Pharmacology; Pantoprazole-Methotrexate Drug Interactions Essay
Pharmacology; Pantoprazole-Methotrexate Drug Interactions Essay
Pantoprazole is a proton inhibitor drug indicated for the treatment of acid reflux, among other stomach issues related to acidity. Methotrexate is indicated for use in chemotherapy for people with cancer and as an immune suppressant, stopping the immune system from destroying the body cells. Proton pump inhibitors act by eliminating acid from the stomach, yet some drugs require the same stomach acid to aid effective absorption, causing drug interactions. With methotrexate, pantoprazole prevents its proper absorption, compromising its clearance, leading to high serum and hydroxy-methotrexate levels, causing toxicity (Pflugbeil et al., 2020).
Management of the interaction involves effective timing. The interaction occurs at high doses of methotrexate, creating a competition with pantoprazole. The recommended guideline for management is taking the two medications simultaneously. The second management guideline is halting the administration of pantoprazole a few days before and after administration of methotrexate (Pflugbeil et al., 2020). This will reduce the competition between the two agents and enhance the proper elimination of methotrexate. Additionally, a doctor can also consider changing the dose of methotrexate to a lower dose to limit the chances of drug interactions. Continuation of both medications should be done under close observation to monitor for side effects.
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The first alternative is using H2 -receptor blockers instead of a proton pump inhibitor. A study by Leducq et al.(2020) confirms the safety and efficacy of using histamine H2 blocker with methotrexate. Moreover, the results show that histamine H2 blocker is effective in cases of difficult-to-treat urticaria (Leducq et al., 2020). Another alternative therapy that could eliminate the drug interaction is using hydroxychloroquine with pantoprazole or other proton pump inhibitor. Hydroxychloroquineprovides similar therapeutic benefits as methotrexate, and there is no evidence indicating drug interaction with proton pump inhibitors, making it a safer option.
References
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Leducq, S., Samimi, M., Bernier, C., & Soria, A. (2020). Efficacy and safety of methotrexate versus placebo as add-on therapy to H1 antihistamines for patients with difficult-to-treat chronic spontaneous urticaria: A randomized, controlled trial. J Am Acad Dermatol, 82(1), 240-243. https://doi.10.1016/j.jaad.2019.07.097.
Pflugbeil, S., Böckl, K., Pongratz, R., & Leitner, M. (2020). Drug interactions in the treatment of rheumatoid arthritis and psoriatic arthritis. Rheumatol Int, 40, 511–521. https://doi.org/10.1007/s00296-020-04526-3.
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Select a medication and apply the available evidence and treatment guidelines to determine appropriate therapeutic options that have a drug-drug interaction with proton pump inhibitors or antacids. Describe the interaction and the clinical management of the situation. Provide rationale and justification for continuing both medications, or discuss alternative therapy that could eliminate the drug-drug interaction.