Effect of high-intensity interval exercise on metformin pharmacokinetics in healthy men, assessed through a population pharmacokinetic model

Abstract

Background and Purpose: Metformin and exercise are first-line therapies for prediabetes and type 2 diabetes. However, it is unclear whether the combination of metformin and exercise is synergistic or antagonistic. The aim of this study was to investigate the effect of exercise on metformin pharmacokinetics and help clarify the contradictory outcomes regarding the combination of metformin and exercise. Experimental Approach: Nine healthy men completed three 24-h sessions. In all sessions, participants received a single oral dose of 1000 mg metformin. In two of the sessions, they performed a high-intensity interval exercise test, 0.75 h (session A) or 4.65 h (session B), after metformin administration; they performed no exercise in the third session (reference). Venous blood samples were collected pre-dose and at 0.66, 1.4, 2.1, 2.5, 3, 3.5, 4, 4.5, 5.3, 6, 6.5, 7, 8, 10, 12 and 24 h after metformin administration. Non-compartmental pharmacokinetic analysis was performed, and a population pharmacokinetic (PopPK) model was constructed to detect covariates for explaining inter-individual and inter-occasion variability (IOV). Key Results: Significant differences were found between sessions for all pharmacokinetic parameters except t1/2. The PopPK model showed that exercise in session A reduced apparent volume of distribution (V/F) and apparent total plasma clearance (CL/F) by 31% and 25%, respectively; exercise in session B reduced CL/F by 17%. Conclusions and Implications: Exercise affected metformin pharmacokinetics, leading to an increase in plasma metformin concentration and becoming a covariate that explains the IOV of metformin pharmacokinetics. Exercise should be performed during a specific time after metformin intake.