List of proton pump inhibitors
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List of Proton Pump Inhibitors (PPIs)
Introduction to Proton Pump Inhibitors
Proton pump inhibitors (PPIs) are a class of medications widely used to treat acid-related disorders such as gastroesophageal reflux disease (GERD), peptic ulcers, and nonulcer dyspepsia. They work by inhibiting the gastric H+/K+-ATPase enzyme in the stomach lining, thereby reducing acid production and alleviating symptoms like heartburn and acid reflux6 9.
Commonly Prescribed Proton Pump Inhibitors
Several PPIs are commonly prescribed and have been approved by the Food and Drug Administration (FDA) for various gastrointestinal conditions. These include:
- Omeprazole (Prilosec®): One of the first PPIs introduced and widely used for treating GERD and peptic ulcers7.
- Lansoprazole (Prevacid®): Known for its effectiveness in treating acid-related disorders and available in both prescription and over-the-counter forms7.
- Pantoprazole (Protonix®): Often prescribed for GERD and Zollinger-Ellison syndrome, a condition involving excessive stomach acid production7.
- Esomeprazole (Nexium®): A more potent enantiomer of omeprazole, used for treating GERD and erosive esophagitis7.
- Rabeprazole (Aciphex®): Used for the treatment of GERD, duodenal ulcers, and in combination with antibiotics for Helicobacter pylori eradication7.
Pharmacokinetics and Mechanism of Action
All PPIs share a similar mechanism of action by covalently binding to cysteine residues on the proton pump, thereby inhibiting acid secretion in the stomach. However, they differ slightly in their pharmacokinetic properties, such as absorption rates, metabolism, and plasma half-lives4 6. These differences can influence the choice of PPI based on the specific needs and conditions of the patient.
Clinical Indications and Efficacy
PPIs are highly effective in managing a variety of acid-related disorders. They are the first choice for treating conditions like GERD, peptic ulcers, and for preventing gastrointestinal bleeding in patients on antiplatelet therapy5 9. Despite their efficacy, PPIs have limitations, such as a short plasma half-life and the need for meal-associated dosing, which can lead to breakthrough symptoms, especially at night4.
Adverse Effects and Concerns
While PPIs are generally considered safe, long-term use has been associated with several potential adverse effects. These include an increased risk of fractures, pneumonia, Clostridium difficile infection, hypomagnesemia, vitamin B12 deficiency, chronic kidney disease, and dementia1 5. Recent studies have also highlighted concerns about drug-drug interactions, particularly with antineoplastic agents and antiplatelet drugs like clopidogrel, which may reduce the efficacy of these medications3 10.
Conclusion
Proton pump inhibitors are a cornerstone in the treatment of acid-related gastrointestinal disorders. Commonly prescribed PPIs include omeprazole, lansoprazole, pantoprazole, esomeprazole, and rabeprazole. While effective, their long-term use requires careful consideration due to potential adverse effects and drug-drug interactions. Regular review and appropriate dosing are essential to maximize benefits and minimize risks associated with PPI therapy.
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Most relevant research papers on this topic
Adverse Effects Associated With Proton Pump Inhibitors.
Proton pump inhibitors (PPIs) are associated with a number of adverse effects and are overprescribed, including chronic kidney disease.
Systematic Review
Rigorous Journal
Highly CitedAGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review.
De-prescribing PPIs is a cost-effective strategy to lower pill burden and reduce risks, but should be considered for patients with uncertain benefits and those with known complications.
Systematic ReviewHighly CitedProton Pump Inhibitors and Cancer: Current State of Play
PPIs may interact with cancer microbiome and antineoplastic agents, potentially decreasing their efficacy and worsening side effects, but their impact on cancer survival remains unclear.
Systematic Review25 Years of Proton Pump Inhibitors: A Comprehensive Review
Proton pump inhibitors (PPIs) are effective in managing acid-related disorders, but their short plasma half-lives and meal-associated dosing may cause some limitations.
Literature ReviewRigorous JournalHighly CitedProton Pump Inhibitors: Review of Emerging Concerns
Long-term use of proton pump inhibitors (PPIs) may increase the risk of serious adverse effects, but current evidence is insufficient to definitively link their use to serious risks.
Highly CitedReview article: the clinical pharmacology of proton pump inhibitors
Proton pump inhibitors inhibit the gastric H+/K+‐ATPase via covalent binding to cysteine residues of the proton pump. All proton pump inhibitors must undergo acid accumulation in the parietal cell through protonation, followed by activation mediated by a second protonation at the active secretory canaliculus of the parietal cell.
Highly CitedProton pump inhibitors
Proton pump inhibitors (PPIs) are a group of medicines that treat acid reflux, stomach and intestinal ulcers by decreasing stomach acid production and reducing discomfort.
Proton pump inhibitors are associated with accelerated development of cirrhosis, hepatic decompensation and hepatocellular carcinoma in noncirrhotic patients with chronic hepatitis C infection: results from ERCHIVES
Proton pump inhibitors may accelerate the development of cirrhosis, hepatic decompensation, and hepatocellular carcinoma in noncirrhotic patients with chronic hepatitis C infection.
Very Rigorous JournalDrug-Drug Interaction Profiles of Proton Pump Inhibitors
PPIs may potentially interact with clopidogrel, potentially increasing the risk of cardiovascular events and requiring further studies to clarify the mechanism.
Very Rigorous JournalHighly Cited