Orally administered, poorly soluble, weak-base drugs are subject to gastric pH-dependent drug-drug interactions which can be clinically significant. Proton pump inhibitors (PPIs) have been shown to reduce the bioavailability of kinase inhibitors, antivirals and triazole antifungals, through elevation of gastric pH. The objective of this study was to determine if chewable ascorbic acid (AA) tablets can induce a transient reduction in gastric pH. Healthy volunteers were pretreated with 20 mg omeprazole to induce hypochlorhydria. On the study day, gastric pH was continuously monitored using a catheter-based pH monitoring system. A pH electrode was transnasally placed in the stomach fundus and pH data was collected in real time. 1000 mg AA chewable tablets were ingested by the study participants with 240 mL of water. In five out of six subjects, a significant drop in gastric pH was observed. A mean (± SD) drop in pH of 3.7 (± 1.8) upon AA intake was observed and time taken to reach lowest gastric pH was 91.2 (± 64) min. Area under the pH versus time curve (AUCpH), below median pH over 15 min duration before AA intake, was determined to be 186.8 ± 136.7 (ΔpH.min). This pilot study demonstrates that 1000 mg of AA tablets can significantly reduce gastric pH in individuals receiving treatment with PPIs, providing a potential approach for mitigating pH-dependent drug-drug interactions of weak-base drugs.
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