Proton-Pump Inhibitors
(PPIs)

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Pharmacy Author:

Omudhome Ogbru, PharmD

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

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Medical and Pharmacy Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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• What are proton pump inhibitors (PPIs) and how do they work?
• For what conditions are proton pump inhibitors (PPIs) used?
• Are there differences among proton pump inhibitors (PPIs)?
• What are the side effects of proton pump inhibitors (PPIs)?
• With which drugs do proton pump inhibitors (PPIs) interact?
• Which proton pump inhibitors (PPIs) are approved in the United States?

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 proton pump inhibitors (PPIs) used?

Proton pump inhibitors 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 proton pump inhibitors (PPIs)?

Proton pump inhibitors 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 proton pump inhibitors (PPIs)?

The most common side effects of proton pump inhibitors are:

• headache,
  
  
• diarrhea,
  
  
• constipation,
  
  
• abdominal pain,
  
  
• nausea, and
  
  
• rash.

Nevertheless, proton pump inhibitors generally are well tolerated.

High doses and long-term use (1 year or longer) may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine. Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated.

With which drugs do proton pump inhibitors (PPIs) interact?

Proton pump inhibitors 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.

Proton pump inhibitors can reduce the break-down of some drugs by the liver and lead to an increase in their concentration in the blood. Omeprazole (Prilosec) is more likely than the other PPIs to reduce the break-down of drugs by the liver. For example, omeprazole (Prilosec) may increase the concentration in the blood of diazepam (Valium), warfarin (Coumadin) and phenytoin (Dilantin).

Which proton pump inhibitors (PPIs) are approved in the United States?

Available proton pump inhibitors  include:

• omeprazole (Prilosec),
  
  
• lansoprazole (Prevacid),
  
  
• rabeprazole (Aciphex),
  
  
• pantoprazole (Protonix),
  
  
• esomeprazole (Nexium), and
  
  
• Zegarid, a rapid release form of omeprazole.

Reference: FDA Prescribing Information

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