PEBC: What You Need to Know: Proton Pump Inhibitors

Examples:

rabeprazole, esomeprazole, omeprazole, lansoprazole, dexlansoprazole, pantoprazole

Indications:

-gastroesophageal reflux disease

-peptic ulcer disease

-H.pylori

-gastroprotection from NSAIDs or blood thinners

Role in Therapy:

-effective medications for acid reduction and stomach protection

Dosing:

-taken once daily 30 minutes before meal (usually before breakfast) and can be increased to twice daily. Taper dose slowly if taken for a long time to avoid rebound acid secretion.

Adverse Effects:

-usually well tolerated, but can cause nausea, diarrhea and headache.

-reduced acidity may result in increased risk for fractures, anemia and infections (C.difficile)

Drug Interactions:

Mostly through reduced absorption via reduced acidic environment:

-May reduce magnesium, vitamin B12, calcium and iron absorption

-Oral bisphosphonates - may put patients at risk for fractures

-Methotrexate (at high chemotherapy doses) - decreased clearance of methotrexate at the kidney level

-Omeprazole: a CYP2C19 inhibitor which can reduce the conversion of clopidogrel into its active metabolite

-Other various drugs which require acidic environment for optimal absorption