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Drug-Drug Interaction After Single Oral Doses of the Furanocoumarin Methoxsalen and Cyclosporine

From the Department of Pharmacology, North-West University, Potchefstroom, South Africa (Dr Rheeders, Ms Bouwer), and the Department of Pharmacokinetics, Dynamics, and Metabolism, Pfizer Global Research and Development, Ann Arbor, Michigan (Dr Goosen).

Furanocoumarins increase the bioavailability of drugs that are CYP3A4 substrates. A possible interaction of methoxsalen with cyclosporine was evaluated in 12 healthy volunteers following oral administration of 40 mg methoxsalen, 200 mg cyclosporine, or a combination of both in a randomized crossover study. Methoxsalen increased area under the plasma concentration-time curve (AUC) and peak plasma concentration (C_max) of cyclosporine by 29% (range, -20% to 172%; P < .05) and 8% (range, -10% to 26%; P < .05), respectively, compared to cyclosporine alone. The AUC geometric means ratio (95% confidence interval) for cyclosporine plus methoxsalen/cyclosporine alone was 1.14 (1.02, 1.27), and treatments were therefore not bioequivalent. Methoxsalen causes a clinically significant interaction with cyclosporine in some susceptible individuals. The reasons for susceptibility and the clinical implications for chronic cyclosporine administration have not been established. Caution is recommended in combination therapy, and more frequent monitoring of cyclosporine plasma levels and clinical monitoring is advised.

Key Words: Methoxsalen • 8-methoxypsoralen • cyclosporine, furanocoumarin • psoralen • psoriasis • drug interaction

Address for reprints: Theunis C. Goosen, Department of Pharmacokinetics, Dynamics, and Metabolism, Pfizer Global Research and Development, Bldg 25-126, 2800 Plymouth Rd, Ann Arbor, MI 48105; e-mail: theunis.goosen{at}pfizer.com.

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