Effect of Citrus Juice and SLCO2B1 Genotype on the Pharmacokinetics of Montelukast

Previously the authors found that a common polymorphism, rs12422149 (SLCO2B1{NM_007256.2}:c.935G>A), in the gene coding for OATP2B1, was associated with absorption of and response to montelukast in humans. In vitro studies showed that citrus juice could reduce the permeability of montelukast consistent with known inhibition of organic anion‐transporting polypeptides. To study the clinical significance of c.935G>A, the authors conducted a single‐dose, pharmacokinetic study of montelukast co‐ingested with citrus juice. On average, congestion with either orange juice or 4× concentrated grapefruit juice had a minimal effect on the area under the plasma concentration—time curve from time zero extrapolated to infinite time (AUC0→∞) of montelukast relative to co‐ingestion with Gatorade control (n = 24). However when the data were stratified by genotype at c.935 (G/G n = 21, A/G n = 5), a significant reduction in AUC0→∞ was detected with orange juice in G/G homozygotes (AUC0→∞, G/G, Gatorade = 2560 ± 900 ng·h·mL−1 vs AUC0→∞, G/G, orange juice = 2010 ± 650 ng·h·mL−1, P = .032). Significantly, A/G heterozygotes showed reduced AUC0→∞ relative to G/G homozygotes, independent of treatment (AUC0→∞, G/G, combined treatments = 2310 ± 820 ng·h·mL−1 vs AUC0→∞, A/G, combined treatments = 1460 ± 340 ng·h·mL−1, P = 2.0 × 10−5) replicating previous observations.