Proton pump inhibitors (PPI's) suppress gastric secretions by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell. They are called proton pump inhibitors because it blocks the final step of acid production. This in turns reduces irritation of the esophageal and gastric mucosa. PPI's are heavily used in patients suffering from upper gastrointestinal problems.
Drugs considered Proton Pump Inhibitors include:
Routinely given to patients suffering from gastroesophageal reflux disease also known as GERD. Proton pump inhibitors are commonly taken with histamine (H2)-receptor blockers to treat GERD. The goal of this drug therapy is to improve lower esophageal sphincter function, increase esophageal clearance and protect the esophageal mucosa. PPI's are very effective in healing esophagitis and incidence of esophageal strictures, a complication of chronic GERD.
It's important for patients to understand that long-term use of proton pump inhibitors may increase the risk of fractures of the hip, wrist, and spine. Lower doses and shorter duration of drug therapy should be considered because they are also associated with increased risk of C.difficile infection in patients that are hospitalized. Some of the common side effects include:
Some lifestyle modification is needed with taking PPI's. Because proton pump inhibitors work on the lower esophageal sphincter (LES), the individual should give particular attention to diet and drugs that may affect the LES. If the patient is overweight, then recommend weight reduction. Avoid reflux-inducing foods (fatty foods, chocolate, tomatoes, peppermint.), alcohol, and acidic PH beverages such as colas, red wine, and orange juice. Avoid milk especially before bedtime since it increases acid production. Small, frequent meals help to prevent over distention of the stomach. Saliva production can be increased by chewing gum and oral lozenges. If the patient is used to often eating throughout the day, advise them to avoid late meals and snacking at night. They should also take fluids between meals rather than with meals to reduce gastric distention. PPI's should be avoided if the patient is using red yeast rice or St. John's wort.
Proton pump inhibitors can increase effect, toxicity levels of Lansoprazole, diazepam, digoxin, penicillin, saquinavir. Can increase bleeding if taken with warfarin and serum levels of disulfiram. Proton pump inhibitors can decrease effect, absorption of atazanavir, nelfinavir, dapsone, iron, itraconazole, ketoconazole, indinavir, calcium carbonate, vitamin B12, clopidogrel, and ampicillin.
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