14 replies to this topic

[Trey]

There is new evidence that acid reflux medications interfere with TKI drugs at two important points.  These medications are called proton pump inhibitors (PPI -- including Prilosec, Nexium, etc).  The first interference by these PPI medications is that they interfere with TKI drugs being absorbed from the gastrointestinal tract.  But there is also a second interference, whereby these acid reflux medications also interfere at the cell level and reduce TKI drug intake into the cell, so less TKI drug enters into the leukemic cells where the BCR-ABL is located.  So these acid reflux drugs can be "double bad" for those of us taking TKI drugs.

The interference is worse for Gleevec than the others, followed by Sprycel.  Oddly, Tasigna cell uptake of TKI drug seems to be enhanced (made better) by the acid reflux drugs, probably because Tasigna is taken into the cells in a slightly different way.  But Tasigna intake from the GI tract would likely offset cell uptake advantages.  So it would be best to stay away from all acid reflux drugs while taking TKI drugs.  If that is not possible, it would probably be better to take Tasigna while taking acid reflux drugs.

http://ash.confex.co...Paper31458.html

http://en.wikipedia....-pump_inhibitor

[VickiW]

thanks Trey!

many of the newbies (or others) may not be aware we are not supposed to take any form PPI or may not be fortunate enough (like me ) to have an Onc who is on the ball with this stuff.  I plan on  asking my Onc this latest infor about PPI's interfering on a secondary level.

I am  sure I speak for many on this board when I say we really appreciate you and all your efforts on our behalf!

[cryjohn]

Trey,

So, if the reflux meds lower the absorption rate, do you think getting to MMR would be in jeopardy if your on these medication?  Interesting you posted this because I have had several discussion with my Onc about interaction of Protonix and Gleevec.  He has indicated for the last 9 months, no problem and has actually increased my dose of Protonix from 40mg/day to 60mg/day.  I did reach CCYR in November (diagnosed 05/10), and have a 2 log reduction on PCR.  Since I've responded pretty good in just 9 months, should I be having a conversation about switching TKI's because of this latest report...going without the Protonix is not an option.  I am due for my next PCR in about a month, hoping to be MMR!

Thanks

Crystal

[Trey]

Statistics in reports do not account for all individuals.  If you are doing well, with steady PCR declines, and you must take a PPI drug, then all is well.  You would possibly have a faster response without the PPI, but health is a matter of considering all the medical issues and developing an acceptable strategy.  It is also possible that you start out with better than average cellular drug uptake, so the impact for you as an individual may be less than for most people.

You may find that achieving deeper response levels becomes more difficult while taking a PPI -- maybe yes, maybe no.  Individual results will vary.  If your PCR decline slows down, you might want to explore a change to Tasigna.  Or you could discuss a switch to Tasigna now with your Onc.

[Sneezy12]

Interesting article re above comments. Frank-WEB ADDRESS NOW WORKS. FRANK

http://www.ncbi.nlm....les/PMC2766475/

[Cathy]

I too am on Nexium and have had a steady progress. Not as fast as I had hoped but working and Onc is happy with results.  But this does make me wonder. I will have to discuss this with my Onc also. I really don't want to change drugs just becuase its so much more expensive! new side effects And wonder how my empolyer will take that. I can't really give up the Nexium I've already tried that a couple times. The study does say might interfer?

thanks for the information,

Cathy 

[Trey]

Here is a list of the more common PPI drugs:

• Omeprazole (Prilosec)
• Lanoprazole (Prevacid)
• Esomeprazole (Nexium)
• Pantoprazole (Protonix)
• Rabeprazole (Acifex)

The report I cited early in this thread shows an overall negative effect of PPI drugs, but is not clearly negative in all cases for all CML types, so that the various PPI drugs had different results for the different TKI drugs.  And in some cases the effect is positive, mainly for Tasigna.  So a switch in PPI drug might also be an option based on the particular TKI drug involved, however that is a tricky issue since individual results will vary.  And the issue is not one of complete interference, but rather one of variable levels of interference or non-interference.  You should ask your doc to decipher which PPI might work best for you if you need to take one.

[Sneezy12]

Above web address now works.Frank

[Susan61]

Hi Cathy:  I am a little confused with this also.  I have been on Nexium since shortly after starting Gleevec back in 2000, due to horrible reflux.  I do find the Nexium is very expensive.  I was just in the hospital for a week with a blood clot, and they did not have Nexium, and they substituted Prilosec for me which did work.

I am thinking of asking my doctor to switch me to the Prilosec from the Nexium if it will save me money.

    Like Trey said it is different for everyone.  I have done well, and gotten to PCRU even with the reflux drug.  I think you have to talk to your doctors about it.

[Cathy]

Hi Susan, I'm glad you said that because I'm confused and I have been on Nexium for a long time I tried to stop it for a while which worked but it seemed with Gleevec my re flux came back to the extent I had to go back on it every day since I've been taking the whole time. My numbers are going down and I did have this talk with my onc right off and we discussed nexium and he said no your okay taking it. I take nexium in the morning and gleevec at night. And I went on the Novartis site today to check out this interaction. They list Nexium and priolsec in the okay column?? So I am totally confused and think I'm okay taking it. But do plan on talking with my Onc next week when I go. And if I'm not 100% Fish negative I'm not going to be happy. I've said that the past 2 Fish! I'm close only have 13 Phily's left from last check! Just one slow process! 9 months now since dx!

Now price was a different story, I asked for the generic to nexium which is prilosec I looked up the generic and its just prilosec which works for me about 2/3 rds the time. But if I eat spicy or something I shouldn't it really doesn't do it. And Prilosec is about 1/4 the cost of nexium. I was just tired of paying for Nexium and some other drugs I take so I was trying to cut my charges down. So it's okay not 100% I think. Much cheaper though!! LOL

I hope your leg is doing better and things calm down for you,

Have a good weekend all,

Cathy

[Susan61]

Hi :  I hope you continue to do well on your Gleevec, and you will get to where you want to be.  It takes longer for some.  When I was diagnosed, there was no Gleevec or any other TKI.  I did the old treatments, but after I started the Gleevec it took me 9 months to get to a cytogenetic remission.

     Thank You for asking about my leg and my blood clot.  I guess it will take time.  They are telling me 6 to 12 months of blood thinners, but I am praying its less time.  Some days I feel like I am getting hit from every angle with health problems, and I guess we all go through it.

     My Oncologist who I really loved, has retired.  He never felt that the Nexium was a problem for me, and now my new Oncologist does not feel its an issue either.

     Make yourself feel better and talk to your doctor.  Even on the Nexium, if I eat something spicy I get that breakthrough heartburn.  Not all the time, but I do get it.

I guess I just feel that taking the Nexium is a better alternative then to end up with esophageal problems on top of the CML.

     Have a good weekend also.

Susan

[Susan61]

Hi Billie:  Boy you have been through it all, but your surviving all of it.  That is the most important thing.  My Nexium is costing me $80.00 for a 90 day supply.  I have an appointment on Wed. to get my leg checked out.  I am going to check to see if I am right about the Prilosec.  I am almost positive that is what they were giving me in the hospital.

     I think my Faith in God is what gets me through these things more than my medications.  Take Care and Just Take One Day At A Time.

[hannibellemo]

Hi, Susan,

I was told nexium and prilosec and essentially the same thing. Nexium was introduced shortly before prilosec went OTC.

Good luck.

Pat