Role of specific cytochrome P450 enzymes in the N-oxidation of the antiarrhythmic agent mexiletine

1. Mexiletine is extensively metabolized in man by C- and N-oxidation and the aim of the present study was to characterize major cytochrome P450 enzyme(s) involved in the formation of N-hydroxymexiletine. 2. Incubations with genetically engineered microsomes indicated that the formation rate of N-hydroxymexiletine was highest in the presence of microsomes expressing high levels of either CYP1A2 or CYP2E1 and the formation of N-hydroxymexiletine by human liver microsomes was inhibited about 40% by antibodies directed against CYP1A1/1A2 or CYP2E1. Additional incubations demonstrated that formation of N-hydroxymexiletine was decreased 47 and 51% by furafylline, 40 muM and 120 muM, respectively, and decreased 55 and 67% by alpha-naphthoflavone, 1 muM and 3 muM, respectively (all p<0.05 versus control). 3. The formation rate of N-hydroxymexiletine in human liver microsomes was highly correlated with CYP2B6 (RS-mexiletine, r=0.7827; R-(-)-enantiomer, r=0.7034; S-(+)-enantiomer, r=0.7495), CYP2E1 (S-(+)-enantiomer, r=0.7057) and CYP1A2 (RS-mexiletine, r=0.5334; S-(+)-enantiomer, r=0.6035). 4. In conclusion, we have demonstrated that CYP1A2 is a major human cytochrome P450 enzyme involved in the formation of N-hydroxymexiletine. However, other cytochrome P450 enzymes (CYP2E1 and CYP2136) also appear to play a role in the N-oxidation of this drug.