Proton pump inhibitors adverse effects

The most common adverse effects (greater than 3%) of proton pump inhibitors include headache and diarrhea. 

Il.b.l.1. Adverse effects of anti-secretory treatment. Histamine H2 antagonists and proton pump inhibitors are very safe as well as effective treatments. Cimetidine has small effects on hepatic drug metabolism which are only of clinical signiflcance with drugs used in doses close to toxic levels, notably phenytoin, aminophylline and warfarin. Other adverse effects such as headache, rash and thrombocytopenia are rare. 

Proton pump inhibitors are also generally safe. More frequent, but still rare, adverse effects are headache, rash and diarrhoea. 

Geriatric Considerations-Summary Adjust dose based on creatinine clearance. Not effective in preventing NSAID-induced gastric ulceration and bleeding proton pump inhibitors should be used for this indication instead. Anticholinergic adverse effects have been observed in older adults taking ranitidine. 

H2 antagonists are extremely safe drugs. Adverse effects occur in less than 3% of patients and include diarrhea, headache, fatigue, myalgias, and constipation. Some studies suggest that intravenous H2 antagonists (or proton pump inhibitors) may increase the risk of nosocomial pneumonia in critically ill patients. 

Cote GA et al Potential adverse effects of proton pump inhibitors. Curr Gastroenterol Rep 2008 10 208. [PMID 18625128]... 

NIFEDIPINE PROTON PUMP INHIBITORS - OMEPRAZOLE Possible t efficacy and adverse effects Small t in bioavailability possible via t intragastric pH Unlikely to be clinically significant... 

STATINS PROTON PUMP INHIBITORS Possible T efficacy and adverse effects of atorvastatin Inhibition of P-gp, reducing first-pass clearance Monitor closely... 

MOCLOBEMIDE PROTON PUMP INHIBITORS -OMEPRAZOLE/ ESOMEPRAZOLE Possible t efficacy and adverse effects of modobemide Inhibition of CYP2C19 Monitor more closely effect only seen in extensive CYP2C19 metabolizers. Dose i may be required... 

PHENYTOIN PROTON PUMP INHIBITORS Possible t efficacy and adverse effects of phenytoin Unclear possible altered metabolism via CYP2C19 1 dose may be required. Use the proton pump inhibitor regularly, not PRN monitor phenytoin levels when starting or stopping treatment. Patients have received omeprazole for 3 weeks without altered phenytoin levels. Effect not reported with pantoprazole or rabeprazole... 

ALMOTRIPTAN, ELETRIPTAN, ZOLMITRIPTAN H2-RECEPT0R BLOCKERS -CIMETIDINE t efficacy and adverse effects of zolmitriptan, e.g. flushing, sensations of tingling, heat, heaviness, pressure or tightness of any part of body including the throat and chest, dizziness Inhibition of metabolism via CYP1A2 Consider alternative acid suppression, e.g. H2 antagonist or proton pump inhibitors (not omeprazole or lansoprazole), or monitor more closely and l maximum dose of zolmitriptan to 5 mg/24 hours... 

PRAMIPEXOLE, ROPINIROLE H2-RECEPTOR BLOCKER-CIMETIDINE T efficacy and adverse effects of pramipexole 1 renal excretion of pramipexole by inhibition of cation transport system. Inhibition of CYP1A2-mediated metabolism of ropinirole Monitor closely i dose of pramipexole may be required. Adjust dose of ropinirole as necessaiy or use alternative acid suppression, e.g. H2 antagonist proton pump inhibitor (not omeprazole or lansoprazole)... 

BZDs PROTON PUMP INHIBITORS -OMEPRAZOLE/ ESOMEPRAZOLE T efficacy and adverse effects, e.g. prolonged sedation Inhibition of metabolism via CYP4S0 (some show competitive inhibition via CYP2C19) Monitor for t side-effects, and 1 dose as necessaiy. Likely to delay recovery after procedures for which BZDs have been used. Consider alternative proton pump inhibitor, e.g. lansoprazole or pantoprazole... 

DISULFIRAM PROTON PUMP INHIBITORS -OMEPRAZOLE Possible T adverse effects of disulfiram Accumulation of metabolites Monitor closely for T side-effects, although patients have received combinations without reported problems... 

TACROLIMUS PROTON PUMP INHIBITORS Possible t efficacy and adverse effects of immunosuppression Altered metabolism from CYP2C19 to CYP3A4 in patients with low CYP2C19 levels Monitor levels more closely... 

VECURONIUM PROTON PUMP INHIBITORS -LANSOPRAZOLE Possible t efficacy and adverse effects of vecuronium Unclear Altered duration of action. May need t recovery time... 

CLARITHROMYCIN PROTON PUMP INHIBITORS -OMEPRAZOLE t efficacy and adverse effects of both drugs t plasma concentration of both drugs No dose adjustment recommended. Interaction considered useful for Helicobacter pylori eradication... 

CIMETIDINE FAMOTIDINE NIZATIDINE, RANITIDINE BRONCHODILATORS -THEOPHYLLINE t efficacy and adverse effects, including seizures. There is conflicting information associated with ranitidine, famotidine and nizatidine Inhibition of metabolism via CYP1A2, cimetidine being the best known inhibitor Use alternative acid suppression, e.g. a proton pump inhibitor (not omeprazole or lansoprazole) or monitor closely considerable patient variation. Check levels on day 3 and then at 1 week. A 30-50% i dose of theophylline may be required. For doses <400 mg/day, the interaction may not be clinically significant... 

PROTON PUMP INHIBITORS ANTIDIABETIC DRUGS - SULPHONYLUREAS Possible t efficacy and adverse effects of sulphonylurea, e.g. hypoglycaemia Possible t absorption Monitor capillary blood glucose more closely 1 dose may be required... 

TRIPOTASSIUM DICITRATOBISMUTHATE PROTON PUMP INHIBITORS - OMEPRAZOLE t adverse effects of tripotassium dicitratobismuthate T absorption Do not use together for more than 16 weeks. Bismuth salicylate and subnitrate do not interact... 

Proton pump inhibitors are widely used and possible adverse effects from very long term exposure, e.g. resistant symptoms from gastro-oesophageal reflux disease, are not yet known. 

Selective inhibition of COX-2 has the objective of preserving anti-inflammatory activity whilst avoiding gastric mucosal toxicity. Rofecoxib, celecoxib and meloxicam vary in their selectivity for COX-2. The incidence of peptic ulcers and their complications with rofecoxib is similar to that seen when proton pump inhibitors are co-administered with nonselective NSAIDs. The adverse effect profile of these drugs remains fully to be evaluated. 

Esomeprazole is the 5-isomer of omeprazole. The pharmacology, pharmacokinetics, efficacy, and safety of esomeprazole have been reviewed (1). Esomeprazole produces acid control comparable to that of currently available proton pump inhibitors. It undergoes less hepatic metabolism than omeprazole, has an oral availability of 89% at a dose of 40 mg, and a half-life of 1.5 hours. Esomeprazole is well tolerated its common adverse effects are diarrhea, headache, nausea, abdominal pain, respiratory infection, and sinusitis. 

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