Influence of 1-Week Helicobacter pylori Eradication Therapy with Rabeprazole, Clarithromycin, and Metronidazole on 13C-Aminopyrine Breath Test

Abstract

Helicobacter pylori eradication therapy is commonly prescribed in the general population. Treatment consists of drugs that are mainly metabolized by the liver cytochrome P-450 (CYP) enzymatic pool. Most H. pylori-infected patients often take drugs for comorbid illnesses, therefore increasing the potential for drug-drug interactions. We aimed to evaluate the interactions of rabeprazole, clarithromycin, and metronidazole 1-week H. pylori eradication therapy with CYP-dependent liver metabolic function in clinical practice. Ten patients referred to our unit for H. pylori infection underwent 1-week eradication therapy with rabeprazole (20 mg, b.i.d.), clarithromycin (500 mg, b.i.d.), and metronidazole (500 mg, b.i.d.). We chose the 13C-aminopyrine breath test (13C-ABT) to evaluate CYP-dependent liver function since it is noninvasive and nonharmful. All patients underwent 13C-ABT at three time points: before therapy (to), at the end of therapy (t8), and after 1 month of follow-up (t38). Mean 13C-ABT dose/hr (t0 = 14.0 +/- 5.4, t8 = 13.5 +/- 4.0, t38 = 16.1 +/- 5.6) as well as 13C-ABT cumulative dose (t0 = 2.4 +/- 1.1, t8 = 2.4 +/- 0.8, t38 = 2.6 +/- 1.0) were not statistically different at the three time points of the study. These results did not seem to be influenced by drugs being administered concomitantly. In everyday clinical practice rabeprazole-based H. pylori eradication therapy does not seem to display any significant interactions with CYP-dependent liver function, even in patients on multiple drugs.

Monitoring Cytochrome P-450 Activity During Rabeprazole Treatment in Patients with Gastresophageal Reflux Disease

“…We have shown that 13 C-ABT can be used to evaluate the modification of CYP activity during Helicobacter pylori eradication therapy with various PPIs, metronidazole, and clarithromycin [7,33]. In one of these studies we found that rabeprazole seems to display less interaction with CYP activity than other PPIs [7]. The results of the current study further strengthen those of our previous study and underscore the safety profile of rabeprazole.…”

“…Furthermore, previous studies have shown that 13 C-ABT can be used as a tool to identify the influence of oral contraceptives, grapefruit juice, and alcohol on liver CYP enzymatic activity [12,13]. We have shown that 13 C-ABT can be used to evaluate the modification of CYP activity during Helicobacter pylori eradication therapy with various PPIs, metronidazole, and clarithromycin [7,33]. In one of these studies we found that rabeprazole seems to display less interaction with CYP activity than other PPIs [7].…”

“…Among PPIs, rabeprazole seems to show a lesser potential for interaction with hepatic CYP enzymes [5,6]. In a previous study we showed that Helicobacter pylori eradication therapy with rabeprazole, clarithromycin, and metronidazole has minimal interaction with CYP activity, as assessed by 13 C-aminopyrine breath test ( 13 C-ABT) [7]. 13 C-ABT is a noninvasive, harmless, dynamic, quantitative liver function test that explores CYP enzyme activity [8].…”

A study of 4‐ and 7‐day triple therapy with rabeprazole, high‐dose levofloxacin and tinidazole rescue treatment for Helicobacter pylori eradication

“…In fact, the peculiar pharmacokinetics and pharmacodynamics of rabeprazole allow a faster onset of action, and more rapid inhibition of proton pumps than other PPIs, 32, 33 thus making this drug more suitable for short‐term eradication treatment because both fast activation and rapid onset of gastric acid suppression are especially needed in short‐term therapy. Moreover, rabeprazole has relevant in vitro antimicrobial activity, 34, 35 and its administration does not seem to interfere with cytochrome P‐450 activity 36, 37 . This is especially important as in this study, and as happens in everyday clinical practice, approximately half of the patients were on co‐medication, and in this setting the occurrence of drug–drug interactions is more likely.…”

Dissociative disorder induced by clarithromycin combined with rabeprazole in a patient with gastritis

“…Clinically, clarithromycin is commonly prescribed in combination with rabeprazole or other antibiotics to eliminate H. pylori. 1 The present case reports the appearance of a dissociative disorder in a woman taking clarithromycin in combination with rabeprazole. The study was approved by the Ethics Committee of The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.…”