Influence of Proton Pump Inhibitors and H2-receptor Antagonists on the Efficacy and Safety of Dasatinib in Chronic Myeloid Leukemia Patients

Hi ,

Like you I am surprised by the results of the study.One of the best sources of drug interactions for CML patients is the study/paper by a group of Swiss researchers Haoula et al which in 2011 published in the journal Blood -Drug Interactions with the tyrosine kinase inhibitors imatinib,dasatinib and nilotinib.

Their work indicated that the three ppis  omeprazole, esomeprazole,and pantoprazole all led to lesser absorption of the drug dasatinib when used in combination;when ppi s were used with imatinib it led to greater imatinib exposure and but seemed to have no effect when used in combination with nilotinib. I know that ppis are often given to limit excess acid in the stomach and used to be prescribed alongside non steroidal anti inflammatories such as diclofenac to attempt to counter issues of sudden bleeding that might arise-medics now tend to avoid using diclofenac I believe.

Of course dasatinib in combination with aspirin is quite dangerous and can lead to stomach  bleeding.The only other factors that I would mention are that dasatinib has a relatively short half life compared to imatinib and nilotinib has the fasting regime of course.

Long term use of ppis themselves has shown to lead to health issues of kidney damage, bone damage and  in the long term greater incidence of dementia.

Despite the results of this study I would be very wary about combining any tki with a ppi on more than a short period of time .

Best wishes

John

"Its interesting though, that different studies on the same matter have such different outcomes."

Which is why there is no such thing as "settled science". We can get close to a consensus on some things, but just when you thought the earth was round ..... https://www.livescience.com/24310-flat-earth-belief.html

(Read all you can, learn, observe opposing views and interpretations of the same data and then make an informed decision. Be ready to change it with new information. P.s. - so far data supports a round earth)

So, after a Gastroscopy a few weeks ago, i get the results yesterday, and i seem to have some Gastritis.

Hospital says in letter, "Probable cause:TKI, no more treatment necessary" 

So i find out myself that PPIs are used in treatment against Gastritis, and thats why i have good relief when using them occasionally (as my symptoms were pretty simular to those with GERD and Ulcers). I have only used them while on Imaitinib, and i have not used them since starting Sprycel because of the things discussed in this thread. I guess some lifestyle changes are the best way to go, but for me that has been an "easier said than done" scenario. But, there are some pretty easy things i can do to help prevent this, so i just have to start somewhere 

Hope everyone is doing well, all the best from Norway 

Teddy

I would follow the advice from the pharmacist.... 2 hours between taking each drug.  

Sandy