Effects of antibiotics on the pharmacokinetics of indoxyl sulfate, a nephro-cardiovascular toxin

Shu Shang Luo, Chung Ping Yu, Yow Wen Hsieh, Pei Dawn Lee Chao, Douglas H. Sweet, Yu Chi Hou*, Shiuan Pey Lin

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

6 Scopus citations


Indoxyl sulfate (IS), a highly protein-bound nephro-cardiovascular toxin, was poorly removed by hemodialysis. IS exists as anions in the body and the renal excretion is mediated by organic anion transporter 1 (OAT1) and OAT3. Acidic antibiotics such as cephalosporins and fluoroquinolones were putative substrates/inhibitors of OATs. We hypothesized that cephalosporins and fluoroquinolones might compete with IS for OAT1- and/or OAT3-mediated renal excretions. This study investigated the effects of ciprofloxacin, cefuroxime, cefotaxime, cefazolin and ofloxacin on the intravenous pharmacokinetics of IS in rats. IS was intravenously injected with and without each individual antibiotics, and the concentrations of IS in serum and lysate were determined by HPLC. The results showed that ciprofloxacin significantly increased AUC0-t and T1/2 of IS by 272% and 491%, respectively, and decreased the clearance by 71%. However, ofloxacin, cefuroxime, cefotaxime and cefazolin did not alter the pharmacokinetics of IS. Furthermore, cell line study showed that ciprofloxacin inhibited the OAT3-mediated transport of IS. This study indicates 30 mg/kg of ciprofloxacin decreased the clearance of IS through inhibition on the OAT3-mediated transport, whereas 50 mg/kg of ofloxacin, cefuroxime, cefotaxime and cefazolin did not show significant influence.

Original languageEnglish
Pages (from-to)588-592
Number of pages5
Issue number5
StatePublished - 03 05 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.


  • HEK293
  • Organic anion transporter
  • cephalosporins
  • ciprofloxacin
  • indoxyl sulfate


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