Pantoprazole – safety in drug-drug interaction
Abstract
The aim of review. To carry out comparative analysis of metabolic pathways of proton pump inhibitors (PPI), to determine the agent with lowest effect on activity of cytochrome CYP2C19 isoenzyme for improvement of safety of combined treatment by pharmaceuticals metabolized by this isoenzyme.
Key points. Pantoprazole is metabolized by CYP2C19 and CYP3A4, however, it has the lowest affinity to these enzymes of all PPIs. The primary metabolite of pantoprazole (the CYP system product 4-hydroxypantoprazole) enters next cytosolic phase of biotransformation i.e. conjugation to sulfate. Second phase of pantoprazole biotransformation does not depend on cytochrome system. It explains lower degree of interaction to CYP2C19 and CYP3A4-metabolized drugs for pantoprazole, in comparison to other PPIs. This is proved by relative safety of clopidogrel to pantoprazole combination in patients with cardio-vascular diseases, demonstrated in clinical studies of the last years.
Conclusion. Data of investigations, available for the present time, in vitro and in vivo allow to consider pantoprazole (Nolpaza) as the most safe drug for application in complex therapy to reduce the drug interaction-associated adverse effects.
About the Authors
E. V. Shikh
State educational government-financed institution of higher professional education Sechenov First Moscow state medical university of the Russian federation Ministry of Health and Social Development
Russian Federation
Russian Federation
D. A. Sychev
State educational government-financed institution of higher professional education Sechenov First Moscow state medical university of the Russian federation Ministry of Health and Social Development
Russian Federation
Russian Federation
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Review
For citations:
Shikh E.V., Sychev D.A. Pantoprazole – safety in drug-drug interaction. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2012;22(5):4-12. (In Russ.)
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