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• W1604172398 abstract "Proton pump inhibitors (PPIs) are widely used for maintenance treatment of gastroesophageal reflux diseases as well as prevention of gastroduodenal ulcers in patients taking nonsteroidal anti-inflammatory drugs. Since they are used for long periods concurrently with other drugs, potential side effects and drug interactions have received attention, with recently reported systemic side effects of PPIs found to be related to their potent acid inhibitory effect. Gastric acidity lowered by PPI administration may also be associated with decreased calcium absorption and cause osteoporosis, resulting in bone fracture. All previous reports concerning the risk of fracture in patients taking PPIs are retrospective observational studies and their results disagree, thus large prospective studies are necessary to clarify the risk of their administration for development of bone fracture. Vitamin B₁₂ and iron absorption may also be decreased by acid inhibition. However, investigations of PPI-induced vitamin B₁₂ and/or iron deficiency are scarce, and their results are inconsistent, though PPI-related risk does not seem to be high. Acid inhibition may also cause bacterial colonization in the distal esophagus and stomach. Reflux and aspiration of bacteria can lead to pneumonia in patients taking PPIs, and early retrospective studies suggested significant risks associated with their administration not only for community-acquired, but also hospital-acquired, pneumonia. However, prospective controlled studies have not confirmed those findings. Therefore, the risk for pneumonia associated with PPI use remains unresolved and may not be clinically meaningful. PPIs interact with other coadministered drugs at the steps of absorption and metabolism. Many drugs have their solubility and stability changed in solutions with different acidity. Therefore, acid inhibition easily alters the bioavailability of drugs such as digoxin, alendronate, and atazanavir. PPIs also influence the activation and degradation of coadministered drugs by competitively inhibiting the hepatic cytochrome p450 enzyme CYP2C19. For example, clopidogrel, an antithrombotic drug, requires activation by cytochrome p450 enzymes including CYP2C19, while PPIs inhibit the activation of clopidogrel and decrease its antithrombotic effect. However, the clinical significance of these actions has not been clearly shown. The systemic side effects of PPIs are equal to or less than those of other commonly used drugs. However, it is important to always note the appropriate indications for PPIs and carefully watch for possible systemic side effects even when the frequency is not high." @default.
• W1604172398 created "2016-06-24" @default.
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• W1604172398 date "2013-01-01" @default.
• W1604172398 modified "2023-10-15" @default.
• W1604172398 title "Administration of Proton Pump Inhibitors and Risk of Systemic Side Effects" @default.
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• W1604172398 doi "https://doi.org/10.1159/000350638" @default.
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