Proton pump inhibitor: Difference between revisions
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| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17054151 | doi=10.1002/14651858.CD001960.pub3 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17537887 Review in: Evid Based Med. 2007 Jun;12(3):79] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17054151 | doi=10.1002/14651858.CD001960.pub3 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17537887 Review in: Evid Based Med. 2007 Jun;12(3):79] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | ||
* [[Gastroesophageal reflux disease]]<ref name="pmid16855986">{{cite journal| author=van Pinxteren B, Numans ME, Bonis PA, Lau J| title=Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. | journal=Cochrane Database Syst Rev | year= 2006 | volume= 3 | issue= | pages= CD002095 | pmid=16855986 | * [[Gastroesophageal reflux disease]]<ref name="pmid16855986">{{cite journal| author=van Pinxteren B, Numans ME, Bonis PA, Lau J| title=Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. | journal=Cochrane Database Syst Rev | year= 2006 | volume= 3 | issue= | pages= CD002095 | pmid=16855986 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=16855986 | doi=10.1002/14651858.CD002095.pub3 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=16855986 | doi=10.1002/14651858.CD002095.pub3 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> Two weeks of therapy may be adequate.<ref name="pmid10024259">{{cite journal| author=Bardhan KD, Müller-Lissner S, Bigard MA, Bianchi Porro G, Ponce J, Hosie J et al.| title=Symptomatic gastro-oesophageal reflux disease: double blind controlled study of intermittent treatment with omeprazole or ranitidine. The European Study Group. | journal=BMJ | year= 1999 | volume= 318 | issue= 7182 | pages= 502-7 | pmid=10024259 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=10024259 | pmc=PMC27748 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
* Reflux esophagitis<ref name="pmid17443524">{{cite journal| author=Khan M, Santana J, Donnellan C, Preston C, Moayyedi P| title=Medical treatments in the short term management of reflux oesophagitis. | journal=Cochrane Database Syst Rev | year= 2007 | volume= | issue= 2 | pages= CD003244 | pmid=17443524 | * Reflux esophagitis<ref name="pmid17443524">{{cite journal| author=Khan M, Santana J, Donnellan C, Preston C, Moayyedi P| title=Medical treatments in the short term management of reflux oesophagitis. | journal=Cochrane Database Syst Rev | year= 2007 | volume= | issue= 2 | pages= CD003244 | pmid=17443524 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17443524 | doi=10.1002/14651858.CD003244.pub2 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17443524 | doi=10.1002/14651858.CD003244.pub2 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> |
Revision as of 21:20, 15 February 2010
In medicine, proton pump inhibitors (PPI) are medications that "inhibit H(+)-K(+)-exchanging atpase. They are used as anti-ulcer agents and sometimes in place of histamine H2 antagonists for gastroesophageal reflux disease."[1] They are also used to eradicate Helicobacter pylori, in combination with antibiotics.
Metabolism
Proton pump inhibitors are metabolized by the CYP2C19 isoenzyme of cytochrome P-450. Lanzoprazole is the strongest inhibitor of CYP2C19,[2] This may be less true for pantoprazole and esomeprazole.[3] Pantoprazole is the strongest inhibitor of the CYP2C9 isoenzyme[2]
Effectiveness
Proton pump inhibitors may improve:
- Non-ulcer dyspepsia[4]
- Gastroesophageal reflux disease[5] Two weeks of therapy may be adequate.[6]
- Reflux esophagitis[7]
Adverse effects
Proton pump inhibitors may be associated with spontaneous bacterial peritonitis.[8] Recent starting of these drugs may also be associated with pneumonia acquired in the community[9] or hospital[10]. These drugs may be associated with Clostridium difficile diarrhea, and fractures.
