Protein Information

Name CYP2C19
Synonyms (R) limonene 6 monooxygenase; Flavoprotein linked monooxygenase; Mephenytoin 4 hydroxylase; (S) limonene 6 monooxygenase; (S) limonene 7 monooxygenase; CYP2C; CPCJ; CYP 2C…

Compound Information

Name warfarin
CAS

Reference List

PubMed Abstract RScore(About this table)
18520598 Uno T, Sugimoto K, Sugawara K, Tateishi T: The role of cytochrome P2C19 in R-warfarin pharmacokinetics and its interaction with omeprazole. Ther Drug Monit. 2008 Jun;30(3):276-81.

Previous studies reported omeprazole to be an inhibitor of cytochrome P450 (CYP) 2C19 and suggested the pharmacokinetic interaction of omeprazole with R-warfarin.
94(1,1,3,4) Details
18615373 Hata M, Hayasaka M, Sezai A, Niino T, Yoda M, Unosawa S, Taoka M, Osaka S, Furukawa N, Kimura H, Minami K: Proton pump inhibitors may increase the risk of delayed bleeding complications after open heart surgery if used concomitantly with warfarin. Thorac Cardiovasc Surg. 2008 Aug;56(5):274-7.

OBJECTIVES: The American Food and Drug Administration has suggested that proton pump inhibitors increase the international normalized ratio (INR) when used concomitantly with warfarin, by being metabolized by cytochrome P450 2C19.
81(1,1,1,1) Details
20002088 Turpault S, Brian W, Van Horn R, Santoni A, Poitiers F, Donazzolo Y, Boulenc X: Pharmacokinetic assessment of a five-probe cocktail for CYPs 1A2, 2C9, 2C19, 2D6 and 3A. Br J Clin Pharmacol. 2009 Dec;68(6):928-35.

AIMS: To assess the pharmacokinetics (PK) of selective substrates of CYP1A2 (caffeine), CYP2C9 (S-warfarin), CYP2C19 (omeprazole), CYP2D6 (metoprolol) and CYP3A (midazolam) when administered orally and concurrently as a cocktail relative to the drugs administered alone.
37(0,1,2,2) Details
20162308 Helsby NA, Lo WY, Thompson P, Laking GR: Do 5-fluorouracil therapies alter CYP2C19 metaboliser status? . Cancer Chemother Pharmacol. 2010 Feb 17.

Down regulation of CYP2C9 and CYP2C19 synthesis by 5FU therapies may explain the adverse effect of 5FU on the clinical disposition of warfarin and phenytoin.
36(0,1,1,6) Details
19745563 Sandanaraj E, Lal S, Cheung YB, Xiang X, Kong MC, Lee LH, Ooi LL, Chowbay B: VKORC1 diplotype-derived dosing model to explain variability in warfarin dose requirements in Asian patients. Drug Metab Pharmacokinet. 2009;24(4):365-75.

The present study identifies the influence of VKORC1 diplotypes, CYP2C9 and CYP2C19 variants on warfarin disposition and dose requirements in Chinese patients (n=107).
13(0,0,2,3) Details
19753682 Niioka T, Uno T: CYP2C19 genotype-based (R)-warfarin disposition assessment: some views on data analysis. J Clin Pharm Ther. 2009 Oct;34(5):611-2.
6(0,0,1,1) Details
20175808 Srinivas NR: CYP2C19 genotype-based (R)-warfarin disposition assessment - some views on data analysis. J Clin Pharm Ther. 2009 Dec;34(6):727-8.
6(0,0,1,1) Details
19378397 Masek V, Anzenbacherova E, Machova M, Brabec V, Anzenbacher P: Interaction of antitumor platinum complexes with human liver microsomal cytochromes P450. Anticancer Drugs. 2009 Jun;20(5):305-11.

Interestingly, clinically non-significant inhibition was found with the CYP2C9 and CYP2C8 indicating low probability of interactions with, for example, warfarin.
Interaction of nine human hepatic cytochromes P450 (CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1, and CYP3A4) with six platinum complexes was studied using pooled human microsomes.
2(0,0,0,2) Details
18784266 Inoue T, Nitta K, Sugihara K, Horie T, Kitamura S, Ohta S: CYP2C9-catalyzed metabolism of S-warfarin to 7-hydroxywarfarin in vivo and in vitro in chimeric mice with humanized liver. Drug Metab Dispos. 2008 Dec;36(12):2429-33. Epub 2008 Sep 10.

