Chest pain proton pump inhibitors

Proton pump inhibitors (PPIs), such as omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole, are commonly prescribed to treat symptoms of heartburn, acid reflux, chest pain, dyspepsia, and chronic cough. PPIs inhibit the transfer of protons into the stomach lumen. Pharmacological acid suppression is thus used to treat gastroesophageal reflux disease (GERD) and esophagitis, peptic ulcers, and Helicobacter pylori infection as well as to prevent ulcer development with concurrent nonsteroidal anti-inflammatory drug use. 

Pantoprazole (Protonix) [Gastric Acid Suppressant/Proton Pump Inhibitor] Uses GERD, erosive gastritis, ZE synd, PUD Action Proton pump inhibitor Dose 40 mg/d PO do not crush/chew tabs 40 mg IV/d (not >3 mg/min, use Protonix filter) Caution [B, /-] Disp Tabs, inj SE Chest pain, anxiety, GI upset Interactions t Effects OF warfarin t effects of photosensitivity W/ St. John s wort X effects OF ketoconazole EMS t Effects of anticoagulants may affect glucose (hypoglycemia) OD Unlikely to cause life-threatening Sxs... 

Sustained acid suppression with twice-daily proton pump inhibitors for at least 3 months is used to treat extraesophageal complications of reflux disease (asthma, chronic cough, laryngitis, and noncardiac chest pain). 

Patients presenting with atypical symptoms may require higher doses and longer treatment courses as compared with patients with typical symptoms. These patients are best diagnosed with ambulatory pH testing or an empiric trial with a proton pump inhibitor. In patients presenting with noncardiac chest pain, a short course (1 to 8 weeks) of... 

Many elderly patients have decreased host defense mechanisms such as saliva production. More aggressive therapy with a proton pump inhibitor may be warranted in patients with symptomatic GERD in patients older than 60 years of age. Often these patients do not seek medical attention because they feel their symptoms are part of the normal aging process. They may present with atypical symptoms such as chest pain, asthma, hoarseness, coughing, wheezing, poor dentition, or jaw pain. Decreased GI motility is a common problem in elderly patients. Unfortunately, there are no good prokinetic agents available to these patients. 

---