Yago Marc R, Frymoyer Adam, Benet Leslie Z, Smelick Gillian S, Frassetto Lynda A, Ding Xiao, Dean Brian, Salphati Laurent, Budha Nageshwar, Jin Jin Y, Dresser Mark J, Ware Joseph A
Department of Bioengineering and Therapeutic Sciences, University of California, 533 Parnassus Avenue, Room U-68, San Francisco, California, 94143-0912, USA.
AAPS J. 2014 Nov;16(6):1358-65. doi: 10.1208/s12248-014-9673-9. Epub 2014 Oct 2.
Many orally administered, small-molecule, targeted anticancer drugs, such as dasatinib, exhibit pH-dependent solubility and reduced drug exposure when given with acid-reducing agents. We previously demonstrated that betaine hydrochloride (BHCl) can transiently re-acidify gastric pH in healthy volunteers with drug-induced hypochlorhydria. In this randomized, single-dose, three-way crossover study, healthy volunteers received dasatinib (100 mg) alone, after pretreatment with rabeprazole, and with 1500 mg BHCl after rabeprazole pretreatment, to determine if BHCl can enhance dasatinib absorption in hypochlorhydric conditions. Rabeprazole (20 mg b.i.d.) significantly reduced dasatinib Cmax and AUC0-∞ by 92 and 78%, respectively. However, coadministration of BHCl significantly increased dasatinib Cmax and AUC0-∞ by 15- and 6.7-fold, restoring them to 105 and 121%, respectively, of the control (dasatinib alone). Therefore, BHCl reversed the impact of hypochlorhydria on dasatinib drug exposure and may be an effective strategy to mitigate potential drug-drug interactions for drugs that exhibit pH-dependent solubility and are administered orally under hypochlorhydric conditions.
许多口服的小分子靶向抗癌药物,如达沙替尼,在与抑酸剂合用时会表现出pH依赖性溶解度,并降低药物暴露量。我们之前证明,盐酸甜菜碱(BHCl)可使药物诱导的胃酸过少的健康志愿者的胃pH值短暂重新酸化。在这项随机、单剂量、三向交叉研究中,健康志愿者分别接受单独的达沙替尼(100 mg)、雷贝拉唑预处理后再接受达沙替尼、以及雷贝拉唑预处理后再接受1500 mg BHCl和达沙替尼,以确定BHCl是否能在胃酸过少的情况下增强达沙替尼的吸收。雷贝拉唑(20 mg,每日两次)分别使达沙替尼的Cmax和AUC0-∞显著降低92%和78%。然而,联合使用BHCl可使达沙替尼的Cmax和AUC0-∞分别显著增加15倍和6.7倍,分别恢复至对照(单独使用达沙替尼)的105%和121%。因此,BHCl逆转了胃酸过少对达沙替尼药物暴露的影响,对于那些表现出pH依赖性溶解度且在胃酸过少情况下口服给药的药物,BHCl可能是减轻潜在药物相互作用的有效策略。