AIDS patients often suffer from both achlorhydria and opportunistic fungal infec

Question

AIDS patients often suffer from both achlorhydria and opportunistic fungal infections. See Figure 1 below, where the absorption of the antifungal agent ketoconazole from the stomach has been shown to be increased in animals that were given cola with it.   It is practically insoluble in water above pH 3, and has to be solubilized to be absorbed. What does the data below tell you about the condition “achlorhydria” which not only occurs in AIDS patients, but can be induced, or caused by the drug omeprazole as shown in the graph below?    What is the graph shwoing, and what do you suppose is the definition of achlorhydria based on this data. (Hint: Think about what you learned in the previous problem). You can simply describe the data shown in your own words for most of the credit. In this paper the cola was not flat and had a pH of 2.5.

A (Control)- 02467 0 1 Time (hrs) FIG. 1. Comparison of ketoconazole treatments. Mean concentration-time profiles are shown for ketoconazole (200-mg tablet) administered with water (treatment A; control), administered with water in the presence of omeprazole- induced achlorhydria (treatment B), and administered with Coca-Cola in the presence of omeprazole-induced achlorhydria (treatment C). Bars show standard deviations.

Explanation / Answer

Ketoconazole can be solubilized in pH less than 3. Since the HCl in our stomach is highly acidic, it can solubilize Ketoconazole even if its taken with water. Based on the graph, achlorhydira must be the condition where there is no production of stomach HCl because omeprazole is a drug used in treating acidity and there is a visible reduction in the absorption of ketoconazole when achlorhydria is induced. In treatment B, the serum concentration of ketoconazole is very less because of the absence of HCl in the stomach to solubilize the ketoconazole when taken with water. But in treatment C, since ketoconazole is taken with cola that has a pH of 2.5, the acidic nature of cola solubilizes ketoconazole even in the absence of HCl in the stomach because of the omeprazole-induced achlorhydria. So the serum concentration of ketoconazole is higher when compared to treatment B.

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