Can Cola Help Manage an Erlotinib-PPI Drug Interaction?
Taking erlotinib with cola resulted in a clinically relevant and statistically significant increase in erlotinib bioavailability during esomeprazole treatment, findings from a study published in the Journal of Clinical Oncology, showed.
Erlotinib (Tarceva; Astellas and Genentech), a kinase inhibitor, is dependent on stomach pH for its bioavailability. When taken with a concomitant proton pump inhibitor (PPI), a clinically relevant decrease in erlotinib bioavailability is seen due to the increase in stomach pH. Researchers tested whether this interaction could be reversed by taking erlotinib with cola, an acidic beverage. The team also studied the effects of cola on erlotinib bioavailability in patients not treated with a PPI.
For the randomized, cross-over pharmacokinetic study, 28 patients with non-small cell lung cancer (NSCLC) were evaluated for differences in absorption (measured as AUC0-12h) after a 7-day period of concomitant erlotinib, with or without esomeprazole, with either cola or water. Patients were hospitalized for 1 day for pharmacokinetic sampling at Days 7 and 14.
For patients treated with erlotinib + esomeprazole with cola, the mean AUC0-12h rose by 39% (P=0.004) vs. 9% in patients treated with just erlotinib and cola (P=0.03). Researchers stated that cola intake led to a significant increase in erlotinib bioavailability with concomitant esomeprazole treatment. The effects of cola were minimal in patients not treated with esomeprazole. Study findings may aid in the management of drug-drug interactions between PPIs and erlotinib, they noted.
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