P-glycoprotein Substrates

    P-glycoprotein substrates include, but are not limited to, dabigatran, digoxin, edoxaban, and fexofenadine. See glossary page for a more comprehensive list.

    Summary

    P-glycoprotein substrates are compounds, including medications, that can be transported out of cells by p-glycoprotein. In the presence of intestinal p-glycoprotein inhibitors or inducers, the bioavailability of p-glycoprotein substrates may be increased or decreased, respectively.

    For example, when p-glycoprotein activity in the intestines is inhibited, there are fewer available pumps removing the substrate from the intestinal cell, which can lead to more substrate being absorbed into the bloodstream (increased bioavailability). Alternatively, when p-glycoprotein activity is induced, there are more available pumps removing the substrate from the cell, which can result in less substrate being absorbed (decreased bioavailability).

    The table below outlines some of the most common or clinically relevant p-glycoprotein substrates.​​ Importantly, this list is not exhaustive.[1][2]

    P-glycoprotein Substrates
    Amitriptyline
    Amprenavir
    Atorvastatin
    Carvedilol
    Celiprolol
    Cimetidine
    Colchicine
    Cyclosporine
    Dabigatran
    Dexamethasone
    Digoxin
    Diltiazem
    Docetaxel
    Domperidone
    Doxorubicin
    Edoxaban
    Erythromycin
    Etoposide
    Everolimus
    Fexofenadine
    Imatinib
    Indinavir
    Itraconazole
    Ivermectin
    Lansoprazole
    Levofloxacin
    Linagliptin
    Loperamide
    Losartan
    Lovastatin
    Methylprednisone
    Morphine
    Nadolol
    Nelfinavir
    Ofloxacin
    Ondansetron
    Paclitaxel
    Phenytoin
    Quinidine
    Ranitidine
    Rifampicin
    Rifaximin
    Risperidone
    Ritonavir
    Saquinavir
    Sirolimus
    Tacrolimus
    Tanilolol
    Tenofovir
    Terfenadine
    Tetracycline
    Verapamil
    Vinblastine
    Vincristine

    References

    1. ^Cascorbi IP-glycoprotein: tissue distribution, substrates, and functional consequences of genetic variations.Handb Exp Pharmacol.(2011)
    2. ^Kim RBDrugs as P-glycoprotein substrates, inhibitors, and inducers.Drug Metab Rev.(2002 Feb-May)