Acid drug
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Acid Drugs: Uses, Environmental Impact, and Health Risks
Acid-Suppressive Drugs: Efficacy and Nocturnal Acid Inhibition
Acid-suppressive drugs (ASDs) are commonly used to manage gastric acid-related conditions. These include proton-pump inhibitors (PPIs), H2-receptor antagonists (H2RAs), and potassium-competitive acid blockers (P-CABs). A systematic review and network meta-analysis compared the nocturnal acid-inhibitory effects of these drugs. The study found that tegoprazan and vonoprazan were the most effective, outperforming new PPIs, additional H2RAs at bedtime (AHB), isomer PPIs, traditional PPIs, and H2RAs1. This suggests that P-CABs like tegoprazan and vonoprazan may offer superior control over nocturnal acid breakthrough compared to other ASDs.
Environmental Presence of Acidic Drugs
Acidic drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) and other pharmaceuticals, have been detected in various water bodies. Studies have shown that these drugs are present in surface waters, such as the Umgeni River in South Africa, with concentrations ranging from 0.0200 to 68.14 µg L-12. Similarly, in the Yellow, Hai, and Liao Rivers in China, seven acidic pharmaceuticals were detected, with ibuprofen and diclofenac posing medium to high risks to aquatic organisms5. These findings highlight the widespread environmental contamination by acidic drugs and the potential ecological risks they pose.
Detection and Quantification Methods
Advanced analytical methods have been developed to detect and quantify acidic drugs in environmental and biological samples. Techniques such as gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) have been optimized for this purpose. These methods have shown high recovery rates and low detection limits, making them effective for monitoring acidic drug residues in water and sewage treatment plant effluents2 6.
Health Risks Associated with Acid-Suppressive Drugs
The use of acid-suppressive drugs has been linked to several health risks. A meta-analysis of observational studies found that long-term use of PPIs is associated with an increased risk of fractures, particularly hip fractures, while H2RAs did not show a significant association7. Another meta-analysis indicated that both PPIs and H2RAs are associated with an increased risk of gastric cancer8. Additionally, there is growing evidence that exposure to acid-suppressive medications may increase the risk of developing allergic diseases, although further research is needed to confirm these findings and understand the underlying mechanisms10.
Conclusion
Acidic drugs, including ASDs, play a crucial role in managing gastric acid-related conditions but come with potential health risks and environmental impacts. Tegoprazan and vonoprazan have shown superior efficacy in nocturnal acid inhibition. However, the presence of acidic drugs in water bodies and their associated ecological risks necessitate improved detection and quantification methods. Furthermore, the potential health risks linked to long-term use of ASDs, such as increased fracture risk, gastric cancer, and allergic diseases, underscore the need for cautious prescribing and further research.
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Most relevant research papers on this topic
Acid‐suppressive drugs: A systematic review and network meta‐analysis of their nocturnal acid‐inhibitory effect
Vonoprazan and tegoprazan have the best nocturnal acid-inhibitory effect compared to other acid-suppressive drugs, including H2RAs, isomer PPIs, traditional PPIs, AHB, and new PPIs.
Meta-AnalysisDetection and quantification of acidic drug residues in South African surface water using gas chromatography-mass spectrometry.
The developed method effectively detects and quantifies acidic drugs in South African surface water, with recovery rates ranging from 60-110% and standard deviations below 15%.
Highly CitedAcidic and basic drugs in medicinal chemistry: a perspective.
Acidic and basic drugs have advantages and disadvantages in medicinal chemistry, but exploring a range of carefully chosen pKa values can help optimize drug design and avoid undesired effects.
Highly CitedOn-line dialysis-SPE-CE of acidic drugs in biological samples.
This fully automated method effectively detects acidic drugs in urine and serum, with detection limits ranging from 0.05-1.0 microgram ml-1 and repeatability better than 10%.
Occurrence and risk assessment of acidic pharmaceuticals in the Yellow River, Hai River and Liao River of north China.
Acidic pharmaceuticals like diclofenac and ibuprofen pose medium to high risks to aquatic organisms in the Yellow, Hai, and Liao Rivers of north China, with concentrations higher in metropolitan areas and river confluences.
Observational StudyHighly CitedAnalysis of acidic drugs in the effluents of sewage treatment plants using liquid chromatography-electrospray ionization tandem mass spectrometry.
The developed LC-ESI-MS-MS method effectively detects and quantifies acidic pharmaceutical drugs in sewage treatment plant effluents, with mean recoveries ranging from 58.9 to 91.5%.
Highly CitedUse of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies
Long-term use of proton pump inhibitors (PPIs) may increase the risk of fractures, while long-term use of histamine 2 receptor antagonists (H2RAs) shows no significant association with fracture risk.
Meta-AnalysisHighly CitedAcid suppressive drugs and gastric cancer: a meta-analysis of observational studies.
Acid suppressive drugs, such as H2RAs and PPIs, are associated with an increased risk of gastric cancer.
Meta-Analysis
Rigorous JournalHighly CitedOccurrence of acidic pharmaceuticals and personal care products in Turia River Basin: from waste to drinking water.
Acidic pharmaceuticals and personal care products (PPCPs) are present in waste, surface, and drinking water in the Turia River Basin, with potential health implications.
Highly CitedAcid suppressant medications and the risk of allergic diseases
Exposure to acid suppressant medications may increase the risk of developing allergic diseases, but further research is needed to clarify this relationship and define their potential mechanisms of action.
Systematic Review