A multicentre prospective study evaluating the impact of proton-pump inhibitors omeprazole and pantoprazole on voriconazole plasma concentrations.
Sara Blanco DoradoOlalla Maroñas AmigoAna Latorre-PellicerMaría Teresa Rodríguez JatoAna López-VizcaínoAurea Gómez MárquezBelén Bardán GarcíaDolores Belles MedallGema Barbeito CastiñeirasMaría Luisa Pérez Del Molino BernalManuel Campos-ToimilFrancisco Otero EspinarAndrés Blanco HortasIrene Zarra FerroÁngel CarracedoMaría Jesús LamasAnxo Fernández-FerreiroPublished in: British journal of clinical pharmacology (2020)
Voriconazole is an antifungal metabolised by CYP2C19 enzyme, which can be inhibited by proton-pump inhibitors (PPIs). A prospective observational study was carried out to determine the influence of PPIs on voriconazole pharmacokinetic. The 78 patients included were divided into 4 groups: omeprazole (n = 32), pantoprazole (n = 25), esomeprazole (n = 3) and no PPI (n = 18). Patients with no PPI had no significant difference in plasma voriconazole concentration when compared with those with PPI (2.63 ± 2.13 μg/mL [95% confidence interval {CI} 1.57-3.69] vs 2.11 ± 1.73 μg/mL [95%CI 1.67-2.55], P > .05). However, voriconazole plasma concentration was significantly lower in patients treated with pantoprazole vs those treated with omeprazole (1.44 ± 1.22 μg/mL [95%CI 0.94-1.94) vs 2.67 ± 1.88 μg/mL [95%CI 2.02-3.32], P = .013) suggesting a greater CYP2C19 enzyme inhibitory effect of omeprazole. This study demonstrates the greater CYP inhibition capacity of omeprazole and should be helpful for the choice of PPIs for patients treated with voriconazole.