Elimination, proton pump inhibitors

Proton Pump Inhibitors and Acid Pump Antagonists retinoid X receptor (RXR) and is also activated by various lipophilic compounds produced by the body such as bile acids and steroids. PXR heterodimerized with RXR stimulates the transcription of cytochrome P450 3A monooxygenases (CYP3A) and other genes involved in the detoxification and elimination of the... 

METHOTREXATE PROTON PUMP INHIBITORS -OMEPRAZOLE Likely t plasma concentration of methotrexate and t risk of toxic effects, e.g. blood dyscrasias, liver cirrhosis, pulmonary toxicity, renal toxicity Attributed to omeprazole decreasing the renal elimination of methotrexate Monitor clinically and biochemically for blood dyscrasias and liver, renal and pulmonary toxicity... 

GUMEPIRIDE H2 RECEPTOR BLOCKERS-CIMETIDINE, RANITIDINE t plasma concentrations of glimepiride and t risk of hypoglycaemic episodes Cimetidine and ranitidine i renal elimination of glimepiride and t intestinal absorption of glimepiride. Cimetidine is also an inhibitor of CYP2D6 and CYP3A4 Consider alternative acid suppression, e.g. proton pump inhibitor (not omeprazole), and monitor more closely... 

Peptic ulcer disease is associated with Helicobacter pylori infection in 90% of patients with gastric and duodenal ulceration. Elimination of H. pylori infection with antibiotics heals the peptic ulcer and the associated symptoms. Combination therapy with antibiotics, anti-secretory agents, namely H2-receptor antagonists or proton pump inhibitors, and bismuth salts has significantly improved the clinical outcome of peptic ulcer disease. Not all strains of H. pylori cause peptic ulcer disease, and other factors are necessary for H. pylori colonization and disease to occur. Flagellated motile bacteria resist peristalsis and adhere to gastric epithelium in a highly specific manner. 

Prilosec, Rapinex, Zegerid) and its S-isomer, esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protonix). These drugs have different substitutions on their pyridine and/or benzimidazole groups but are remarkably similar in their pharmacological properties. Omeprazole is a racemic mixture of R- and S-isomers the S-isomer, esomeprazole (S-omeprazole), is eliminated less rapidly than R-omeprazole, which theoretically provides a therapeutic advantage because of the increased half-life. Despite claims to the contrary, all proton-pump inhibitors have equivalent efficacy at comparable doses. 

Delavirdine Due to its shorter tj, d rapid emergence of resistance, delavirdine is the least used of the NNRTIs. Its absorption is best at acid pH and may be decreased by histamine Hj receptor antagonists or proton pump inhibitors. It is cleared predominantly by CYP3A4 and has an elimination tj 6 hours. It should be avoided with CYP3A4 substrates with a narrow therapeutic index and not combined with potent inducers of CYP3A4 (e.g., carbamazepine, phenobarbital, phenytoin, rifabutin, and rifampin). 

Drug-drug iuteractious Proton pump inhibitors Proton pump inhibitors have been associated with delayed elimination of high-dose methotrexate and with impaired renal function [81 ]. 

Santucci R, Leveque D, Lescoute A, Kemmel V, Herbrecht R. Delayed elimination of methotrexate associated with co-administration of proton pump inhibitors. Anticancer Res 2010 30(9) 3807-10. 

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