Drug interactions with proton pump inhibitors.
Omeprazole, lansoprazole and pantoprazole are all mainly metabolised by the polymorphically expressed cytochrome P450 (CYP) isoform CYP2C19 (S-mephenytoin hydroxylase). All 3 proton pump inhibitors have a very limited potential for drug interactions at the CYP level. Small effects on CYP reported for these compounds are usually of no clinical relevance. No dose related adverse effects have been identified, suggesting that the small proportion of slow metabolisers is at no additional risk for clinically important drug interactions. The absorption of some compounds, e.g. benzylpenicillin (penicillin G), are altered during treatment with proton pump inhibitors as a result of the increased intragastric pH. A synergy has been confirmed between omeprazole and amoxicillin or clarithromycin in the antibacterial effect against Helicobacter pylori.
Unge
P
P
Department of Medicine, Sandviken Hospital, Sweden.
Andersson
T
T
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001189:Aryl Hydrocarbon Hydroxylases; D001562:Benzimidazoles / Q000378:metabolism*; D065731:Cytochrome P-450 CYP2C19; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism*; D004347:Drug Interactions; D004791:Enzyme Inhibitors / Q000378:metabolism*; D006801:Humans; D064747:Lansoprazole; D006899:Mixed Function Oxygenases / Q000378:metabolism*; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000378:metabolism*; D000077402:Pantoprazole; D013454:Sulfoxides / Q000378:metabolism*
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001562:Benzimidazoles; D004791:Enzyme Inhibitors; D013454:Sulfoxides; D064747:Lansoprazole; D003577:Cytochrome P-450 Enzyme System; D000077402:Pantoprazole; D006899:Mixed Function Oxygenases; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D009853:Omeprazole