代谢
苯海拉明经历快速而广泛的首过代谢。特别是,连续发生两次N-脱甲基反应,其中苯海拉明被脱甲基成为N-去甲苯海拉明(N-去甲基代谢物),然后这个代谢物本身再次被脱甲基成为N,N-二去甲苯海拉明(N,N-二去甲基代谢物)。随后,通过N,N-二去甲基代谢物的胺基部分生成了乙酰代谢物,如N-乙酰-N-去甲苯海拉明。此外,N,N-二去甲基代谢物还经历了一些氧化反应,生成了二苯基甲氧基乙酸代谢物。剩余的给药剂量百分比以原形排泄。代谢物进一步与甘氨酸和谷氨酰胺结合并随尿排出。此外,研究表明,多种细胞色素P450同工酶参与了苯海拉明的主要代谢途径N-脱甲基反应,包括CYP2D6、CYP1A2、CYP2C9和CYP2C19。特别是,CYP2D6与苯海拉明底物的亲和力催化作用高于其他已识别的同工酶。因此,这些CYP酶的诱导剂或抑制剂可能会影响血清浓度以及与苯海拉明暴露相关的不良反应的发生率和/或严重程度。
Diphenhydramine undergoes rapid and extensive first-pass metabolism. In particular, two successive N-demethylations occur wherein diphenhydramine is demethylated to N-desmethyldiphenhydramine (the N-desmethyl metabolite) and then this metabolite is itself demethylated to N,N-didesmethyldiphenhydramine (the N,N-didesmethyl metabolite). Subsequently, acetyl metabolites like N-acetyl-N-desmethyldiphenhydramine are generated via the amine moiety of the N,N-didesmethyl metabolite. Additionally, the N,N-didesmethyl metabolite also undergoes some oxidation to generate the diphenylmethoxyacetic acid metabolite as well. The remaining percentage of a dose of administered diphenhydramine is excreted unchanged. The metabolites are further conjugated with glycine and glutamine and excreted in urine. Moreover, studies have determined that a variety of cytochrome P450 isoenzymes are involved in the N-demethylation that characterizes the primary metabolic pathway of diphenhydramine, including CYP2D6, CYP1A2, CYP2C9, and CYP2C19. In particular, CYP2D6 demonstrates higher affinity catalysis with the diphenhydramine substrate than the other isoenzymes identified. Consequently, inducers or inhibitors of these such CYP enzymes may potentially affect the serum concentration and incidence and/or severity of adverse effects associated with exposure to diphenhydramine.
来源:DrugBank