Influence of Lansoprazole and Rabeprazole on Mycophenolic Acid Pharmacokinetics One Year After Renal Transplantation
Comment from Dr. Oesterheld: This article shows how sophisticated clinical studies have become, this study shows that genetic variations of ABCB1 and CYP2C19 can increase lansoprazole concentration and secondarily, decrease the absorption of mycophenolic acid. So this drug interaction is based in genetic variation and changes in absorption.
Ther Drug Monit. 2008 Feb;30(1):46-51. Influence of Lansoprazole and Rabeprazole on Mycophenolic Acid Pharmacokinetics One Year After Renal Transplantation.
Miura M, Satoh S, Inoue K, Kagaya H, Saito M, Suzuki T, Habuchi T.
From the Department of *Pharmacy and †Urology, Akita University School of Medicine, Akita, Japan. Peptic ulcer disease is a common complication after organ transplantation, and long-term administration of antiulcer agents is needed in many renal transplant recipients. Although several drug interactions with mycophenolic acid (MPA), the active metabolite of the prodrug mycophenolate mofetil (MMF), have been reported, little is known about the interaction between MPA and proton pump inhibitors (PPIs). The present study investigated the drug interaction between MMF and lansoprazole or rabeprazole and the impact of cytochrome(CYP) 2C19, and multidrug resistance (MDR)1 C3435T polymorphisms on these drug interactions at 1 year after renal transplantation.
Retrospectively, 61 recipients were divided into 3 groups: MMF and tacrolimus as combination immunosuppressive therapy, together with either 30 mg lansoprazole (n = 22) or 10 mg rabeprazole (n = 17), or without PPI (n = 22). One year after transplantation, plasma concentrations of MPA were measured by high-performance liquid chromatography. The mean dose-unadjusted and -adjusted Cmax of MPA with 30 mg lansoprazole were significantly lower than those without PPI (11.8 vs. 17.8 mug/mL, P = 0.0197, and 22.6 vs. 33.1 ng/mL/mg MMF, P = 0.0222, respectively). In recipients having the CYP2C19 *1/*2 +*1/*3 or MDR1 C3435T CC genotype, the mean dose-adjusted AUC0-12 of MPA with 30 mg lansoprazole was significantly smaller than that with 10 mg rabeprazole or without PPI. The plasma concentration of MPA was influenced by 30 mg lansoprazole but not 10 mg rabeprazole. Because of the greater gastric acid secretion-inhibitory effect of 30 mg lansoprazole in recipients having the CYP2C19 *1/*2+*1/*3 (intermediate metabolizer) or MDR1 C3435T CC genotype, the elution and hydrolysis of MMF might be decreased. Although the clinical relevance might be minor, the fact that administration of 30 mg lansoprazole in patients having the CYP2C19 *2 or *3 allele or the
MDR1 C3435T CC genotype diminishes the absorption of MPA in the maintenance stage after renal transplantation should be taken into consideration with regard to the MPA pharmacokinetics.
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