Starting proton pump inhibitors in healthy volunteers may induce acid-related symptoms when PPIs are stopped[11] This is problematic considering how often PPIs are incorrectly prescribed.[12]
Proton pump inhibitors may induce acid-related symptoms in healthy volunteers after withdrawal, presumably due to rebound acid hypersecretion.[11]
Drug interactions
In the United States, the Food and Drug Administration has issued warnings regarding combining PPIs with clopidogrel.[13][14]
Trial | Patients | Intervention | Comparison | Outcome | Results | |
---|---|---|---|---|---|---|
PPI | Control | |||||
Ontario nested case-control study[15] | 13,636 subjects taking clopidogrel after myocardial infarction | 782 subjects readmitted for myocardial infarction | 2057 subjects not readmitted | Rate of PPI usage other than pantoprazole | Odds ratio = 1.40 (95% CI 1.10–1.77) | |
Cohort study from the VA Cardiac Care Follow-up Clinical Study[16] | 8205 subjects with acute coronary syndrome | 64% were taking PPIs: • 0.2% used pantoprazole • 50% received stents • Probably < 50% used drug eluting stents[19] |
Subjects not taking PPIs | Major vascular events | 29.8% | 20.8% |
Odds ratio = 1.25 (95% CI: 1.11-1.41) • "each 10% increase in the proportion of time taking clopidogrel plus PPI during follow-up was associated with a higher risk" | ||||||
Cohort study taken from TRITON-TIMI 38 randomized controlled trials[17][20][21] 2 of 14 authors disclosed payments from AstraZenca, the maker of omeprazole and esomeprazole |
6795 subjects with acute coronary syndrome who were randomized to the clopidogrel arm of the trial | 33% (4529) were taking PPIs at randomization: • 2814 took PPIs for duration of study • 41% used pantoprazole • 94% received stents • 47% received at least one drug eluting stent |
Subjects not taking PPIs | Major vascular events | 11.8% | 12.2% |
• Patients taking any PPI HR = 0.94, (95% CI 0.80–1.11) • Patients taking any PPI for duration of study HR = 1.05 (95% CI 0.85–1.30) • Results similar for each individual PPI • Results also insignificant when restricted to analysis of patients with a reduced function allele | ||||||
Medco cohort study[18] | 16,718 subjects who took clopidogrel for 12 months after coronary stent | 41% were taking PPIs: • 24% used pantoprazole • 100% received stents • Unknown use of drug eluting stents |
Subjects not taking PPIs | Major vascular events | 24% to 29% | 17.9% |
• Pantoprazole HR=1.61 (pantoprazole had most GI bleeding) • Esooprazole HR=1.57 • Lansoprazole HR=1.39 • Omeprazole HR=1.39 • Histamine H2 antagonists HR=1.14 (insignicant) |
Proton pump inhibitors (especially inhibitors other than pantoprazole[15]), which are metabolized by the CYP2C19 isoenzyme of cytochrome P-450, may[16] or may not[17] increase adverse cardiac events when given to patients taking clopidogrel for coronary heart disease.
References
- ↑ Anonymous (2024), Proton pump inhibitor (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Jump up to: 2.0 2.1 Li XQ, Andersson TB, Ahlström M, Weidolf L (2004). "Comparison of inhibitory effects of the proton pump-inhibiting drugs omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole on human cytochrome P450 activities.". Drug Metab Dispos 32 (8): 821-7. PMID 15258107.
- ↑ Siller-Matula JM, Spiel AO, Lang IM, Kreiner G, Christ G, Jilma B (January 2009). "Effects of pantoprazole and esomeprazole on platelet inhibition by clopidogrel". Am. Heart J. 157 (1): 148.e1–5. DOI:10.1016/j.ahj.2008.09.017. PMID 19081411. Research Blogging.
- ↑ Moayyedi P, Soo S, Deeks J, Delaney B, Innes M, Forman D (2006). "Pharmacological interventions for non-ulcer dyspepsia.". Cochrane Database Syst Rev (4): CD001960. DOI:10.1002/14651858.CD001960.pub3. PMID 17054151. Research Blogging. Review in: Evid Based Med. 2007 Jun;12(3):79
- ↑ van Pinxteren B, Numans ME, Bonis PA, Lau J (2006). "Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease.". Cochrane Database Syst Rev 3: CD002095. DOI:10.1002/14651858.CD002095.pub3. PMID 16855986. Research Blogging.
