文獻回顧及實務應用：消化道癌族群併用Capecitabine和氫離子幫浦抑制劑的交互作用爭議

Literature Review and Clinical Practice of Controversial Drug-Drug Interaction Between Capecitabine and Proton Pump Inhibitors in Gastrointestinal Cancer Populations

張又勻(Yu-Yun Chang) ； 顏秋蘭(Chiu-Lan Yen) ； 黃志偉(Chih-Wei Huang) ； 李宜勳(I-Hsun Li)

《臺灣臨床藥學雜誌》 30卷3期 (2022/07) Pp. 200-207

https://doi.org/10.6168/FJCP.202207_30(3).0002

摘要

Capecitabine做為口服化療藥物被用於治療多種實體腫瘤。事後分析研究及回溯型研究指出，合併使用氫離子幫浦抑制劑（proton pump inhibitors, PPIs）可能減弱capecitabine的療效，推論兩者之間存有交互作用；可能機轉為PPIs增加胃液pH值導致capecitabine溶解度及吸收度下降。Micromedex及Lexicomp也因此在資料庫建立該項交互作用警示，但卻做出不同的評論及建議；此外，對於適用capecitabine的消化道癌族群，使用PPIs仍有其必要性，造成臨床治療上的兩難；另一方面，也有其他研究認為兩者之間是否具有交互作用是存疑的。因此，本文將依據現有文獻探討，希望能夠協助臨床醫療人員做出更適合病人的決策。

關鍵字

Capecitabine ； 氫離子幫浦抑制劑 ； 藥物交互作用 ； 消化道癌

並列摘要

Capecitabine is an oral antineoplastic drug administered in multiple malignancies. Post-hoc analysis and retrospective studies suggest that concomitant administration of proton pump inhibitors (PPIs) can negatively affect the efficacy of capecitabine. The drug-drug interaction can be attributed to the increase in gastric pH upon PPIs administration, thereby reducing the dissolution and absorption of capecitabine. Micromedex and Lexicomp have included this interaction in their databases but gave different severity levels and managements. Furthermore, PPIs might still be necessary to treat gastric symptoms for patients under capecitabine treatments, making the therapy problematic. However, some studies suggest that this interaction might be unlikely. Hence, this study aims to summarize the clinical evidence to help medical staff manage this interaction.

並列關鍵字

Capecitabine ； Proton Pump Inhibitors ； Drug-Drug Interaction ； Gastrointestinal Cancer