Proton Pump Inhibitors

Conditions treated

Proton pump inhibitors (PPIs) are used to treat several conditions that affect the digestive system. These include:

• Gastroesophageal reflux disease (GERD). A condition in which acidic food or liquid from the stomach backs up into the esophagus, which connects the mouth to the stomach. Proton pump inhibitors are considered to be the most effective medication for treating GERD.
• Peptic ulcers. Sores that develop in the lining of the stomach or duodenum, the first part of the small intestine. PPIs do not kill Helicobacter pylori, the bacterium that causes peptic ulcers. For this reason, antibiotics may also be used to treat peptic ulcers.
• Gastritis. Inflammation of the stomach lining. PPIs are used when the condition is severe enough to require the strongest medication available.
• Indigestion. A burning feeling or discomfort in the upper abdomen caused by many different factors, including diseases such as GERD and ulcers, as well as lifestyle activities such as eating too much or eating high-fat foods.
• Zollinger-Ellison syndrome. Rare condition that causes tumors to form in the pancreas and duodenum, or ulcers to form in the stomach or duodenum. PPIs are considered to be the most effective drug for treating this condition, and are used to both reduce production of stomach acid and to promote healing.

Conditions of concern

Few conditions prohibit the use of proton pump inhibitors (PPIs) in patients. Patients who have a history of hypersensitivity to PPIs should not take these medications. In addition, patients who have severe liver disease should only use these medications with extra caution.

A recent study shows that taking PPIs for a year or longer can markedly increase the risk of hip fractures in people over the age of 50. Therefore, it is often recommended that individuals age 50 or older who take PPIs for an extended period also take supplemental calcium and vitamin D to strengthen the bones. Because of their acid blocking activity, PPIs have the potential to cause small bowel bacterial overgrowth, which may result in bad breath.

Potential side effects

Proton pump inhibitors (PPIs) are generally considered to cause relatively few side effects in people who use them. Side effects that do occur are similar to those associated with use of H2 blockers. The most common include headache, diarrhea, stomach or abdominal pain, flatulence, dry mouth, constipation, nausea and skin rash. Recently there have been conflicting reports about whether the use of PPIs is associated with Clostridium difficile (a type of bacterium) infections in patients. There have also been concerns that use of PPIs may increase a patient’s risk of cancer of the stomach or esophagus. However, recent research suggests that the medication is not associated with elevated cancer risk.

Drug or other interactions

Patients should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications.

Proton pump inhibitors (PPIs) significantly raise a patient’s gastric pH level, which may affect the body’s ability to absorb drugs such as:

• Certain antibiotics including amoxicillin, ampicillin, clarithromycin, and griseofulvin. PPIs may decrease the absorption of certain antibiotics. However, antibiotics are often prescribed for several days to weeks along with certain PPIs to treat the Helicobacter pylori bacteria which cause peptic ulcers.
• Antifungals such as itraconazole and ketoconazole.
• Iron supplements.
• Vitamin B.

Other drugs that may be affected by PPI use include:

• Diazepam (antianxiety drug)
• Digoxin (antirrhythmic heart drug)
• Phenytoin (anticonvulsant)
• Sucralfate (antiulcer medication)
• Theophylline (bronchodilator)
• Warfarin (anticoagulant)

Newer PPIs such as rabeprazole and pantoprazole may have fewer drug interactions than older versions.

Pregnancy use issues

Women who are pregnant or are thinking of becoming pregnant should not use proton pump inhibitors (PPIs) without discussing the potential risks and benefits of using these drugs with a physician. It is not known whether or not PPIs pass into breast milk. For this reason, they should not be used by women who are breastfeeding.

Child use issues

The safety of proton pump inhibitors in children has not been established.

Elderly use issues

Elderly patients generally tolerate proton pump inhibitors as well as younger adults. Dosage adjustments are not usually necessary in elderly patients who have kidney disease or mild liver disease.