Related Experiment Video

Updated: May 20, 2026

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
06:46

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

Published on: December 14, 2020

Evaluation of potential interactions between mycophenolic acid derivatives and proton pump inhibitors

Steven Gabardi1, Ali Olyaei

  • 1Department of Transplant Surgery, Brigham and Women's Hospital, Boston, MA, USA. sgabardi@partners.org

The Annals of Pharmacotherapy
|July 20, 2012
PubMed
Abstract

Insights

Gastrointestinal complications are common in solid organ transplant recipients. Proton pump inhibitors reduce exposure to mycophenolate mofetil, but not enteric-coated mycophenolic acid, potentially increasing rejection risk.

Area of Science:

  • Pharmacology
  • Transplantation Medicine
  • Gastroenterology

Background:

  • Gastrointestinal (GI) complications are prevalent in solid organ transplant (SOT) recipients, affecting up to 70% of patients.
  • These complications significantly impact transplant outcomes, often necessitating immunosuppressant dose adjustments.
  • Proton pump inhibitors (PPIs) are frequently used in SOT recipients.

Purpose of the Study:

  • To assess the incidence of GI complications in SOT recipients.
  • To determine the impact of GI complications on transplant outcomes.
  • To evaluate drug interactions between mycophenolic acid (MPA) derivatives and PPIs.

Main Methods:

  • Conducted an unrestricted literature search from 1980 to January 2012 using MEDLINE and EMBASE.
  • Included original research and review articles in English focusing on GI complications in SOT or drug interactions.
  • Reviewed abstracts from scientific meetings and reference citations of identified publications.

Main Results:

  • GI complications are frequent in SOT recipients, impacting renal transplant outcomes.
  • PPIs significantly reduce MPA exposure from mycophenolate mofetil but not from enteric-coated mycophenolic acid (EC-MPA).
  • Most data are pharmacokinetic, lacking clinical impact assessment of this drug interaction.

Conclusions:

  • A significant interaction exists between PPIs and mycophenolate mofetil due to increased gastric pH affecting dissolution.
  • EC-MPA bioavailability is maintained during PPI coadministration as it bypasses gastric absorption.
  • The clinical significance of reduced MPA exposure is unknown but may increase allograft rejection risk.

Related Concept Videos

Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors01:13

Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors

Peptic ulcers, often induced by H. pylori infections or NSAID usage, arise from disruptions in the delicate balance of gastric acid production. Peptic ulcers stem from heightened gastric acid levels due to H. pylori infections or NSAID use. The protective mucus layer diminishes in the presence of these factors, allowing gastric acid to erode the stomach lining and form ulcers.
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...
Drug toxicity: Drug–Drug Interaction01:30

Drug toxicity: Drug–Drug Interaction

Drug–drug interactions can precipitate toxicity through multiple mechanisms. Absorption interactions alter how drugs enter the body, exemplified when ranitidine increases the absorption of basic drugs, while cholestyramine decreases the levels of propranolol. Protein binding interactions occur when drugs share the same binding sites on plasma proteins. Drugs like aspirin and warfarin, when bound in excess, can lead to increased free drug concentrations, enhancing the potential for...
Pharmacokinetics: Drug–Drug Interactions01:25

Pharmacokinetics: Drug–Drug Interactions

Drug interactions occur when the pharmacological effect of one drug is altered by another substance, either enhancing or diminishing its activity. The drug whose activity is altered is known as the object drug, and the substance causing the alteration is called the agent drug or the precipitant. The net effects of these interactions are mostly undesirable, leading to decreased effectiveness or increased adverse effects. In rare cases, interactions can be beneficial, such as the enhanced...
Acid Suppressive Drugs for Peptic Ulcer Disease: Histamine H2-Receptor Antagonists01:28

Acid Suppressive Drugs for Peptic Ulcer Disease: Histamine H2-Receptor Antagonists

Histamine H2 receptors, which are intricately located on the basolateral membrane of parietal cells, play a crucial role in modulating gastric acid secretion. When released from enterochromaffin-like cells, histamine engages H2 receptors, initiating the cyclic AMP (cAMP) pathway. In this pathway, adenylyl cyclase converts ATP into cAMP, elevating intracellular cAMP levels. The activation of protein kinase A follows, stimulating the proton pump. This stimulation prompts the secretion of hydrogen...
Acid Suppressive Drugs for Peptic Ulcer Disease: Antacids01:31

Acid Suppressive Drugs for Peptic Ulcer Disease: Antacids

In the complex environment of the gastric lumen, excessive acid secretion can lead to the formation or worsening of ulcers within the delicate mucosal layer. Antacids, such as sodium bicarbonate and calcium carbonate, provide relief by neutralizing this acid, transforming it into harmless salt and water. This neutralization process raises the gastric pH from a highly acidic level of 1 to a more basic 3-4, reducing the acidity within the stomach.
However, this neutralization reaction between...
Pharmacokinetics: Drug–Food and Drug–Viral Interactions01:26

Pharmacokinetics: Drug–Food and Drug–Viral Interactions

A drug interaction occurs when the concurrent use of another drug, food, or an external substance alters the pharmacological activity of a drug. This interaction can modify the action of the original drug, affecting its effectiveness and safety.Drug–food interactions are significant as they impact drug absorption, metabolism, and excretion. For example, grapefruit juice is a well-known disruptor of drug metabolism. It inhibits the cytochrome P450 3A4 enzyme, crucial for the metabolism of many...