Acute Porphyria Drug Database

N01BB09 - Ropivacaine
Propably not porphyrinogenic
PNP

Rationale
Ropivacaine differs structurally from the bupivacaine only in the in the substitution of a propyl group for the N-butyl group. Sharing the structural metabolic prerequisites of the non-porphyrogenic drug bupivacaine gives theoretical grounds to classify ropivacaine as probably not porphyrinogenic.
Chemical description
Ropivacaine is a local anesthetic of the amide type. Ropivacaine is exclusively the S-(-)-enantiomer (Ekström, G. & Gunnarsson, U.B., 1996). Ropivacaine differs from bupivacaine only in the 1-substituent on the ring-nitrogen, i.e. propyl versus butyl.
Therapeutic characteristics
Local anaesthetic.
Hepatic exposure
Volume required to reach uM concentrations when injected intravenously: approximately 1.5 ml (of ropivacaine 10mg/ml).
Metabolism and pharmakokinetics
Ropivacaine is extensively metabolised in the liver, predominantly mediated by CYP1A2; the isoenzyme CYP3A4 plays a minor role in the metabolism of ropivacaine. Ropivacaine is a ligand to CYP 3A4 and may in therapeutic use reach the hepatocyte µM levels needed for activation the nuclear receptors that trigger transcription of the ALAS1 gene. However, the drug is not found to be an inducer or irreversible inhibitor of drug metabolizing cytochrome P450 species (Rendic, 2002) and is therefore most probably devoid of capacity for ALAS1-induction. CYP1A2 is the most important isozyme for the metabolism of ropivacaine. A potent inhibitor of CYP3A4 causes a minor decrease in clearance of ropivacaine, which should be of no clinical relevance (Arlander, E., Ekström, G. et al, 1998) (Ekström, G. & Gunnarsson, U.B., 1996). Ropivacaine is an inhibitor of CYP2D6, but this does not seem to be of major clinical importance (Wink J., Veering B.T. et al, 2008). Rendic (2002) reports that ropivacaine is a substrate of CYP3A4 CYP1A1, CYP1A2, CYP2B6 and 2D6.
IPNet drug reports
None.

References

  1. Scientific articles
  2. Rendic, S. Summery of information on human CYP enzymes: human P450 metabolism. Drug metabolism reviews 2002; 34(1&2), 83-448. #1025
  3. Thunell, Stig, Evidence-based porphyrogenicity assessment of seven local anasthetics (2009, to be published). #2510
  4. Arlander E, Ekström G et al. Metabolism of ropivacaine in humans is mediated by CYP1A2 and to a minor extent by CYP3A4: an interaction study with fluvoxamine and ketoconazole as in vivo inhibitors. Clin Pharmacol Ther 1998; 64(5):484-91. PMID 9834040. #2511
  5. Ekström G, Gunnarsson UB. Ropivacaine, a new amide-type local anesthetic agent, is metabolized by cytochromes P450 1A and 3A in human liver microsomes. Drug Metab Dispos 1996;24(9):955-61. PMID 8886604. #2512
  6. Wink J, Veering BT, et al. The effect of a long term epidural infusion of ropivacaine on CYP2D6 activity. Anesth Analg 2008; 106(1):143-6. PMID 18165569. #4647
  7. Drug reference publications
  8. Sweetman SC, editor. Martindale: The complete drug reference. Ropivacaine Hydrochloride. Pharmaceutical Press 2009. #2513

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