Bad Effects of Gastric Acid Lowering Drugs in Long Term Use

Image via Wikipedia

Gastric acid lowering drugs dramatically improved the treatment options of acid peptic diseases. Once the primary treatment, surgery has become perhaps the second or third option in acid peptic disease management. There are two main groups of these drugs;

• Histamine II blockers;
1. Cimetidine,
2. Ranitidine,
and
3. Famotidine
etc.and
• Proton pump inhibitors (PPI);
1. Omeprazole,
2. esomeprazole,
3. Lansoprazole,
4. Rabeprazole,
and
5. Pantoprazole

etc. Now FDA has certain reservations to make the PPI drugs available over the counter (OTC).
Main adverse effect of cimetidine was gynaecimastia and it not much in use.
PPIs were first blamed for development of benign stomach tumors, but subsequently cleared from it. Now, researchers indicate these for;

1. Osteopenia; related to the decreased calcium absorption due to gastric acid lowering, hampered calcium ionization and absorption from the gut.
2. Decreasing the full potential of tamoxifen action on breast cancer by sharing its the metabolic pathway in the liver; resulting in more recurrence rate of breast cancer.
3. Decreasing the blood thinning effect of clopidogrel when used along with aspirin as a gastro-protector and thereby increasing the return of heart patients to emergency department with increased cardiovascular events.
4. Continuous use of it is also linked to increased colonization of harmful bacteria in the gut, and specially C. difficile, known to cause colitis and loose motion.
5. These drugs by  virtue of strong acid lowering property often suppress the symptoms of gastric cancer resulting in loss of golden hours and time in subjecting a patient to endoscopy for diagnosis of cancer. These patients, especially in India come very late when PPIs no more improve the symptoms or secondary effects of cancer appear
These are good drugs having very good utility, but patients by virtue of dependency and ignorance are overusing PPIs and further, over the counter (OTC) availability will definitely increase their misuse, ultimately landing to more problems. Always, judicious use of a good armor in the hands of physicians will yield very good results.  

Related articles by Zemanta

• FDA warns about possible fracture risk with high-dose or long-term use of PPIs (medicineandtechnology.com)
• More Evidence that PPIs Blunt Antiplatelet Activity (drppanda.wordpress.com)

More Evidence that PPIs Blunt Antiplatelet Activity

Image via Wikipedia

This link is all about the warning of FDA in concomitant use of some proton pump inhibitors (PPI) with clopidogrel; a blood thinning agent usually prescribed after stent placements and other cases of coronary artery disease treatment. It has been seen by the researchers that pantaprazole a PPI prescribed to reduce adverse effect of aspirin, which is also co-prescribed along with clopidogrel may interfere with the action of clopidogrel, adversely affecting the task of blood thinning.

clipped from www.medpagetoday.com The risk of rehospitalization for myocardial infarction (MI) almost doubled in patients treated with both a proton pump inhibitor (PPI) and clopidogrel (Plavix) after acute MI or coronary stent deployment, data from a retrospective cohort study showed. PPIs are frequently used to reduce the risk of gastrointestinal bleeding in patients treated with clopidogrel. However, a growing volume of evidence has suggested that PPIs might reduce clopidogrel's efficacy, the authors wrote. In one recent study, patients treated with omeprazole (Prilosec) in addition to aspirin and clopidogrel had a significantly higher platelet reactivity index score after seven days of treatment than patients who didn't get the PPI (J Am Coll Cardiol 2008; 51: 256-60). However, a subgroup analysis of a large clinical trial showed no increased risk of adverse events in patients who received clopidogrel with or without a PPI (Circulation 2008; 118(suppl 2): Abstract 3999).

Related articles by Zemanta

• Patients Who Take a Proton-Pump Inhibitor Are Less Likely To Be Hospitalized for Bleeding Ulcers (nlm.nih.gov)
• New evidence on co-prescribing for heart and stroke patients (scienceblog.com)
• FDA Adds Boxed Warning to Plavix Label to Highlight Reduced Effectiveness of the Drug In Poor Metabolizers (spittoon.23andme.com)