Scientia Pharmaceutica Review Pharmacokinetic Enhancers (Boosters)—Escort for Drugs against Degrading Enzymes and Beyond Jürgen Krauß and Franz Bracher * Department of Pharmacy-Center for Drug Research, Ludwig-Maximilians University, Butenandtstr. 5-13, 81377 Munich, Germany;
[email protected] * Correspondence:
[email protected]; Tel.: +49-89-218077301 Received: 22 August 2018; Accepted: 20 September 2018; Published: 27 September 2018 Abstract: Pharmacokinetic enhancers (boosters) are compounds used in combination with a primary therapeutic agent (drug) and are not used for their direct effects on the disease but because they enhance or restore the activity of the primary agent. Hence, in certain cases, they represent an indispensable escort for enzyme-labile drugs. Pharmacokinetic enhancers can exert their activity on different ways. In the most common case, they inhibit enzymes such as human cytochrome P450 enzymes in the liver or other organs and, thereby, block or reduce undesired metabolism and inactivation of the primary drug. In this review, an overview will be given on the therapeutically most important classes of pharmacokinetic enhancers like β-lactamase inhibitors, inhibitors of CYP (cytochrome P450) enzymes in HIV therapy and hepatitis C, boosters for fluoropyrimidine-type anticancer agents, compounds utilized for enabling therapy of Parkinson’s disease with levodopa, and others. Inhibitors of efflux pumps in both pathogenic bacteria and tumor cells will be addresses shortly. Keywords: pharmacokinetic enhancer; booster; enzyme; inhibitor; β-lactamase; DOPA decarboxylase; antibiotic; resistance; efflux pump; protease; antimetabolite 1. Introduction Pharmacokinetic enhancers, which are also named boosters or boosting agents, are compounds used in combination with a primary therapeutic agent (drug) not for their direct effects on the disease itself but because they enhance or restore the activity, increase the levels, and/or prolong the half-life of the primary agent.