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.
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.
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:
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:
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?
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation (gastritis) of the inner lining of the stomach in humans. This bacteria also is the most common cause of ulcers worldwide.
A peptic ulcer is an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to Helicobacter pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication, prescription medication, and surgery.
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
What are nonsteroidal anti-inflammatory drugs (NSAIDs)?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medications for the inflammation of arthritis and other body tissues, such as in
tendinitis and bursitis. The are also used for minor aches and pain.
Examples of NSAIDs include:
aspirin,
indomethacin (Indocin),
ibuprofen (Motrin),
naproxen (Naprosyn),
piroxicam (Feldene),
nabumetone (Relafen), and
Celecoxib (Celebrex).
NSAIDs are available by prescription or without a prescription (over-the-counter). They are also ingredients in many over the counter medications used for
colds and minor aches and
pain. They are administered orally as capsules, tablets, liquids, or by
injection ketorolac
(Toradol). Although not included in this review, NSAIDs are also used as eye drops for eye inflammation (f...
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