Background. Cytochrome P450 (CYP450) enzymes plays an important role in the metabolism of 70-
80% of the currently used medications, including proton pump inhibitors. There are some data
analyzing the impact of gene polymorphisms of CYP450 enzymes on most widely used PPIs, such as
omeprazole, however, the data on pantoprazole are highly lacking.
Objective. To summarize the most recent publications and studies on the role of polymorphisms of the
genes encoding CYP450 enzyme 2C19 in the metabolism of pantoprazole and pantoprazole based
Helicobacter pylori eradication regimens.
Methods. We performed a non-systematic search of the available literature on selected topic.
Results and conclusion. The data on cytochrome P450 gene polymorphisms and their role in
pantoprazole metabolism and pantoprazole based Helicobacter pylori eradication remain conflicting.
Individual differences in pantoprazole metabolism might be partly related to genetic polymorphisms of
CYP450 enzymes. Most of the studies support the observation that cytochrome 2C19 polymorphisms
have an impact on the pharmacokinetics of pantoprazole and its therapeutic effects: poor metabolizers
of PPIs are more likely to have a better response to pantoprazole therapy and achieve better H. pylori
eradication rates compared to rapid metabolizers. The determination of alleles that are associated with
decreased (e.g. *2, *3 alleles) or increased (e.g. *17 allele) cytochrome 2C19 enzyme activity might be
used as predictive factors for the potential of acid suppression and the success of Helicobacter pylori
eradication. Overall, currently available data do not provide robust evidence, therefore the application
of genetic polymorphisms of cytochrome enzymes in clinical practice still cannot be recommended as
routine practice for personalized pantoprazole prescription strategies.