The CYP2C isoform in chimeric mouse liver was also confirmed to be the human isoform, CYP2C9, by immunoblot analysis.
2(0,0,0,2) Details
18381488 Lu C, Berg C, Prakash SR, Lee FW, Balani SK: Prediction of pharmacokinetic drug-drug interactions using human hepatocyte suspension in plasma and cytochrome P450 phenotypic data. Drug Metab Dispos. 2008 Jul;36(7):1261-6. Epub 2008 Apr 1.

Using the available P450 phenotypic information on theophylline, tolbutamide, omeprazole, S-warfarin, phenytoin, cyclosporine, and midazolam and that determined in this study for sirolimus and tacrolimus, we found that the predictions for area under the curve increases for most of these drugs in the presence of fluconazole were remarkably similar (within 35%) to the observed clinical values.
Fluconazole is also a moderate inhibitor of CYP2C9 and CYP2C19.
1(0,0,0,1) Details
19855097 Chaudhry AS, Urban TJ, Lamba JK, Birnbaum AK, Remmel RP, Subramanian M, Strom S, You JH, Kasperaviciute D, Catarino CB, Radtke RA, Sisodiya SM, Goldstein DB, Schuetz EG: CYP2C9*1B promoter polymorphisms, in linkage with CYP2C19*2, affect phenytoin autoinduction of clearance and maintenance dose. J Pharmacol Exp Ther. 2010 Feb;332(2):599-611. Epub 2009 Oct 23.

The commonly prescribed antiepileptic drug phenytoin has a narrow therapeutic range and wide interindividual variability in clearance explained in part by CYP2C9 and CYP2C19 coding variants.
These rPMs explained as much as 10% of the variation in phenytoin maintenance dose in epileptic patients, but were not correlated with other patients' warfarin dose requirements or with phenytoin metabolite ratio in human liver microsomes.
1(0,0,0,1) Details
19067473 Vakily M, Lee RD, Wu J, Gunawardhana L, Mulford D: Drug interaction studies with dexlansoprazole modified release (TAK-390MR), a proton pump inhibitor with a dual delayed-release formulation: results of four randomized, double-blind, crossover, placebo-controlled, single-centre studies. Clin Drug Investig. 2009;29(1):35-50. doi: 10.2165/0044011-200929010-00004.

As with lansoprazole, dexlansoprazole is metabolized mainly by CYP3A and CYP2C19.
METHODS: Four separate randomized, double-blind, two-way crossover, placebo-controlled, single-centre studies were conducted in healthy volunteers to evaluate the effect of dexlansoprazole on the pharmacokinetics of four test substrates (diazepam, phenytoin, theophylline [administered as intravenous aminophylline] and warfarin), which were selected based on in vitro and/or in vivo data that suggest a potential drug interaction with CYP isoenzymes or potentially coadministered narrow therapeutic index drugs.
1(0,0,0,1) Details
20147896 Dumond JB, Vourvahis M, Rezk NL, Patterson KB, Tien HC, White N, Jennings SH, Choi SO, Li J, Wagner MJ, La-Beck NM, Drulak M, Sabo JP, Castles MA, Macgregor TR, Kashuba AD: A Phenotype-Genotype Approach to Predicting CYP450 and P-Glycoprotein Drug Interactions With the Mixed Inhibitor/Inducer Tipranavir/Ritonavir. Clin Pharmacol Ther. 2010 Feb 10.


The subjects received oral (p.o.) caffeine, warfarin + vitamin K, omeprazole, dextromethorphan, and midazolam and digoxin (p.o. and intravenous (i.v.)) at baseline, during the first three doses of TPV/r (500 mg/200 mg b.i.d.), and at steady state.
0(0,0,0,0) Details
19408964 Miller GP, Jones DR, Sullivan SZ, Mazur A, Owen SN, Mitchell NC, Radominska-Pandya A, Moran JH: Assessing cytochrome P450 and UDP-glucuronosyltransferase contributions to warfarin metabolism in humans. Chem Res Toxicol. 2009 Jul;22(7):1239-45.

On the basis of total OH-WAR levels, (S)-7-OH-WAR was the predominant metabolite indicating the significance of CYP2C9 in WAR metabolism, although other CYP2C enzymes also contributed to clearance of this isomer. (R)-WAR hydroxylation to OH-WARs was more diverse among the patients as reflected in varying contributions of CYP1A2 and multiple CYP2C enzymes.
1(0,0,0,1) Details
20043560 Kuanprasert S, Dettrairat S, Palacajornsuk P, Kunachiwa W, Phrommintikul A: Prevalence of CYP2C9 and VKORC1 mutation in patients with valvular heart disease in northern Thailand. J Med Assoc Thai. 2009 Dec;92(12):1597-601.

