Drug-Drug Interactions Associated with Kinase Inhibitors - Pharmacokinetics, Absorption

Effect of pH on drug absorption: Overview

Before absorption can occur a drug first has to be in a soluble state. The solubility of orally-administered drugs is dependent on their chemical properties and often by the intragastric pH the drug is exposed to in the process of absorption:¹

Weakly basic drugs may show decreased absorption, while the absorption of weakly acidic drugs may increase at higher intragastric pH.^1-3

Increased intragastric pH may increase drug absorption for drugs that are unstable at lower intragastric pH.²

Effect of acid-lowering agents on absorption of tyrosine kinase inhibitors

As many orally-administered kinase inhibitors exhibit pH-dependent solubility, coadministration of these therapies with acid-reducing agents, including proton pump inhibitors (PPIs), H2 antagonists, and antacids, is thought to influence their absorption significantly.^1,2 For example, when acid-suppressive drugs such as PPIs are taken, the pH of the stomach increases from pH 1 to approximately 4. As a result, coadministration of kinase inhibitors with PPIs may significantly decrease the exposures of several orally-administered kinase inhibitors.^1,2

Effects of stomach pH on kinase bioavailability and exposure

Because kinase inhibitors are typically weakly basic, they can be present in either ionised or non-ionised forms, depending on the intragastric pH and the pKa of the drug (i.e., the pH at which the kinase inhibitors reaches equilibrium between the ionised and non-ionised form).¹ Ionised forms normally dissolve more easily in vivo than non-ionised.¹

If a kinase inhibitor is administered with an acid-reducing agent, the intragastric pH is increased from 1 to about 4.¹ This causes the equilibrium of the kinase inhibitors to shift to the less soluble non-ionised form, decreasing the bioavailability of the kinase inhibitors.¹ If the pKa of a kinase inhibitors inhibitor is near the pH of 1-4, the shift towards the less soluble non-ionised form, will be greater than that for a kinase inhibitor with a higher pKa.¹ Thus, the administration of kinase inhibitors with a pKa of less than 4-5 are more prone to DDIs with acid-reducing agents and as a result bioavailability will drop significantly.¹

Next page: More about the distribution process

References

1. van Leeuwen RW, van Gelder T, Mathijssen RH, Jansman FG. Drug-drug interactions with tyrosine-kinase inhibitors: a clinical perspective. Lancet Oncol 2014; 15: e315-326.
2. Budha NR, Frymoyer A, Smelick GS et al. Drug absorption interactions between oral targeted anti-cancer agents and PPIs: is pH-dependent solubility the Achilles heel of targeted therapy? Clin Pharmacol Ther 2012; 92: 203-213.
3. Scripture CD, Figg WD. Drug interactions in cancer therapy. Nat Rev Cancer 2006; 6: 546-558.