Proton pump inhibitors, or PPIs, are prescription medications used for the treatment of gastrointestinal esophageal reflux disease, or GERD. Symptoms of GERD are heartburn, belching and regurgitation.The PPIs include Nexium (esomeprazole), Prilosec and Zegerid (omeprazole), Prevacid (lansoprazole), Aciphex (rabeprazole), Protonix (pantoprazole) and Dexilant (dexlansoprazole). A health care provider can diagnose a patient properly and dose him accordingly.
Actions in the Body
Proton pump inhibitors block the gastric acid secreted in the stomach by blocking a chemical called H+/K+-adenosine triphosphate in the cells found on the lining of the stomach. "Pharmacotherapy: A Pathophysiologic Approach" explains that this will prevent the secretion of acid and maintain a low level of acid for a long period of time. The PPIs are superior to H2-receptor antagonists, such as famotidine or ranitidine, and are able to control symptoms and heal esophagitis in patients with GERD.
Side Effects
PPIs may cause many common side effects. Headache and dizziness may occur in up to 10 percent of patients, according to the "Drug Information Handbook." These undesired effects will begin to decrease as the body grows accustomed to the new drug. Gastrointestinal side effects include nausea, vomiting, abdominal pain, and constipation. Chewing gum and sucking on candy can help alleviate these side effects. Exercising regularly and obtaining an adequate amount of fiber in the diet will alleviate constipation. If any of these side effects worsen, the patient should speak with a physician.
Precautions
Atrophic gastritis is chronic inflammation of the lining of the stomach and is characterized by changes in the cells found there. Long-term therapy with PPIs may lead to the development of atrophic gastritis. In May 2010, the U.S. Food and Drug Administration announced that revisions have been made on the labels of PPIs to warn patients of a possible risk of fracture of the hip, wrist, and spine associated with PPIs. The FDA advises health care providers to consider a lower dose or shorter duration of therapy when prescribing PPIs while ensuring that the patient is treated effectively.
Dosage Adjustments
Dosage adjustments are not needed in elderly patients, states the "Drug Information Handbook." Patients who have kidney impairment do not need a dosage adjustment, as well. Those with mild to moderate liver impairment will be dosed with the usual dose. Patients who have severe liver impairment require dosage adjustment and closer monitoring.
Interactions
PPIs may interact with medications that are eliminated from the body in the same manner. Some of the medications that interact with PPIs include atazanavir, indinavir, ketoconazole, itraconazole, carbamazepine and phenytoin, among others. The patient should inform the physician of his past medical history, including all current over-the-counter and prescription medications. Food may also decrease the levels of the PPI. The medication is best taken in the morning before breakfast.
References
- "Drug Information Handbook 15th Edition"; Charles F. Lacy, Lora L. Armstrong, et al.; 2007
- "Pharmacotherapy: A Pathophysiologic Approach"; Josep T. Dipiro, Robert L. Talbert., et al.; 2008
- FDA.gov: Proton Pump Inhibitors (PPI): Class Labeling Change
