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Pharmacopsychiatry 2020; 53(02): 65-70
DOI: 10.1055/a-1021-8827
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

The Effects of Co-prescription of Pantoprazole on the Clozapine Metabolism

Maxim Kuzin‡
1   Psychiatric and Psychotherapeutic Private Clinic Clienia Schlössli, Academic Teaching Hospital of the University of Zurich, Oetwil am See, Switzerland
,
Georgios Schoretsanitis  ‡
2   The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA
,
Ekkehard Haen
3   Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany
4   Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
,
Gerhard Dammann
5   Psychiatric Services of Thurgovia, Academic Teaching Hospital of the Medical University of Salzburg, Münsterlingen, Switzerland
,
Christoph Hiemke
6   Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
,
Gerhard Gründer
7   Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
,
Michael Paulzen
8   Alexianer Hospital Aachen, Aachen, Germany
9   Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany, and JARA – Translational Brain Medicine, Jülich, Germany
› Author Affiliations
Further Information

Publication History

received 20 June 2019
revised 29 August 2019

accepted 20 September 2019

Publication Date:
15 October 2019 (online)

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Abstract

Background Polypharmacy including somatic medications such as proton pump inhibitors is a common phenomenon in psychiatric care. The aim of this study was to evaluate the pantoprazole effects on clozapine metabolism.

Methods A large therapeutic drug-monitoring database containing plasma concentrations of CLZ was analyzed. The results were stratified into four groups: a non-smoking (n=250) and a smoking group (n=326), and two groups co-medicated with pantoprazole: non-smokers (n=26) and smokers (n=29). The analysis was based on the non-parametrical Mann-Whitney U test (M-W-U) with a significance level of 0.05.

Results Differences reached statistical significance for pharmacokinetic parameters between CLZ monotherapy and co-medication with pantoprazole neither in smokers nor in non-smokers (p>0.05 for M-W-U in pairwise comparisons). In patients with clozapine monotherapy, smokers had a higher daily dosage of CLZ compared to non-smokers (mean dosage 363±181 vs. 291±145 mg/day, p<0.001 for M-W-U).

Conclusions Adding pantoprazole to an ongoing treatment with clozapine does not alter the metabolism of clozapine to a significant extent.

Key words

therapeutic drug monitoring - clozapine - pantoprazole - CYP2C19 - smokers
 

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