- ↑ Bardhan KD, Müller-Lissner S, Bigard MA, Bianchi Porro G, Ponce J, Hosie J et al. (1999). "Symptomatic gastro-oesophageal reflux disease: double blind controlled study of intermittent treatment with omeprazole or ranitidine. The European Study Group.". BMJ 318 (7182): 502-7. PMID 10024259. PMC PMC27748.
- ↑ Khan M, Santana J, Donnellan C, Preston C, Moayyedi P (2007). "Medical treatments in the short term management of reflux oesophagitis.". Cochrane Database Syst Rev (2): CD003244. DOI:10.1002/14651858.CD003244.pub2. PMID 17443524. Research Blogging.
- ↑ Bajaj JS, Zadvornova Y, Heuman DM, et al. (May 2009). "Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites". Am. J. Gastroenterol. 104 (5): 1130–4. DOI:10.1038/ajg.2009.80. PMID 19337238. Research Blogging.
- ↑ 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
- ↑ 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
- ↑ Jump up to: 11.0 11.1 Reimer C, Søndergaard B, Hilsted L, Bytzer P (2009). "Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy.". Gastroenterology 137 (1): 80-7, 87.e1. DOI:10.1053/j.gastro.2009.03.058. PMID 19362552. Research Blogging.
Cite error: Invalid
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tag; name "pmid19362552" defined multiple times with different content - ↑ Wohlt PD, Hansen LA, Fish JT (2007). "Inappropriate continuation of stress ulcer prophylactic therapy after discharge.". Ann Pharmacother 41 (10): 1611-6. DOI:10.1345/aph.1K227. PMID 17848420. Research Blogging.
- ↑ Anonymous. (2009) Early Communication about an Ongoing Safety Review of clopidogrel bisulfate (marketed as Plavix)
- ↑ Anonymous (11/17/2009) Information for Healthcare Professionals: Update to the labeling of Clopidogrel Bisulfate (marketed as Plavix) to alert healthcare professionals about a drug interaction with omeprazole (marketed as Prilosec and Prilosec OTC)
- ↑ Jump up to: 15.0 15.1 15.2 Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV et al. (2009). "A population-based study of the drug interaction between proton pump inhibitors and clopidogrel.". CMAJ 180 (7): 713-8. DOI:10.1503/cmaj.082001. PMID 19176635. PMC PMC2659819. Research Blogging. Review in: Ann Intern Med. 2009 Aug 18;151(4):JC2-13 Review in: Evid Based Med. 2009 Oct;14(5):154
- ↑ Jump up to: 16.0 16.1 16.2 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.
- ↑ Jump up to: 17.0 17.1 17.2 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.
- ↑ Jump up to: 18.0 18.1 Stanek EJ et al. (2009) A National Study of the Effect of Individual Proton Pump Inhibitors on Cardiovascular Outcomes in Patients Treated with Clopidogrel Following Coronary Stenting: The Clopidogrel Medco Outcomes Study Society for Cardiovascular Angiography and Interventions 2009 Annual Meeting
- ↑ Ho PM, Fihn SD, Wang L, Bryson CL, Lowy E, Maynard C et al. (2007). "Clopidogrel and long-term outcomes after stent implantation for acute coronary syndrome.". Am Heart J 154 (5): 846-51. DOI:10.1016/j.ahj.2007.08.028. PMID 17967588. Research Blogging.
- ↑ Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT et al. (2009). "Cytochrome p-450 polymorphisms and response to clopidogrel.". N Engl J Med 360 (4): 354-62. DOI:10.1056/NEJMoa0809171. PMID 19106084. Research Blogging.
- ↑ Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S et al. (2007). "Prasugrel versus clopidogrel in patients with acute coronary syndromes.". N Engl J Med 357 (20): 2001-15. DOI:10.1056/NEJMoa0706482. PMID 17982182. Research Blogging.