BACKGROUND: Warfarin has been widely used for the prevention and treatment of thromboembolism.
The purpose of the present study was to investigate the prevalence of CYP2C and VKORC1 in the Northern Thai population.
1(0,0,0,1) Details
19752777 Jorgensen AL, Al-Zubiedi S, Zhang JE, Keniry A, Hanson A, Hughes DA, Eker D, Stevens L, Hawkins K, Toh CH, Kamali F, Daly AK, Fitzmaurice D, Coffey A, Williamson PR, Park BK, Deloukas P, Pirmohamed M: Genetic and environmental factors determining clinical outcomes and cost of warfarin therapy: a prospective study. Pharmacogenet Genomics. 2009 Oct;19(10):800-12.

Novel associations with some clinical outcomes were found with single nucleotide polymorphisms in the cytochrome 450 genes CYP2C18 and CYP2C19, which were independent of the associations observed with CYP2C9 and in genes encoding CYP3A5, protein S and clotting factor V, although the variability explained by these genes was small.
1(0,0,0,1) Details
19245785 DiMaio Knych HK, DeStefano Shields C, Buckpitt AR, Stanley SD: Equine cytochrome P450 2C92: cDNA cloning, expression and initial characterization. Arch Biochem Biophys. 2009 May 1;485(1):49-55. Epub 2009 Feb 24.

CYP2C92 demonstrated comparable tolbutamide and (S)-warfarin hydroxylase activity compared to CYP2C9, upon addition of b (5) to the reactions.
The results of this study demonstrate substantial interspecies differences in metabolism of substrates by CYP2C orthologues in the horse and human and support the need to fully characterize this enzyme system in equids.
1(0,0,0,1) Details
18855611 Zhou SF, Di YM, Chan E, Du YM, Chow VD, Xue CC, Lai X, Wang JC, Li CG, Tian M, Duan W: Clinical pharmacogenetics and potential application in personalized medicine. Curr Drug Metab. 2008 Oct;9(8):738-84.

For example, warfarin serves as a good practical example of how pharmacogenetics can be utilized prior to commencement of therapy in order to achieve maximum efficacy and minimum toxicity.
CYP2D6, CYP2C19 and CYP2C9 gene polymorphisms and gene duplications account for the most frequent variations in phase I metabolism of drugs since nearly 80% of drugs in use today are metabolised by these enzymes.
1(0,0,0,1) Details
18975556 Yokota H, Satoh Y, Ono Y, Kaneko M, Ikeda H, Tsuji S, Yatomi Y: [Establishment of a pharmacogenomic testing system for the realization of individual pharmacotherapy]. Rinsho Byori. 2008 Sep;56(9):772-80.

Furthermore, in August 2007, testing for CYP2C9*3, the enzyme involved in the metabolism of Warfarin, and vitamin K epoxidereductase1 (VKORC1) 6484 C> T was started.
In the CYP2C19 genotyping, the high incidence of poor metabolizers has been demonstrated; it was speculated that the test could confirm the adverse effects of the drug, i.e., after administration of the drug to patients.
1(0,0,0,1) Details
20217574 Burmester JK, Sedova M, Shapero MH, Mansfield E: DMET microarray technology for pharmacogenomics-based personalized medicine. Methods Mol Biol. 2010;632:99-124.

The power of the DMET Assay has previously been demonstrated with regard to several different drugs including warfarin and clopidogrel.
Additionally, the assay has been used to demonstrate that CYP2C19 variants with decreased enzyme activity led to lower levels of the active clopidogrel metabolite, resulting in a decreased inhibition of platelets and a higher rate of cardiovascular events when compared to noncarriers of the DNA variant.
1(0,0,0,1) Details
19204416 Guessous I, Gwinn M, Yu W, Yeh J, Clyne M, Khoury MJ: Trends in pharmacogenomic epidemiology: 2001-2007. Public Health Genomics. 2009;12(3):142-8. Epub 2009 Feb 10.

Warfarin was the single most frequently cited drug.
Just 4 genes together accounted for nearly one-fifth of all publications: ABCB1, CYP2C9, CYP2C19, and CYP2D6.
1(0,0,0,1) Details
18574025 Wadelius M, Chen LY, Lindh JD, Eriksson N, Ghori MJ, Bumpstead S, Holm L, McGinnis R, Rane A, Deloukas P: The largest prospective warfarin-treated cohort supports genetic forecasting. Blood. 2009 Jan 22;113(4):784-92. Epub 2008 Jun 23.

0(0,0,0,0) Details