What are proton pump inhibitors (PPIs) and how do they work?

Proton-pump inhibitors reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid. The reduction of acid prevents ulcers and allows any ulcers that exist in the esophagus, stomach and duodenum to heal.

For what conditions are PPIs used?

PPIs are used for the prevention and treatment of acid-related conditions such as ulcers, gastroesophageal reflux disease (GERD), and Zollinger-Ellison syndrome. They also are used in combination with antibiotics for eradicating Helicobacter pylori, a bacterium that together with acid causes ulcers of the stomach and duodenum.

Are there differences among PPIs?

PPIs are very similar in action and there is no evidence that one is more effective than another. They differ in how they are broken-down by the liver and their drug interactions. The effects of some PPIs may last longer and they, therefore, may be taken less frequently.

What are the side effects of PPIs?

The most common side effects of PPIs are headache, diarrhea, constipation, abdominal pain, nausea, and rash. Nevertheless, PPIs generally are well-tolerated.

With which drugs do PPIs interact?

PPIs interact with few drugs. The absorption into the body of some drugs is affected by the presence of acid in the stomach, and because PPIs reduce acid in the stomach, they may affect the absorption of these drugs. Specifically, PPIs reduce the absorption and concentration in the blood of ketoconazole (NIZORAL) and increase the absorption and concentration of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole and an increase in digoxin toxicity. PPIs can reduce the break-down of some drugs by the liver and lead to an increase in their concentration in the blood. Omeprazole is more likely than the other PPIs to reduce the break-down of drugs by the liver. For example, omeprazole may increase the concentration in the blood of diazepam (Valium), warfarin (Coumadin) and phenytoin (Dilantin).

Which PPIs are approved in the United States?

Available PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium).

Medical Author: Omudhome Ogbru, Pharm.D.
Medical Editor: Jay W. Marks,M.D.

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