Nexium, Prilosec, Protonix, Prevacid
Generic Name
Proton Pump Inhibitor
Manufacturer
Multiple generic and innovator manufacturers worldwide
Country
Global
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Description
Overview of the medicine
Proton Pump Inhibitors (PPIs) are a class of medications that reduce the production of stomach acid by irreversibly blocking the H+/K+-ATPase enzyme system (proton pump) in the gastric parietal cells. They are widely used to treat conditions associated with excessive stomach acid.
Uses & Indications
Dosage
Adults
Typical adult dosages range from 10 mg to 40 mg once daily, usually before a meal, depending on the specific PPI and indication. For severe conditions, dosages may be higher or twice daily.
Elderly
Generally, no dose adjustment is needed for elderly patients, but individual assessment is recommended due to potential polypharmacy and comorbidities.
Renal_impairment
No dose adjustment is usually required in patients with renal impairment, as PPIs are primarily metabolized by the liver.
How to Take
Take orally, usually once daily, before the first meal of the day. Do not crush or chew delayed-release capsules/tablets. For oral suspension, follow instructions for reconstitution.
Mechanism of Action
PPIs covalently bind to and irreversibly inhibit the H+/K+-ATPase enzyme (proton pump) on the secretory surface of the gastric parietal cells. This inhibition prevents the final step of acid secretion, leading to a significant and prolonged reduction in gastric acid production.
Pharmacokinetics
Onset
Acid secretion inhibition starts within 1-3 hours of the first dose, with full effect usually observed after 2-3 days of daily dosing.
Excretion
Excreted primarily through urine (renal) and feces (biliary excretion), with varying proportions depending on the specific PPI.
Half life
Plasma half-life is generally short (1-2 hours), but the duration of action is much longer due to irreversible enzyme inhibition.
Absorption
Rapidly absorbed after oral administration, typically within 0.5 to 3.5 hours, depending on the specific PPI and formulation.
Metabolism
Primarily metabolized in the liver by the cytochrome P450 (CYP) enzyme system, mainly CYP2C19 and CYP3A4.
Side Effects
Contraindications
- Hypersensitivity to the active substance or any excipients of the specific PPI.
- Concomitant use with rilpivirine-containing products.
Drug Interactions
Clopidogrel
PPIs (especially Omeprazole, Esomeprazole) can reduce the antiplatelet effect of clopidogrel by inhibiting CYP2C19. Consider alternatives or close monitoring.
Methotrexate
May increase methotrexate levels, leading to potential toxicity, especially with high-dose methotrexate. Monitor closely.
Warfarin/Coumadin
Potential for increased INR/prothrombin time with some PPIs; monitor coagulation parameters.
Iron Salts, Ketoconazole, Itraconazole, Atazanavir
PPIs reduce gastric acidity, which can impair the absorption of drugs that require an acidic environment for absorption.
Storage
Store at room temperature (15-30°C / 59-86°F), away from moisture and light. Keep out of reach of children.
Overdose
Overdose is rare. Symptoms are generally mild and transient, including nausea, vomiting, abdominal pain, diarrhea, and headache. Treatment is symptomatic and supportive. PPIs are not readily dialyzable.
Pregnancy & Lactation
Generally considered safe during pregnancy (Category B or C for most PPIs), but use only if clearly needed and under medical supervision. Excreted in breast milk in small amounts; generally considered compatible with breastfeeding, but consult a doctor.
Side Effects
Contraindications
- Hypersensitivity to the active substance or any excipients of the specific PPI.
- Concomitant use with rilpivirine-containing products.
Drug Interactions
Clopidogrel
PPIs (especially Omeprazole, Esomeprazole) can reduce the antiplatelet effect of clopidogrel by inhibiting CYP2C19. Consider alternatives or close monitoring.
Methotrexate
May increase methotrexate levels, leading to potential toxicity, especially with high-dose methotrexate. Monitor closely.
Warfarin/Coumadin
Potential for increased INR/prothrombin time with some PPIs; monitor coagulation parameters.
Iron Salts, Ketoconazole, Itraconazole, Atazanavir
PPIs reduce gastric acidity, which can impair the absorption of drugs that require an acidic environment for absorption.
Storage
Store at room temperature (15-30°C / 59-86°F), away from moisture and light. Keep out of reach of children.
Overdose
Overdose is rare. Symptoms are generally mild and transient, including nausea, vomiting, abdominal pain, diarrhea, and headache. Treatment is symptomatic and supportive. PPIs are not readily dialyzable.
Pregnancy & Lactation
Generally considered safe during pregnancy (Category B or C for most PPIs), but use only if clearly needed and under medical supervision. Excreted in breast milk in small amounts; generally considered compatible with breastfeeding, but consult a doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years when stored under recommended conditions.
Availability
Pharmacies, Hospitals, Clinics
Approval Status
Approved by major regulatory bodies globally (e.g., FDA, EMA, DGDA)
Patent Status
Mostly generic (original patents have expired)
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established the efficacy and safety of individual PPIs for various acid-related disorders. Ongoing research continues to explore long-term effects and new applications.
Lab Monitoring
- Consider monitoring serum magnesium levels in patients on long-term PPI therapy, especially if concomitant with other magnesium-lowering drugs (e.g., diuretics).
- Monitor Vitamin B12 levels in patients on prolonged PPI therapy (e.g., >3 years).
Doctor Notes
- Prescribe the lowest effective dose for the shortest necessary duration.
- Regularly reassess the need for continued PPI therapy.
- Educate patients about potential long-term risks and proper administration.
- Consider magnesium and Vitamin B12 monitoring for long-term users.
Patient Guidelines
- Take your medication exactly as prescribed by your doctor.
- Take the capsule/tablet whole; do not chew, crush, or break it.
- Usually taken once daily before a meal, preferably in the morning.
- Inform your doctor about all other medications you are taking, including over-the-counter drugs and herbal supplements.
Missed Dose Advice
If a dose is missed, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Driving Precautions
PPIs generally do not impair the ability to drive or operate machinery. However, if you experience side effects like dizziness or visual disturbances, avoid driving until you feel well.
Lifestyle Advice
- Avoid trigger foods such as spicy, fatty, or acidic foods. Limit caffeine and alcohol intake. Maintain a healthy weight. Avoid eating late at night and elevate the head of your bed if you have GERD.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.