New Insight Into an Effective Treatment of Marginal Ulceration After Roux-en-Y Gastric Bypass

Tansel, Aylin; Graham, David Y.

doi:10.1016/j.cgh.2016.12.025

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…Vonoprazan was confirmed to be superior in the secondary prevention of nonsteroidal anti-inflammatory drug-induced peptic ulcers (Mizokami et al, 2018). Vonoprazan is also thought to potentially show superiority over PPIs in patients who are difficult to treat, given that it can reliably achieve a therapeutically required intragastric pH (Tansel and Graham, 2017).…”

Section: Discussionmentioning

confidence: 99%

Cytochrome P450-Based Drug-Drug Interactions of Vonoprazan In Vitro and In Vivo

Wang

et al. 2020

Front. Pharmacol.

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Background: Vonoprazan fumarate is a potassium-competitive acid blocker that was developed as a novel acid-suppressing drug for multiple indications. As a potential alternative to proton-pump inhibitors, the determination of the drug-drug interactions is vital for further applications. Probe drug cocktails are a type of rapid, economical, and efficient approach for evaluating cytochrome P450 enzyme activities. Since vonoprazan is metabolized partly by cytochrome P450, cocktails were used to study CYP-based drugdrug interactions. Methods: This study was conducted both in vitro and in vivo. In the in vitro study of rat liver microsomes, ultra-performance liquid chromatography coupled to tandem mass spectrometry was utilized to assess the reversible inhibition of cytochrome P450 by vonoprazan by determining the concentration of probe drugs (phenacetin, bupropion, tolbutamide, dextromethorphan, midazolam, chlorzoxazone). The differences in the levels of probe drugs between the rat groups with or without vonoprazan administration were also tested in the rats. Results: In vitro analysis revealed that the IC 50 values of midazolam, tolbutamide, dextromethorphan, and bupropion in rat microsomes were 22.48, 18.34, 3.62, and 3.68 mM, respectively, while chlorzoxazone and phenacetin displayed no inhibition. In vivo analysis revealed that midazolam, bupropion, dextromethorphan, and tolbutamide showed significant (P < 0.05) differences in distinct pharmacokinetic parameters after vonoprazan administration, while those of chlorzoxazone and phenacetin were not significantly different. Conclusion: The in vitro and in vivo results indicated that vonoprazan can inhibit CYP3A4, CYP2C9, CYP2D6, and CYP2B6, suggesting that the coadministration of vonoprazan with cytochrome P450 substrates should be performed cautiously in clinical settings.

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Section: Discussionmentioning

confidence: 99%

Cytochrome P450-Based Drug-Drug Interactions of Vonoprazan In Vitro and In Vivo

Wang

et al. 2020

Front. Pharmacol.

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“…31 The long duration of action, good bioavailability, stability in acid, and inhibition of both active and inactive proton pumps suggest that vonoprazan may also be useful for difficult to manage patient such as those with Roux-en-Y gastric bypass or other bariatric surgeries in which lack of antral release of gastrin, rapid gastric emptying, and the small absorptive area for dissolution and absorption of enteric-coated PPIs make traditional antisecretory therapy difficult. 32 Currently, vonoprazan plays an important and unique role when more acid suppression is needed than can be obtained with 60-70 mg of OE bid. However, situations are rare and, except for Zollinger-Ellison syndrome, would generally be of short duration.…”

Section: Discussionmentioning

confidence: 99%

Update on the Use of Vonoprazan: A Competitive Acid Blocker

Graham

Dore

2018

Gastroenterology

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“…4 To maximize PPI bioavailability, we suggested trying several daily administrations of solubilized PPI. 4 Despite Dr Howden’s concerns, soluble PPIs can be easily and cheaply prepared 5 and are commercially available (ie, FIRST-Omeprazole Compounding Kits, Cutis Pharma, Wilmington, MA). Prior studies confirmed absorption of micronized omeprazole suspended in bicarbonate is excellent.…”

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confidence: 99%

“…We proposed an experimental approach, as the solution will not come from more opinions but rather needs experimentally derived data such as measuring PPI blood levels, the pH within the pouch, and healing rates with different therapeutic approaches. 4 “All genuine progress results from finding new facts.” 8 Let’s set about obtaining the data.…”

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confidence: 99%