Drug General Information (ID: DDIO2C845W)
Drug Name			Ranitidine (bismuth citrate)		Drug Info		Pazopanib		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiulcer Agents				Vegf/Vegfr Inhibitors
Structure

Mechanism of Ranitidine (bismuth citrate)-Pazopanib Interaction (Severity Level: Major)
Altered gastric pH Click to Show/Hide Mechanism Graph
Drug Name		Ranitidine (bismuth citrate)				Pazopanib
Mechanism		Gastric alkalinizer				Gastric pH sensitive
Key Mechanism Factor 1
		Factor Name		Gastric pH
		Factor Description		The normal pH range of gastric acid is between 1.5 and 3.5 and is highly acidic, consisting mainly of hydrochloric acid. Changes in the pH of the stomach can alter the absorption of drugs.
Mechanism Description		Decreased absorption of Pazopanib due to altered gastric pH caused by Ranitidine (bismuth citrate)

Recommended Action
Management		Concomitant use of pazopanib with proton pump inhibitors and H2-receptor antagonists should generally be avoided. If acid-suppression therapy is required, short-acting antacids should be considered, with dosing separated by several hours from pazopanib dosing. Similarly, when coadministration with an H2-receptor antagonist is required, it has been recommended that pazopanib be taken without food at least 2 hours before or 10 hours after a dose of the H2-receptor antagonist.

References
1	EMEA. European Medicines Agency "EPARs. European Union Public Assessment Reports.".
2	van Leeuwen RW, van Gelder T, Mathijssen RH, Jansman FG "Drug-drug interactions with tyrosine-kinase inhibitors: a clinical perspective." Lancet Oncol 15 (2014): e315-e326. [PMID: 24988935]
3	Yu G, Zheng QS, Wang DX, Zhou HH, Li GF "Drug interactions between tyrosine-kinase inhibitors and acid suppressive agents: more than meets the eye." Lancet Oncol 15 (2014): e469-70. [PMID: 25281461]