Proton Pump Inhibitors (PPIs) Drug Class

  • Pharmacy Author:
    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.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    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 (mechanism of action)?

Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid. Acid is necessary for the formation of most ulcers in the esophagus, stomach, and duodenum, and the reduction of acid with PPIs prevents ulcers and allows any ulcers that exist in the esophagus, stomach, and duodenum to heal.

What diseaes or conditions do PPIs treat?

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.cs for eradicating H. 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; therefore, they 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.

PPIs may increase the risk of Clostridium difficile infection of the colon. High doses and long-term use (1 year or longer) may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine. Prolonged use also reduces absorption of vitamin B12 (cyanocobalamin).

Long-term use of PPIs has also been associated with low levels of magnesium (hypomagnesemia). Analysis of patients taking PPIs for long periods of time showed an increased risk of heart attacks.

Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated.

Other serious side effects associate with PPIs include:

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What drugs interact with proton pump inhibitors (PPIs)?

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).
  • Omeprazole (Prilosec, Prilosec OTC) reduces the effect of clopidogrel (Plavix) by blocking the conversion of clopidogrel to its active form. This combination should be avoided.

List of examples of brand and generic names for PPIs

Available proton pump inhibitors include:

Note: The brand name Kapidex was changed to Dexilent to avoid confusion with other drugs.

Reference: FDA Prescribing Information

Summary

Proton pump inhibitors (PPIs) reduce the production of acid in the wall of the stomach (that produces acid) thereby preventing ulcers and assists in the healing of ulcers that exist on the esophagus, stomach, or duodenum. PPIs are prescribed for the prevention and treatment for acid-related conditions such as GERD (gastroesophageal reflux disease), ulcers, and Zollinger-Ellison syndrome. PPIs may also be used in combination with antibiotics for the treatment of Helicobacter pylori. Examples of proton pump inhibitors approved in the U.S. include:

Common side effects of PPIs include:

Proton pump inhibitors interact with few drugs.

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Reviewed on 10/14/2016
References
Reference: FDA Prescribing Information

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