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Axid Oral Solution and Pazopanib Hydrochloride

Determining the interaction of Axid Oral Solution and Pazopanib Hydrochloride and the possibility of their joint administration.

Check result:
Axid Oral Solution <> Pazopanib Hydrochloride
Relevance: 16.06.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

By reducing the acidity level in the stomach, raNITIdine may interfere with the absorption of PAZOPanib and reduce its effectiveness. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that interact to a lesser extent, or you may need to adjust the timing of your medication doses to minimize the interaction. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

GENERALLY AVOID: Coadministration with proton pump inhibitors or H2-receptor antagonists may significantly decrease the oral bioavailability of pazopanib and reduce its concentrations in plasma. The solubility of pazopanib is pH-dependent, thus an increase in pH may interfere with its absorption. According to the product labeling, pazopanib is very slightly soluble at pH 1 and practically insoluble above pH 4 in aqueous media. When pazopanib (800 mg once daily in the morning) was coadministered with esomeprazole (40 mg once daily in the evening) for 5 days in 12 patients with advanced solid tumors, mean steady-state pazopanib peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by approximately 40% each. The AUCs of three metabolites were also decreased. Mean steady-state trough concentration of pazopanib was reduced to 17.3 mcg/mL, which is close to the reported threshold of >=15 mcg/mL for clinical efficacy as suggested by a phase I trial of pazopanib. However, the potential for subtherapeutic pazopanib exposure in some patients cannot be excluded.

MANAGEMENT: Concomitant use of pazopanib with proton pump inhibitors and H2-receptor antagonists should generally be avoided. If acid-suppression therapy is required, short-acting antacids should be considered, with dosing separated by several hours from pazopanib dosing. Some experts recommend administering pazopanib at least 1 hour before or 2 hours after antacids. Alternatively, a group of Dutch clinical pharmacologists and the EMA (European Medicines Agency) suggest that pazopanib may be given with a proton pump inhibitor, when necessary, if pazopanib is administered without food once daily in the evening concomitantly with the proton pump inhibitor. This recommendation is based on physiological considerations rather than actual clinical data. Since gastric pH has been reported to be lowest just before dinner in patients treated with esomeprazole daily in the evening, the thought is that impact on pazopanib solubility and absorption should be minimized when pazopanib is also administered in the evening. Similarly, when coadministration with an H2-receptor antagonist is required, it has been recommended that pazopanib be taken without food at least 2 hours before or 10 hours after a dose of the H2-receptor antagonist.

References
  • van Leeuwen RW, van Gelder T, Mathijssen RH, Jansman FG "Drug-drug interactions with tyrosine-kinase inhibitors: a clinical perspective." Lancet Oncol 15 (2014): e315-e326
  • EMEA. European Medicines Agency "EPARs. European Union Public Assessment Reports. Available from: URL: http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid."
  • Yu G, Zheng QS, Wang DX, Zhou HH, Li GF "Drug interactions between tyrosine-kinase inhibitors and acid suppressive agents: more than meets the eye." Lancet Oncol 15 (2014): e469-70
  • "Product Information. Votrient (pazopanib)." GlaxoSmithKline, Research Triangle Park, NC.
  • Tan AR, Gibbon DG, Stein MN, et al. "Effects of ketoconazole and esomeprazole on the pharmacokinetics of pazopanib in patients with solid tumors." Cancer Chemother Pharmacol 71 (2013): 1635-43
  • Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
Axid Oral Solution

Generic Name: nizatidine

Brand name: Baciguent, Probiotic Formula, Proferrin-ES

Synonyms: n.a.

Pazopanib Hydrochloride

Generic Name: pazopanib

Brand name: Votrient

Synonyms: Pazopanib

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

Interaction with food and lifestyle