Proton Pump Inhibitor

January 4, 2012 by staff 

Proton Pump InhibitorProton Pump Inhibitor, Proton-pump inhibitors (PPIs) are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today. The group followed and has largely superseded another group of pharmaceuticals with similar effects, but different mode-of-action, called H2-receptor antagonists. These drugs are among the most widely-selling drugs in the world and are generally considered effective. The vast majority of these drugs are benzimidazole derivatives; however, promising new research indicates that imidazopyridine derivatives may be a more effective means of treatment. High dose or long-term use of PPIs carry a possible increased risk of bone fractures.
The effectiveness of proton pump inhibitors has not been demonstrated in every case, despite their widespread use for these conditions. For example, proton pump inhibitors do not change the length of Barrett’s oesophagus. The most objective test to assess success of PPI therapy in patients with GERD is esophageal pH monitoring.

The FDA advises that no more than three 14-day treatment courses should be used in one year.

In general, proton pump inhibitors are well tolerated, and the incidence of short-term adverse effects is relatively uncommon. The range and occurrence of adverse effects are similar for all of the proton pump inhibitors, though they have been reported more frequently with omeprazole. This may be due to its longer availability and, hence, clinical experience.

Common adverse effects include: headache (in 5.5% of users in clinical trials), nausea, diarrhea, abdominal pain, fatigue, and dizziness. Long-term use is associated with hypomagnesemia.

Because the body uses gastric acid to release B12 from food particles, decreased vitamin B12 absorption may occur with long-term use of proton-pump inhibitors and may lead to Vitamin B12 deficiency.

Infrequent adverse effects include rash, itch, flatulence, constipation, anxiety, and depression. In rare cases, PPI use may cause ‘idiosyncratic’ reactions such as erythema multiforme, pancreatitis, Stevens-Johnson syndrome, and acute interstitial nephritis.

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