Proton pump inhibitors: side effects and interaction

Abstract

Proton pump inhibitors are the most important medicines in the treatment of acid related diseases. All proton pump inhibitors are weak bases being selectively metabolised in the acid environment and blocking the function of active proton pumps. Proton pump inhibitors provide efficient treatment for gastroesophageal reflux disease, Helicobacter pylori eradication, functional dyspepsia and NSAIDgastropathy. Proton pump inhibitors differ in pharmacokinetc properties but these differences do not necessarily have clinically relevant consequences. Generally, 2^nd generation proton pump inhibitors provide faster onset of effect, longer gastric secretion inhibition, and specifically the effect of rabeprazole is less dependent on the method of administration and has less influence on the function of the cytochrome P450. The main effect of the 1st generation proton pump inhibitors is modified by the genetic variety of the enzyme CYP2C19 and it is significantly lower in rapid metabolizers. Proton pump inhibitors are very safe and immediate complications are exceptional. They can cause progression of gastritis in Helicobacter infection. In spite of hypergastrinemiathey do not have malignant potential. Their long-lasting usage is associated with an increased risk of pelvis and hip fractures, community pneumonia, and clostridium infection. They decrease the effect of antiaggregant therapy with clopidogrel, and increase the risk of recurrent cardiovascular events. The instructions for patients are clearly presented and often important information is lacking.