersed in the formulations in an amorphous state. Bioequivalency comparisons between freeze-dried formulations, after regeneration with water, and control capsules containing the pure drug substances were studied in four male volunteers. Determination of the plasma dicumarol levels indicated superiority of the dicumarol-milk formulation. Statistically significant differences were found between area under the curve, maximum plasma concentration, and apparent elimination rates. Analysis of the urine sulfamethizole data revealed that the two formulations exhibit statistically equivalent rates and extents of excretion of unchanged sulfamethizole. The binding of both drugs to casein and their solubility in the presence of casein were measured in vitro. The presence of casein caused an increase in the solubility of dicumarol, while it had no effect on the solubility of sulfamethizole. Normal protein binding cannot be responsible for the effects noted. Extrapolation of the in vitro data to the in vivo situation was attempted. Drug-milk freeze-dried formulations are promising for the enhancement of the bioavailability of sparingly water soluble drugs.

Adult

Inhibitory effect of dicumarol on the excitability of the sarcolemma of skeletal muscle.

Dicumarol (7.5 x 10(-6) M -7.5 x 10(-5) M) inhibited the twitches and the simultaneously recorded electromyogram of the indirectly stimulated rat diaphragm preparation. The directly stimulated curarized preparation was inhibited in a similar way. Accordingly, the excitability of the sarcolemma was inhibited by dicumarol. The inhibitory effect was irreversible upon washing. Intracellular microelectrode recordings disclosed that the inhibitory effect was accompanied by a depolarization, and the inhibition was potentiated in high K+ (9.5 mM) solution. In addition, the ability of the preparations to produce a depolarization contracture with KCl (100 mM) was inhibited by dicumarol. Therefore, a part of the inhibitory effect might be caused by the depolarization. On the other hand, subthreshold direct stimulation disclosed that the inhibitory effect might be due to an increase of the threshold. However, a lack of synergistic interaction with lidocaine (0.2 mM) showed that this effect of dicumarol was probably not a membrane stabilizing or local anaesthetic effect.

Anesthetics, Local

Management of thrombo-embolism after aortic valve replacement with the Björk-Shiley tilting disc valve. Medicamental prevention with dicumarol in comparison with dipyridamole - acetylsalicylic acid. Surgical treatment of prosthetic thrombosis.

Dicumarol anticoagulation poved very effective in the prevention of thromboembolic complications after aortic valve replacement with the Björk-Shiley tilting disc valve. We have, however, encountered six late deaths because of massive cerebral hemorrhage, which represent 3% of the patients who were maintained on dicumarol medication at that time. This unacceptable mortality prompted us to introduce two programmes, one without anticoagulation and another one with dipyridamole-acetylsalicylic acid. Furthermore, dicumarol was terminated in patients with haemorrhagic episodes, instable anticoagulation, pregnancy, and in those reguiring surgery. The results were disappointing, however, and the majority of the patients involved were therefore put on dicumarol medication. Eleven of the 64 consecutive patients taking dipyridamole - acetylsalicylic acid had thrombo-embolic episodes during a mean follow-up period of 9 months...

Adult

Effect of bilirubin on the distribution, elimination and anticoagulant action of dicumarol in Gunn rats-1-2 (38547).

Jaundiced Gunn rats were found to have a significantly larger apparent volume of distribution and higher rate constant for elimination of dicumarol than their nonjaundiced littermates. Anticoagulant effect-log plasma dicumarol concentration lines were parallel in the two groups of animals, with the line for the jaundiced rats shifted to a lower concentration range. In vitro studies showed that bilirubin can displace dicumarol from serum protein binding sites. There are indications of a genetic influence on the distribution and anticoagulant effect of dicumarol in Gunn rats.

Animals

Enhancement of xanthine dehydrogenase mediated mitomycin C metabolism by dicumarol.

These studies examined the effect of dicumarol on xanthine dehydrogenase (XDH), an enzyme recently shown to bioreduce mitomycin C. Dicumarol, which has previously been shown to inhibit xanthine oxidase (XO), inhibited both XDH and XO mediated conversion of xanthine to uric acid but potentiated the metabolism of mitomycin C by XDH and XO. Formation of 2,7-diaminomitosene following mitomycin C bioactivation by XDH was increased 3-fold aerobically and 4-fold hypoxically when 20 microM dicumarol was included in the reaction mixture. XO mediated metabolism of mitomycin C hypoxically was increased approximately 50% by the inclusion of dicumarol.

Animals