Proton pump inhibitor: Difference between revisions

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In [[medicine]], '''proton pump inhibitors''' ('''PPI''') are [[medication]]s that "inhibit H(+)-K(+)-exchanging atpase. They are used as [[anti-ulcer agent]]s and sometimes in place of [[histamine H2 antagonist]]s for [[gastroesophageal reflux]]."<ref>{{MeSH}}</ref> They are also used as part of curative [[therapy]] for ''[[Helicobacter pylori]]'', in combination with [[antibiotic]]s.
==Metabolism==
Proton pump inhibitors are metabolized by the CYP2C19 isoenzyme of [[cytochrome P-450]]. This may be less true for [[pantoprazole]] and [[esomeprazole]].<ref name="pmid19081411">{{cite journal |author=Siller-Matula JM, Spiel AO, Lang IM, Kreiner G, Christ G, Jilma B |title=Effects of pantoprazole and esomeprazole on platelet inhibition by clopidogrel |journal=Am. Heart J. |volume=157 |issue=1 |pages=148.e1–5 |year=2009 |month=January |pmid=19081411 |doi=10.1016/j.ahj.2008.09.017 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00822-3 |issn=}}</ref>
==Adverse effects==
Proton pump inhibitors may be associated with [[spontaneous bacterial peritonitis]].<ref name="pmid19337238">{{cite journal |author=Bajaj JS, Zadvornova Y, Heuman DM, ''et al.'' |title=Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites |journal=Am. J. Gastroenterol. |volume=104 |issue=5 |pages=1130–4 |year=2009 |month=May |pmid=19337238 |doi=10.1038/ajg.2009.80 |url=http://dx.doi.org/10.1038/ajg.2009.80 |issn=}}</ref> Recent starting of these drugs may also be associated with [[pneumonia]] acquired in the community<ref name="pmid18794558">Sarkar M, Hennessy S, Yang YX. Proton-pump inhibitor use and the risk for community-acquired pneumonia. Ann Intern Med. 2008 Sep 16;149(6):391-8. PMID 18794558</ref> or hospital<ref name="pmid19470989">Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA. 2009 May 27;301(20):2120-8. PMID 19470989</ref>. These drugs may be associated with ''[[Clostridium difficile]]'' diarrhea, and [[fracture]]s.
Starting proton pump inhibitors in  healthy volunteers may induce acid-related symptoms PPIs are stopped<ref name="pmid19362552">{{cite journal| author=Reimer C, Søndergaard B, Hilsted L, Bytzer P| title=Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. | journal=Gastroenterology | year= 2009 | volume= 137 | issue= 1 | pages= 80-7, 87.e1 | pmid=19362552
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19362552 | doi=10.1053/j.gastro.2009.03.058 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> This is problematic considering how often PPIs are incorrectly prescribed.<ref name="pmid17848420">{{cite journal| author=Wohlt PD, Hansen LA, Fish JT| title=Inappropriate continuation of stress ulcer prophylactic therapy after discharge. | journal=Ann Pharmacother | year= 2007 | volume= 41 | issue= 10 | pages= 1611-6 | pmid=17848420
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17848420 | doi=10.1345/aph.1K227 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
==Drug interactions==
==Drug interactions==
Proton pump inhibitors (especially inhibitors other than [[pantoprazole]]<ref name="pmid19176635">Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV, Henry DA, Kopp A, Mamdani MM. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ. 2009 Mar 31;180(7):713-8. Epub 2009 Jan 28. PMID 19176635</ref>), which are metabolized by the CYP2C19 isoenzyme of [[cytochrome P-450]], may<ref name="pmid19258584">{{cite journal |author=Ho PM, Maddox TM, Wang L, ''et al.'' |title=Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome |journal=JAMA |volume=301 |issue=9 |pages=937–44 |year=2009 |month=March |pmid=19258584 |doi=10.1001/jama.2009.261 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=19258584 |issn=}}</ref> or may not<ref name="pmid19726078">{{cite journal| author=O'Donoghue ML, Braunwald E, Antman EM, Murphy SA, Bates ER, Rozenman Y et al.| title=Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. | journal=Lancet | year= 2009 | volume= 374 | issue= 9694 | pages= 989-97 | pmid=19726078  
Proton pump inhibitors (especially inhibitors other than [[pantoprazole]]<ref name="pmid19176635">Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV, Henry DA, Kopp A, Mamdani MM. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ. 2009 Mar 31;180(7):713-8. Epub 2009 Jan 28. PMID 19176635</ref>), which are metabolized by the CYP2C19 isoenzyme of [[cytochrome P-450]], may<ref name="pmid19258584">{{cite journal |author=Ho PM, Maddox TM, Wang L, ''et al.'' |title=Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome |journal=JAMA |volume=301 |issue=9 |pages=937–44 |year=2009 |month=March |pmid=19258584 |doi=10.1001/jama.2009.261 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=19258584 |issn=}}</ref> or may not<ref name="pmid19726078">{{cite journal| author=O'Donoghue ML, Braunwald E, Antman EM, Murphy SA, Bates ER, Rozenman Y et al.| title=Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. | journal=Lancet | year= 2009 | volume= 374 | issue= 9694 | pages= 989-97 | pmid=19726078  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19726078 | doi=10.1016/S0140-6736(09)61525-7 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> increase adverse cardiac events when given to patients taking [[clopidogrel]] for [[coronary heart disease]].
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19726078 | doi=10.1016/S0140-6736(09)61525-7 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> increase adverse cardiac events when given to patients taking [[clopidogrel]] for [[coronary heart disease]].
==References==
<references/>

Revision as of 20:04, 8 October 2009

Drug interactions

Proton pump inhibitors (especially inhibitors other than pantoprazole[1]), which are metabolized by the CYP2C19 isoenzyme of cytochrome P-450, may[2] or may not[3] increase adverse cardiac events when given to patients taking clopidogrel for coronary heart disease.

  1. ↑ Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV, Henry DA, Kopp A, Mamdani MM. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ. 2009 Mar 31;180(7):713-8. Epub 2009 Jan 28. PMID 19176635
  2. ↑ Ho PM, Maddox TM, Wang L, et al. (March 2009). "Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome". JAMA 301 (9): 937–44. DOI:10.1001/jama.2009.261. PMID 19258584. Research Blogging.
  3. ↑ O'Donoghue ML, Braunwald E, Antman EM, Murphy SA, Bates ER, Rozenman Y et al. (2009). "Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials.". Lancet 374 (9694): 989-97. DOI:10.1016/S0140-6736(09)61525-7. PMID 19726078. Research Blogging.
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