Clinical Usefulness of Limited Sampling Strategies for Estimating AUC of Proton Pump Inhibitors

Cytochrome P450 (CYP) 2C19 (CYP2C19) genotype is regarded as a useful tool to predict area under the blood concentration-time curve (AUC) of proton pump inhibitors (PPIs). In our results, however, CYP2C19 genotypes had no influence on AUC of all PPIs during fluvoxamine treatment. These findings suggest that CYP2C19 genotyping is not always a good indicator for estimating AUC of PPIs. Limited sampling strategies (LSS) were developed to estimate AUC simply and accurately. It is important to minimize the number of blood samples because of patient's acceptance. This article reviewed the usefulness of LSS for estimating AUC of three PPIs (omeprazole: OPZ, lansoprazole: LPZ and rabeprazole: RPZ). The best prediction formulas in each PPI were AUC(OPZ)=9.24 X C-6h + 2638.03, AUC(LPZ)=12.32 X C-6h + 3276.09 and AUC(RPZ)=1.39 X C-3h 7.17 X C-6h + 344.14, respectively. In order to optimize the sampling strategy of LPZ, we tried to establish LSS for LPZ using a time point within 3 hours through the property of pharmacokinetics of its enantiomers. The best prediction formula using the fewest sampling points (one point) was AUC(racemic) (LPZ)=6.5 X C-3h of (R) -LPZ + 13.7 X C-3h of (S) -LPZ-9917.3 X G1 - 14387.2 X G2 + 7103.6 (G1: homozygous extensive metabolizer is 1 and the other genotypes are 0; 02: heterozygous extensive metabolizer is 1 and the other genotypes are 0). Those strategies, plasma concentration monitoring at one or two time-points, might be more suitable for AUC estimation than reference to CYP2C19 genotypes, particularly in the case of coadministration of CYP mediators.