PHARMACODYNAMIC AND PHARMACOKINETIC REACTIONS IN THE USE OF NEXT-GENERATION BIOTHERAPEUTICS (PROBIOTICS)
DOI:
https://doi.org/10.32782/2786-7684/2025-3-15Keywords:
probiotics, pharmacokinetics, pharmacodynamics, microbiota, drug metabolism, drug interactionAbstract
Introduction. Modern pharmacotherapy increasingly views probiotics not only as tools for microbiota correction but also as potentially active biotherapeutic agents capable of influencing the pharmacokinetics and pharmacodynamics of drugs. However, the mechanisms and clinical significance of these interactions remain insufficiently studied. Given the growing use of drugs with narrow therapeutic windows and the wide availability of probiotic products, investigating such effects is a relevant task for clinical pharmacology and biopharmaceutics. Objective of the research: To analyze the impact of probiotics on the pharmacokinetic and pharmacodynamic characteristics of drugs through a systematic review of recent literature. Materials and Methods. A literature analysis was conducted using publications from PubMed, Scopus, Web of Science, and national sources over the past 10 years. Sources were selected using keywords such as “probiotics,” “pharmacokinetics,” “drug metabolism,” “microbiota,” and related terms. The study methods included content analysis and comparative analysis of clinical and preclinical data. Results and Discussion. Probiotics can alter the activity of metabolic enzymes (CYP450, GST, UGT), regulate transporter expression (P-gp, OATP), and modulate microbial enzymes (β-glucuronidases, azoreductases, nitroreductases). These changes can affect drug bioavailability, toxicity, and efficacy–for example, with L-DOPA, gliclazide, and chemotherapy agents. Both beneficial effects (e.g., reduced irinotecan toxicity, enhanced PD-1 inhibitor efficacy) and risks (e.g., decreased digoxin efficacy, altered tacrolimus levels) have been reported. Some effects are strain-specific. Conclusions. Probiotics can significantly influence the pharmacological properties of drugs, and these effects should be considered in personalized therapy. Further research is needed to standardize evaluation approaches and develop clinical guidelines for combining probiotics with specific drug classes.
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