Cola Consumption May Increase Erlotinib Absorption in Patients Taking PPIs

Consumption of the acidic beverage cola resulted in a clinically relevant and statistically significant increase in the absorption of the kinase inhibitor erlotinib in patients also taking the proton pump inhibitor (PPI) esomeprazole, a study published in the Journal of Clinical Oncology has shown.1

PPIs, including esomeprazole, pantoprazole, and omeprazole, are used for the treatment of gastroesophageal reflux disease (GERD), gastric ulcers, and duodenal ulcers. These drugs are known to interfere with absorption of drugs for which gastric pH can impact bioavailability.

The acidity of the stomach influences the bioavailability of erlotinib, and when erlotinib is taken simultaneously with a PPI, there is a clinically relevant reduction in erlotinib bioavailability. Therefore, researchers sought to determine whether cola intake would reverse this drug-drug interaction.

For the study, researchers enrolled 28 patients non-small cell lung cancer (NSCLC) receiving erlotinib with or without esomeprazole. Patients were randomly assigned to drink cola or water with their pills.

Results showed that absorption of erlotinib increased by 39% in patients treated with erlotinib and esomeprazole with cola compared with those who drank water (P = .004). In patients not treated with a PPI, the effects of cola were marginal; there was only a slight increase in absorption after erlotinib intake with cola.

“These findings can be used to optimize the management of drug-drug interactions between PPIs and erlotinib,” the authors concluded.

Reference

van Leeuwen RWF, Peric R, Hussaarts KGAM, et al. Influence of the acidic beverage cola on the absorption of erlotinib in patients with non–small-cell lung cancer [published online ahead of print February 8, 2016]. J Clin Oncol. doi: 10.1200/JCO.2015.65.2560.

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