Table 2.

Available information for drug dose adjustment of proton pump inhibitors for patients with obesity.

Proton Pump Inhibitor	Approach	Drug Formulation	Major PK/PD Finding	Dose Recommendation For Obesity	Population Studied
Omeprazole	Prospective, fixed single dose, PK study with PopPK modeling	Oral enteric-coated capsule	CL/F and ke decreased in obesity; AUC increased in obesity	Decrease dose by 50% if no liver dysfunction. Decrease dose by 75% if comorbid mild liver dysfunction [33].	Adults n=61 obesity n=40 healthy weight
	Prospective, fixed single dose PK study with parent to metabolite ratios before and after weight loss	Oral enteric-coated capsule	CYP2C19 activity 2.7-fold lower in obesity; mean activity increases by 30% after bariatric surgery (n=40)	None mentioned [57].	Adults n=81 obesity n=18 healthy weight
	Prospective, fixed single dose PK study before and after bariatric surgery	Oral enteric-coated capsule	Tmax, Tlag and AUC decreased, Cmax increased, post-surgery	Dose escalation may be needed after bariatric surgery [56].	Adults n=34 obesity
Pantoprazole	Prospective, LBW-based dosing, single dose, PK study	Immediate-release liquid	Weight-adjusted CL/F decreased in obesity	LBW-based dosing recommended in obesity [44].	Children n=13 obesity n=16 overweight n=28 healthy weight
	Prospective, LBW-based tiered, single dose PK study with PopPK modeling	Delayed-release tablet	Weight-adjusted CL/F decreased in obesity	LBW-based dosing or dosing per the drug label without dose escalation [34].	Children n=40 obesity historic healthy controls
	Prospective FFM-based tiered, repeat single dose PK/PD study	Intravenous	Study ongoing	Study ongoing	Children and Young Adults undergoing and not undergoing weight reduction
Lansoprazole	Prospective, FFM-based tiered, single dose PK study	Oral enteric-coated capsule	Study ongoing	Study ongoing	Children
Esomeprazole	Prospective, single dose longitudinal study	Tablet	No PK/PD reported	Patients wither higher BMI may require a dose increase [53]	Adults n=180 control n=127 overweight n=43 obese
Rabeprazole	Prospective, double-blind, placebo-controlled single dose study	Reconditioned capsules	Increased time above a gastric pH >3, lower mean acid concentrations	No change [51]	Adults n=18 obese

Abbreviations: AUC: area under the concentration time-curve, CL/F: apparent oral drug clearance, FFM: free fat mass, k_e: elimination rate constant, PK: pharmacokinetics, PD: pharmacodynamics, PopPK: population pharmacokinetic modeling, T_lag: lag time, T_max: time to maximum drug concentration