Pantoprazole Drug Interactions
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Increased Effect/Toxicity
Decreased effect due to pantoprazole
- Small studies have suggested that coadministration of PPI's (specifically omeprazole) with atazanavir and nelfinavir may result in decreased exposure (AUC) of the antiviral drug. The exact mechanism of the interaction is unidentified, however it is hypothesized that the interaction is likely a class effect of all PPI's. The manufacturers of atazanavir and nelfinavir recommend against concomitant treatment with PPI's.
- Many medications rely on certain intragastric pH for absorption (such as ampicillin, delavirdine, iron salts, itraconazole, ketoconazole, gefitinib, cyanocobalamin). Administration of pantopraozole raises intragastric pH, decreasing the absorption, and subsequent exposure, to the pH dependent medications.
Decreased effect of pantoprazole
- Pantoprazole (as with other PPI's) only work on active proton pumps of parietal cells in the gastric mucosa. Medications such as H2, that inhibit the proton pump at any point upstream of the binding site of PPI's, will prevent optimal acid suppression by pantoprazole.
Increased effect/toxicity
- Pantoprazole is metabolized extensively via CYP2C19. Competitive metabolism via CYP 2C19, may cause a decrease in the metabolism of medications dependent upon the CYP 2C19 enzyme. Medicatons such as warfarin, fluvastatin, and carbamazepine may require dosage adjustment when coadministered with pantoprazole. Although premarket, phase III studies did not suggest a basis for pharmacokinetic interaction between warfarin and pantoprazole, several post-marketing case reports have suggested pantoprazole as the cause of a sudden increase in INR. Monitoring is advised when pantoprazole is either discontinued or added to a drug regimen containing the above medications. Carbamazepine and Fluvastatin AUC's have been shown to increase when administered with pantoprazole, therefore caution and monitoring is advised when used with pantoprazole. [1][2]
- The risk of upper GI adverse effects associated with alendronate therapy was increased according to a small study with omeprazole and alendronate coadministration. Caution is advised if patients are treated with both alendronate and pantoprazole [3]
Miscellaneous increased effects/toxicity:
- The SODAS drug delivery system that is utilized in dexmethylphenidate XR and methylphenidate LA (Focalin XR and Ritalin LA respectively) relies on the higher pH of the small intestine for release of the drug. Treatment with pantoprazole may raise intragastric pH to a level which can cause release of the drug from the SODAS system in an immediate release manner. Caution is advised when coadministering either medication with pantoprazole.
