When Drug-Drug interactions occur, one drug is usually the victim and the other is the
perpetrator. In other cases, the drug could be a victim of high pharmacogenetic variability, such
as being metabolized by CYP2D6 or CYP2C19. The perpetrator compound could be involved in
either inhibition (sometimes also time dependent) or induction of clearance enzymes.
Examples of Ameliorating compound series when the lead compound is a victim or possibly a
perpetrator will be described.
Three examples:
An example of changing clearance pathways so that the pharmacogenetically variable CYP2D6
enzyme was not involved in the end, in the clearance of a kinase compound (victim) will be
shown.
An example of changing a series of compounds (perpetrator) involved in metabolite-based
inhibition (MBI), will be shown.
Lastly, the rational modification of compounds (perpetrator) initially involved in CYP3A
induction via the PXR nuclear receptor so that the final compounds did not induce CYP3A, will
be shown.