Abstract
Background: Liver transplant recipients are frequently treated with proton pump inhibitors. Drug interactions have been described especially with respect to omeprazole. Due to the lower binding capacity of pantoprazole to CYP2C19 this drug became preferred and became the most used proton pump inhibitor in Germany. The data on the influence of pantoprazole on immunosuppressive drugs in liver transplant recipients a very scarce.Methods: The authors performed a single center analysis in liver transplant recipients on the effect of pantoprazole on the serum trough levels of different immunosuppressants. The trough levels were compared over a period of 1 year before and after start or stop of a continuous oral co-administration of 40 mg pantoprazole once daily.Results: The serum trough levels of tacrolimus (n = 30), everolimus (n = 7), or sirolimus (n = 3) remain constant during an observation period of at least 1 year before and after co-administration of pantoprazole. None of the included patients needed a change of dosage of the observed immunosuppressants during the observation period.Conclusions: The oral co-administration of pantoprazole is safe in immunosuppressed liver transplant recipients according to the serum trough levels of tacrolimus, everolimus, and sirolimus. This analysis provides first data on the influence of pantoprazole on immunosuppressive drugs in liver transplant recipients.
Highlights
Proton pump inhibitors (PPIs) are frequently used in non-transplanted liver cirrhotic patients [1]
The metabolizing process leads to a competitive inhibition of these enzymes which might affect the metabolism of other drugs like the immunosuppressive drugs tacrolimus, everolimus and sirolimus which are metabolized by CYP3A4 [7]
The combination of omeprazole with the immunosuppressive agents cyclosporin A as well as tacrolimus in liver transplant recipients might lead to side effects due to increased serum levels e.g., nephrotoxicity, neurotoxicity and post-transplant diabetes mellitus [12,13,14,15,16,17,18]
Summary
Proton pump inhibitors (PPIs) are frequently used in non-transplanted liver cirrhotic patients [1]. Drug interactions of PPIs have been described during the last years, especially about omeprazole [6, 7]. Omeprazole is strongly metabolized by cytochrome P450 enzymes (CYP), especially by CYP2C19 and less by CYP3A4 [8,9,10,11]. Liver transplant recipients are frequently treated with proton pump inhibitors. Drug interactions have been described especially with respect to omeprazole. Due to the lower binding capacity of pantoprazole to CYP2C19 this drug became preferred and became the most used proton pump inhibitor in Germany. The data on the influence of pantoprazole on immunosuppressive drugs in liver transplant recipients a very scarce
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