Clinical Research
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2007; 13(42): 5618-5628
Published online Nov 14, 2007. doi: 10.3748/wjg.v13.i42.5618
Rational prescription of drugs within similar therapeutic or structural class for gastrointestinal disease treatment: Drug metabolism and its related interactions
Quan Zhou, Xiao-Feng Yan, Zhong-Miao Zhang, Wen-Sheng Pan, Su Zeng
Quan Zhou, Xiao-Feng Yan, Zhong-Miao Zhang, Department of Clinical Pharmacology & Clinical Pharmacy, the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Wen-Sheng Pan, Department of Gastroenterology, the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Su Zeng, Department of Pharmaceutical Analysis & Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, Zhejiang Province, China
Author contributions: All authors contributed equally to the work.
Supported by the Scientific Research Project of Zhejiang Provincial Bureau of Education, No. 20061449, No. 20010535
Correspondence to: Quan Zhou, Associate Professor, Department of Clinical Pharmacology & Clinical Pharmacy, the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China. zhouquan142602@zju.edu.cn
Telephone: +86-571-87783891 Fax: +86-571-87213864
Received: January 11, 2007
Revised: April 16, 2007
Accepted: August 12, 2007
Published online: November 14, 2007
Abstract

AIM: To review and summarize drug metabolism and its related interactions in prescribing drugs within the similar therapeutic or structural class for gastrointestinal disease treatment so as to promote rational use of medicines in clinical practice.

METHODS: Relevant literature was identified by performing MEDLINE/Pubmed searches covering the period from 1988 to 2006.

RESULTS: Seven classes of drugs were chosen, including gastric proton pump inhibitors, histamine H2-receptor antagonists, benzamide-type gastroprokinetic agents, selective 5-HT3 receptor antagonists, fluoroquinolones, macrolide antibiotics and azole antifungals. They showed significant differences in metabolic profile (i.e., the fraction of drug metabolized by cytochrome P450 (CYP), CYP reaction phenotype, impact of CYP genotype on interindividual pharmacokinetics variability and CYP-mediated drug-drug interaction potential). Many events of severe adverse drug reactions and treatment failures were closely related to the ignorance of the above issues.

CONCLUSION: Clinicians should acquaint themselves with what kind of drug has less interpatient variability in clearance and whether to perform CYP genotyping prior to initiation of therapy. The relevant CYP knowledge helps clinicians to enhance the management of patients with gastrointestinal disease who may require treatment with polytherapeutic regimens.

Keywords: Cytochrome P450; Pharmacokinetics; Drug metabolism; Genotype; Polymorphism; Drug interaction; Pharmacotherapy; Gastrointestinal diseases