Proton pump inhibitors

Proton pump inhibitors

Proton pump inhibitors (PPIs) are a group of drugs whose main action is a pronounced and long-lasting reduction of stomach acid production. They are the most potent inhibitors of acid secretion available today. The group includes prilosec, prevacid, nexium, and protonix. PPIs are used in the treatment of many conditions, such as peptic ulcer disease, gastroesophageal reflux disease (GERD), and Zollinger–Ellison syndrome.

Category

Medication

Molecular Formula

Varies by specific type of PPI

Mechanism of Action

Proton pump inhibitors act by irreversibly blocking the hydrogen/potassium adenosine triphosphatase enzyme system (the H+/K+ ATPase, or more commonly just gastric proton pump) of the gastric parietal cells, thereby suppressing the secretion of gastric acid.

Evidence Grade

A

Other Names

• PPIs
• Omeprazole
• Esomeprazole
• Lansoprazole
• Pantoprazole
• Rabeprazole
• Dexlansoprazole

Primary Benefits

• Treatment of peptic ulcers
• Treatment of GERD
• Treatment of Zollinger–Ellison syndrome

Recommended Dosage

Side Effects

• Headache
• Nausea
• Diarrhea
• Abdominal pain
• Fatigue
• Dizziness

Precautions

• Not recommended for long-term use
• May increase risk of bone fractures if used for more than a year
• May affect absorption of certain nutrients like magnesium and vitamin B12
• May increase risk of certain infections

Interactions

• Can cause decreased efficacy of certain drugs like clopidogrel
• May increase serum levels of methotrexate
• May alter absorption of drugs dependent on gastric pH like ketoconazole or atazanavir

Key References

• Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013
• FDA Drug Safety Communication: Clostridium difficile-associated diarrhea can be associated with stomach acid drugs known as proton pump inhibitors (PPIs)