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Obese Children Require Lower Doses of Pantoprazole Than Nonobese Peers to Achieve Equal Systemic Drug Exposures


Journal Article

Shakhnovich, V.; Smith, P. B. ; Guptill, J. T.; James, L. P.; Collier, D. N.; Wu, H.; Livingston, C. E.; Zhao, J.; Kearns, G. L.


102-108 e1

J Pediatr




Administration, Oral Adolescent Area Under Curve Body Weight Child Cytochrome P-450 CYP2C19/genetics Drug Dosage Calculations Female Gastroesophageal Reflux/complications/*drug therapy Genotype Humans Male Pantoprazole/administration & dosage/*pharmacokinetics Pediatric Obesity/complications/*drug therapy/genetics Prospective Studies Proton Pump Inhibitors/administration & dosage/*pharmacokinetics obesity pediatrics pharmacokinetics proton pump inhibitors

OBJECTIVE: To assess appropriate pantoprazole dosing for obese children, we conducted a prospective pharmacokinetics (PK) investigation of pantoprazole in obese children, a patient population that is traditionally excluded from clinical trials. STUDY DESIGN: A total of 41 obese children (6-17 years of age), genotyped for CYP2C19 variants *2, *3, *4, and *17, received a single oral dose of pantoprazole, ~1.2 mg/kg lean body weight (LBW), with LBW calculated via a validated formula. Ten post-dose pantoprazole plasma concentrations were measured, and PK variables generated via noncompartmental methods (WinNonlin). Linear and nonlinear regression analyses and analyses of variance were used to explore obesity, age, and CYP2C19 genotype contribution to pantoprazole PK. PK variables of interest were compared with historic nonobese peers treated with pantoprazole. RESULTS: Independent of genotype, when normalized to dose per kg total body weight, pantoprazole apparent clearance and apparent volume of distribution were significantly lower (P < .05) and systemic exposure significantly higher (P < .01) in obese vs nonobese children. When normalized per kg LBW, these differences were not evident in children >/=12 years of age and markedly reduced in children <12 years of age. CONCLUSIONS: LBW dosing of pantoprazole led to pantoprazole PK similar to nonobese peers. Additional factors, other than body size (eg, age-related changes in CYP2C19 activity), appear to affect pantoprazole PK in children <12 years of age. TRIAL REGISTRATION: NCT02186652.

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