Re-thinking the possible interaction between proton pump inhibitors and capecitabine

Proton Pump Inhibitors (PPI) rank within the top ten most prescribed medications in Europe and USA. A high frequency of PPI use has been reported amongst patients undergoing chemotherapy, to mitigate treatment-induced gastritis or gastro-oesophageal reflux. Several recent, mostly retrospective, obse...

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Bibliographic Details
Published inCancer chemotherapy and pharmacology Vol. 90; no. 5; pp. 381 - 388
Main Authors Jeong, Soo Hee, Molloy, Lara, Ang, Edmond, Helsby, Nuala
Format Journal Article
LanguageEnglish
Published Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2022
Springer Nature B.V
Subjects
Bioavailability
Cancer Research
Cancer therapies
Chemotherapy
Colorectal cancer
Drug dosages
Drug interactions
Gastritis
Gastroesophageal reflux
Inhibitors
Long-term effects
Medicine
Medicine & Public Health
Observational studies
Oncology
Patients
Pharmacokinetics
Pharmacology
Pharmacology/Toxicology
Proton pump inhibitors
Review
Review Article
Treatment outcomes
Proton pump inhibitors
Capecitabine
Drug–drug interaction
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Summary:Proton Pump Inhibitors (PPI) rank within the top ten most prescribed medications in Europe and USA. A high frequency of PPI use has been reported amongst patients undergoing chemotherapy, to mitigate treatment-induced gastritis or gastro-oesophageal reflux. Several recent, mostly retrospective, observational studies have reported inferior survival outcomes among patients on capecitabine who concomitantly use PPI. Whilst this association is yet to be definitively established, given the prominence of capecitabine as an anti-cancer treatment with multiple indications, these reports have raised concern within the oncological community and drug regulatory bodies worldwide. Currently, the leading mechanism of interaction postulated in these reports has focussed on the pH altering effects of PPI and how this could diminish capecitabine absorption, leading to a decrease in its bioavailability. In this discourse, we endeavour to summarise plausible pharmacokinetic interactions between PPI and capecitabine. We provide a basis for our argument against the currently proposed mechanism of interaction. We also highlight the long-term effects of PPI on health outcomes, and how PPI use itself could lead to poorer outcomes, independent of capecitabine.
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ISSN:0344-5704
1432-0843
DOI:10.1007/s00280-022-04473-9