Proton Pump Inhibitors - What You Should Know

What Are Proton Pump Inhibitors?

Proton pump inhibitors are a group of medicines that inhibit gastric acid secretions and are used widely to treat acid-related diseases. These are regarded as safe and beneficial clinically. Proton pumps are enzymes that line the stomach and help it to make acid for food digestion. The proton pump inhibitor's drugs target these proton pumps and limit acid production in the stomach. As a result, they reduce acid reflux into the esophagus and reduce the symptoms of resulting heartburn.

What Are Proton Pump Inhibitors Used to Treat?

• Proton pump inhibitors are used to treat conditions associated with high stomach acid affecting the stomach and gut, such as gastro-oesophageal reflux disease (GERD), which is inflammation of the esophageal lining caused by acid reflux from the stomach.

• The proton pump inhibitors help to treat stomach and duodenal ulcers.

• These medications prevent ulcers in people at risk, such as those on long-term NSAIDs, as it helps heal inflammation.

• Proton pump inhibitors are often prescribed antibiotics to eradicate Helicobacter pylori, a bacteria associated with duodenal ulcer recurrence.

• Proton pump inhibitors relieve heartburn and acid reflux triggered by anxiety, smoking, and alcohol consumption.

• They are used to treat conditions like erosive esophagitis and Zollinger-Ellison syndrome.

Types of Proton Pump Inhibitors:

Proton pump inhibitors are available over-the-counter and by prescription.The over-the-counter include

• Lansoprazole.

• Omeprazole.

• Esomeprazole.

The proton pump inhibitors available by prescription include

• Dexlansoprazole.

• Pantoprazole.

• Rabeprazole.

Lansoprazole and Omeprazole are also available by prescription.

What Are the Dosages of Proton Pump Inhibitors?

The proton pump inhibitors are available as enteric-coated tablets, gelatin capsules, and suspensions. The intravenous formulations are available for Lansoprazole, Pantoprazole, and Esomeprazole.

The proton pump inhibitors stop the stomach lining cells from producing too much acid. In addition, they block the gastric proton pump of the gastric parietal cells. It helps to prevent ulcer formation and assists in the healing of existing ulcers. The proton pump inhibitors help decrease stomach acid over four to twelve weeks and allow proper healing of the esophageal tissue. The proton pump inhibitors work best for GERD as they relieve symptoms for longer.

How to Take Proton Pump Inhibitors?

Proton pump inhibitors are taken orally and are available as tablets or capsules. The medicines are taken on an empty stomach 30 minutes before the day's first meal. After that, taking proton pump inhibitors twice daily, with the second dose before dinner, is recommended. It is because the blood concentration of proton pump inhibitors reaches a peak three hours after oral administration. In addition, the proton pump inhibitors decrease gastric acid levels without disrupting the G-cells (gastric cells); hence, it is considered adequate to have the medicine one hour before meals.

It is advised to take the proton pump inhibitors simultaneously each day and should not be stopped without talking to your doctor.

Do Proton Pump Inhibitors Work Immediately After Administration?

Proton pump inhibitors are absorbed well by the body but take more time to start working compared to H2 blockers and may take two to three days to reach a steady state of acid secretion. Rabeprazole has a rapid onset of proton pump inhibition. And significantly affects intragastric pH after the first dose.

Difference Between H2 (Histamine) Blockers and Proton Pump Inhibitors:

Both medications work by blocking and decreasing acid production in the stomach. However, proton pump inhibitors like Omeprazole and Esomeprazole are more potent and faster.

The H2 blockers block histamine, the first stimulus for acid production, while the proton pump inhibitors block the proton pumps that pump H+ ions into the stomach in exchange for potassium.

What Precaution Should Be Taken While Taking Proton Pump Inhibitors?

• Pregnancy and Breastfeeding - Proton pump inhibitors are taken cautiously in the first trimester of pregnancy. The drug passes in the breast milk, but the baby's body absorbs little.

• Liver Disease - Using proton pump inhibitors may increase the risk of hepatic encephalopathy and promote liver diseases.

• Kidney Disease - Prolonged use of proton pump inhibitors may increase the risk of chronic kidney disease.

• Elderly - It is advised to avoid using proton pump inhibitors in older adults due to the potential risk of bone loss and fractures. Proton pump inhibitors are associated with increased dementia and Alzheimer's disease risk.

• Alcohol - Drinking alcohol while taking proton pump inhibitors can increase side effects and worsen gastrointestinal problems. It can worsen conditions such as heartburn and stomach ulcers as it irritates the stomach lining and delays healing.

• Children - Long-term use of proton pump inhibitors in children may increase the risk of fractures and should be given with caution. The inhibitors deteriorate calcium absorption and decrease growth plate thickness.

• Asthma - The inhibitors can trigger asthma and increase the risk of adverse health outcomes.

• Osteoporosis - Long-term proton pump inhibitors may decrease bone mineral density and increase the risk of osteoporosis-related fractures.

• Food Allergy - As the proton pump inhibitors alter the pH of the gastrointestinal system, they can lead to food allergy.

What Drugs Interact With Proton Pump Inhibitors?

Proton pump inhibitors alter the stomach's pH, which may change how certain drugs work or are absorbed into the body.

• Ketoconazole - The inhibitors reduce the blood's absorption, concentration, and effectiveness.

• Digoxin - Proton pump inhibitors increase the absorption and concentration of Digoxin and can cause toxicity.

• Diazepam - Omeprazole reduces the breakdown of Diazepam, resulting in increased concentration in the blood.

• Harvoni - Proton pump inhibitors decrease the acid in the stomach and prevent the absorption of Harvoni.

• Warfarin - Proton pump inhibitors like Omeprazole affect the metabolism of Warfarin and block the body’s ability to eliminate them. It results in a buildup in the bloodstream, causing adverse events.

• Phenytoin - The inhibitors reduce the breakdown of Phenytoin and cause increased concentration in the blood.

• Clopidogrel - Proton pump inhibitors like Omeprazole and Esomeprazole block the CYP2C19 enzyme, which activates the Clopidogrel effect as a blood thinner.

Food to Avoid with Proton Pump Inhibitors:

Certain foods like citrus fruits, peppermint, spicy food, food rich in sugar, caffeinated drinks, chocolate, high-fat food, and red and processed meats as they trigger acid reflux.

What Are the Side Effects of Proton Pump Inhibitors?

The side effects of proton pump inhibitors may include

• Headaches.

• Nausea.

• Diarrhea.

• Rash.

• Constipation.

• Stomach pain.

• Vomiting.

• Fever.

• Flatulence.

Serious side effects may include:

• An increased risk of infection.

• Serious allergic reactions.

• Stevens-Johnson syndrome.

• Toxic epidermal necrolysis.

• Reduced kidney function.

• Pancreatitis.

• Reduced liver function.

• Erythema multiforme.

Conclusion:

Proton pump inhibitors stop or slow the acid production in the stomach and relieve symptoms of acid-related diseases like GERD. However, it is advised to make changes in the diet, like consuming less fat, avoiding snacks before bedtime, avoiding alcohol and tobacco, and following other lifestyle changes for better results.