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Lanosterol 14-alpha demethylase Cytochrome P450 3A5 Cytochrome P450 3A4 Cytochrome P450 2B6 Cytochrome P450 2E1 P-glycoprotein ATP-dependent translocase ABCB1 ATP-dependent translocase ABCB1 Solute carrier family 15 member 1 Canalicular multispecific organic anion transporter 2 Cytochrome P450 3A4 Itraconazole Itraconazole 4,4-Dimethylcholesta- 8,14,24-trienol Hydroxyitraconazole Itraconazole Itraconazole Itraconazole Hydroxyitraconazole Lanosterol O2 NADPH Formic acid NADP H2O NADPH O2 NADP H2O H+ Heme Heme Heme Heme Heme Heme Cytochrome P450 3A7 Heme Itraconazole Pathway Steroid Biosynthesis Renal and Fecal Excretion Itraconazole ingested through a pill Blood Vessel Intestinal Lumen Hepatocyte Intestinal Epithelial Cell Itraconazole is sent to target cells unchanged Endoplasmic Reticulum Itraconazole is more selective for fungal Lanosterol 14-alpha demethylase, however, it does still inhibit the enzyme in homo sapiens to a degree. Itraconazole is extensively metabolized into many different metabolites. The main one being Hydroyitraconazole. Only 0.03% of renal excretion is Itraconazole. 40% of the dose is inactive metabolites that excreted renally. 3-18% of the dose is excreted fecally Itraconazole inhibits these 5 liver enzymes that have the same azole ring as Lanosterol 14-alpha demethylase. It is much more selective for fungal enzymes, so only sometimes inhibits these. Bile Ducts
Endoplasmic Reticulum CYP51A1 CYP3A5 CYP3A4 CYP2B6 CYP2E1 ABCB1 ABCB1 ABCB1 SLC15A1 ABCC3 CYP3A4 Itraconazole Itraconazole 4,4- Dimethylcholesta- 8,14,24- trienol Hydroxyitraconazole Itraconazole Itraconazole Itraconazole Hydroxyitraconazole Lanosterol Oxygen NADPH Formic acid NADP Water NADPH Oxygen NADP Water Hydrogen Ion CYP3A7 Itraconazole Pathway Steroid Biosynthesis Renal and Fecal Excretion