PROTON-PUMP INHIBITORS
| Drug |
Duodenal Ulcer |
Gastric Ulcer |
H.
pylori tx |
GERD |
| Omeprazole (Prilosec) |
20mg QD x 4wks |
20-40mg QD x 4-8wks |
20mg QD |
20-60mg QD |
| Esomeprazole* (Nexium) |
|
|
|
20-40mg QD |
| Lansoprazole (Prevacid) |
15mg QD x 4wks |
30mg QD x 4-8wks |
30mg QD |
15-30mg QD |
| Rabeprazole (Aciphex) |
20mg QD x 4wks |
20-40mg QD x 4-8wks |
20mg QD |
|
| Pantoprazole (Protonix) |
|
|
|
40mg QD |
*--Esomeprazole is the s-isomer of omeprazole
- Pharmacology
- Reduce HCl secretion more than
H2-blockers
- Omeprazole inhibits cytochrome p-450
enzymes (see above under
"Cimetidine")
- Adverse effects
- Can cause some nausea, abd. pain,
constipation or diarrhea; acute
interstitial nephritis has been reported
- May increase risk of
pneumonia
- In a prospective study
of a population of 364,000 pts over 3y, use of either
H2-blockers or PPIs were ass'd with RR 4.5 for
incidence of community-acquired pneumonia (JAMA
292:1955, 2004--JW)
- In a case-control study in 63,878 adult non-ICU
inpatients hospitalized for 3d or longer, of whom
27,000 received PPIs and 7,500 received
H2-blockers, incidence of hospital-acquired
pneumonia was sig. higher in pts receiving acid
suppression (4.9% vs. 2.0%). After
adjustment for potential confounders, OR was 1.3;
all excess risk was associated with PPI use (JAMA
301:2120, 2009-JW)
- Cause hyperplasia of gastric enterochromaffin-like cells in animals
& humans and neuroendocrine cell
tumors and hepatocellular carcinoma in
animals
- May accelerate the progression of Osteoporosis
by interfering with calcium absorption
- In a retrospective study of about 400,000 pts who received at least one prescription for a PPI and/or H2 blocker, after adjustment for potential confounders, pts on a PPI for > 1y had sig. increased incidence of hip fracture (RR 1.44) c/w pts who did not use any acid-suppression therapy. No sig. diff. between users of H2 blockers and non-users. There was evidence of a dose- and duration-dependent effect (JAMA 296:2947, 2006--JW)
- Some evidence for rare association with Acute
Interstitial Nephritis in children from retrospective
studies (Clin. Gastroent. Hepatol. 4:597, 2006--JW)
- Some association with risk of Clostridium dificile
colitis in case-control studies (JAMA 294:2989,
2005--JW)
- See section on NSAIDs
for info on use of PPI's for prevention of NSAID-induced
ulcers