Proton pump inhibitor: Difference between revisions

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imported>Robert Badgett
imported>Robert Badgett
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==Drug interactions==
==Drug interactions==
{| class="wikitable"
{| class="wikitable"
|+ [[Cohort study|Cohort studies]] of [[drug interaction]]s between PPIs and [[clopidogrel]]<ref name="pmid19176635">{{cite journal| author=Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV et al.| title=A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. | journal=CMAJ | year= 2009 | volume= 180 | issue= 7 | pages= 713-8 | pmid=19176635  
|+ Studies of [[drug interaction]]s between PPIs and [[clopidogrel]]<ref name="pmid19176635">{{cite journal| author=Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV et al.| title=A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. | journal=CMAJ | year= 2009 | volume= 180 | issue= 7 | pages= 713-8 | pmid=19176635  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19176635 | doi=10.1503/cmaj.082001 | pmc=PMC2659819 }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19687487 Review in: Ann Intern Med. 2009 Aug 18;151(4):JC2-13]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19794029 Review in: Evid Based Med. 2009 Oct;14(5):154] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><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><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=19176635 | doi=10.1503/cmaj.082001 | pmc=PMC2659819 }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19687487 Review in: Ann Intern Med. 2009 Aug 18;151(4):JC2-13]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19794029 Review in: Evid Based Med. 2009 Oct;14(5):154] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><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><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><ref name="medco">Stanek EJ et al. (2009) [http://www.scai.org/annualmeeting/ 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</ref>
| 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><ref name="medco">Stanek EJ et al. (2009) [http://www.scai.org/annualmeeting/ 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</ref>

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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."[1] They are also used as part of curative therapy for Helicobacter pylori, in combination with antibiotics.

Metabolism

Proton pump inhibitors are metabolized by the CYP2C19 isoenzyme of cytochrome P-450. This may be less true for pantoprazole and esomeprazole.[2]

Adverse effects

Proton pump inhibitors may be associated with spontaneous bacterial peritonitis.[3] Recent starting of these drugs may also be associated with pneumonia acquired in the community[4] or hospital[5]. These drugs may be associated with Clostridium difficile diarrhea, and fractures.

Starting proton pump inhibitors in healthy volunteers may induce acid-related symptoms PPIs are stopped[6] This is problematic considering how often PPIs are incorrectly prescribed.[7]

Drug interactions

Studies of drug interactions between PPIs and clopidogrel[8][9][10][11]
Trial Patients Intervention Comparison Outcome Results
PPI Control
Nested case-control study[8] 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 Cardiac Care Follow-up Clinical Study[9] 8205 subjects with acute coronary syndrome 64% were taking PPIs:
(0.2% used pantoprazole)		 Subjects not taking PPIs Major vascular events 20.8% 29.8%
Odds ratio = 1.25 (95% CI: 1.11-1.41)
Cohort study taken from TRITON-TIMI 38 randomized controlled trial[10] 6795 subjects with acute coronary syndrome who were randomized to the clopidogrel arm of the trial 33% were taking PPIs:
(41% used pantoprazole)		 Subjects not taking PPIs Major vascular events 11.8% 12.2%
Hazards ratio = 0.94 (95% CI 0.80–1.11)
Cohort study[11] 16,718 subjects who took clopidogrel for 12 months after coronary stent 41% were taking PPIs:
(24% used pantoprazole)		 Subjects not taking PPIs      

Proton pump inhibitors (especially inhibitors other than pantoprazole[8]), which are metabolized by the CYP2C19 isoenzyme of cytochrome P-450, may[9] or may not[10] increase adverse cardiac events when given to patients taking clopidogrel for coronary heart disease.

References

  1. ↑ Anonymous (2024), Proton pump inhibitor (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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
  5. ↑ 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
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 8.0 8.1 8.2 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
  9. ↑ 9.0 9.1 9.2 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.
  10. ↑ 10.0 10.1 10.2 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.
  11. ↑ 11.0 11.1 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
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