Influence of pantoprazole on the absorption of other drugs.
The substance can weaken the absorption of drugs, the level of bioavailability of which depends on the pH of the stomach (for example, this includes individual antimycotics, among which posaconazole with ketoconazole and itraconazole or other drugs, eg erlotinib).
Drugs used to treat HIV (eg, atazanavir).
The combination of the drug with the substance atazanavir and other drugs against HIV, the absorption index of which varies in accordance with the pH level, can cause a significant decrease in the bioavailability of these drugs, and in addition, affect their effectiveness. Because of this, such a drug combination is considered undesirable.
Anticoagulants of indirect action (such as fenprokumone with warfarin).
Although interactions in the case of a combination of Pantasana with warfarin or fenprocumone are not observed, information about changes in the values of PSI was isolated. Therefore, it is required to perform regular monitoring of the PIF / PI indicators in persons taking indirect anticoagulants together with pantoprazole, and also after its cancellation or in the case of an occasional use of this substance.
The combination of a drug with methotrexate (often in high doses) can cause an increase in the serum levels of methotrexate or its degradation product of hydrometotrexate. As a result of such a change in the values, the development of toxicity of the substance is possible. Therefore, people who use methotrexate in large doses, as well as those who suffer from psoriasis or cancer, are advised to cancel the use of pantoprazole for the duration of treatment.
A significant part of pantoprazole undergo intrahepatic metabolism (with the help of the enzyme system of hemoprotein P450). The main way of this process is demethylation, in which the element 2C19 participates. The effect is carried out and with the use of other metabolic pathways (among them, oxidation with the help of the enzyme CYRZA4). Tests of drugs, the metabolism of which occurs in the same way (it is diazepam with fenprokumone, carbamazepine with glibenclamide and nifedipine, and oral contraception containing substances ethinyl estradiol with levonogestrel), did not reveal significant treatment interactions.
Studies on the possible development of interactions have shown that the active substance Pantasana does not affect the metabolism of components that change with the help of the following elements:
- CYP1A2 (this theophylline with caffeine);
- CYP2S9 (here include naproxen and piroxicam with diclofenac);
- CYP2D6 (for example, metoprolol substance);
- CYP2E1 (among these are ethanol).
The drug does not affect the activity of p-glycoprotein, which ensures the absorption of digoxin.
Combination with antacid medicines does not cause significant interactions.
When studying the relationship between pantoprazole and individual antibiotics (for example, amoxicillin, as well as clarithromycin and metronidazole), it was not possible to identify important interactions.