Proton Pump Inhibitors: Exploring Cardiovascular Complications and Prescription Protocol

Sarnaik, Mubashira K; Modi, Srimy; Pisipati, Yasaswi; Vaidya, Sarayoo; Gaggatur, Naqvi Syed; Sange, Aliya H; Srinivas, Natasha; Sange, Ibrahim

doi:10.7759/cureus.16744

Cited by 6 publications

(3 citation statements)

References 32 publications

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“…18 A high prevalence of prescribing PPIs among cardiovascular patients receiving antiplatelet therapy has been reported by many studies; furthermore, inappropriate prescribing of PPIs has been documented. [19][20][21][22] However, no studies have been conducted in Palestine to determine physician adherence to the FDA recommendations when prescribing PPIs and clopidogrel and the clinical interaction associated with this combination. In this study, we utilized data from the Nat Health Insurance claim processor to examine the prescriber's adherence to FDA recommendations and evaluate whether each of the four PPIs (omeprazole, esomeprazole, pantoprazole, and lansoprazole) is associated with an increased risk of cardiovascular events when used concomitantly with clopidogrel.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Safety of Prescribing PPIs with Clopidogrel in Palestine

Abukhalil¹,

Sheikh²,

Muallem³

et al. 2023

PPA

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Background: Proton pump inhibitors (PPIs) are commonly prescribed medications that are thought to increase the risk of cardiovascular events because they reduce the effectiveness of clopidogrel via shared hepatic pathways. Objective: This study examined the prevalence of concomitant prescribing of clopidogrel/PPI among patients diagnosed with acute coronary syndrome and the adverse cardiovascular event associated with this interaction. Methods: A retrospective cohort study was conducted by retrieving patient data from the Nat Health Insurance claims processor database in Palestine. Adults diagnosed with Acute Coronary Syndrome (ACS) from 2019 through 2021 who were prescribed clopidogrel or clopidogrel in combination with a PPI were included in the study. Endpoints were adverse cardiac events, including readmission for revascularization during the first year of treatment. Results:The study included 443 patients; the prevalence of prescribing concomitant clopidogrel with a PPI was 74.7%, whereas 49.2% were prescribed interacting PPI (omeprazole, esomeprazole, and lansoprazole). 59 (13.3%) of participants experienced a cardiovascular event within 1 year of starting therapy, including 27 (12.4%) patients who had a cardiovascular event while taking an interacting PPI. No significant association was found between PPI administration and increased CV event risk in patients receiving concomitant clopidogrel and PPIs therapy (p = 0.579). Conclusion:In this study, we observed a high prevalence of prescribing a PPI in combination with clopidogrel, regardless of the FDA recommendations. No significant increase in cardiovascular events was observed in patients receiving concomitant clopidogrel and PPI therapy.

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Section: Introductionmentioning

confidence: 99%

Prevalence and Safety of Prescribing PPIs with Clopidogrel in Palestine

Abukhalil¹,

Sheikh²,

Muallem³

et al. 2023

PPA

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“…It has become the first‐line drug for abnormal gastric acid secretion and related diseases combined with amoxicillin, clarithromycin and other drugs to treat Helicobacter pylori infection 8,9 . PPIs have the advantages of fast onset, strong acid inhibition, long action time, low blood drug concentration and low adverse reactions 10 . The first generation includes omeprazole, lansoprazole and pantoprazole; the second generation includes iprazole, rabeprazole and esomeprazole.…”

Section: Introductionmentioning

confidence: 99%

“… 8 , 9 PPIs have the advantages of fast onset, strong acid inhibition, long action time, low blood drug concentration and low adverse reactions. 10 The first generation includes omeprazole, lansoprazole and pantoprazole; the second generation includes iprazole, rabeprazole and esomeprazole. Compared with the first‐generation PPIs, in terms of drug properties, the second‐generation PPIs have the advantages of higher bioavailability, less affected by food and anti‐acid drugs, slow plasma clearance, less first‐pass effect after oral administration, higher stability, less adverse reactions and longer half‐life.…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitors display anti‐tumour potential in glioma

Rao

2022

Cell Proliferation

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Objectives: Glioma is one of the most aggressive brain tumours with poor overall survival despite advanced technology in surgical resection, chemotherapy and radiation.Progression and recurrence are the hinge causes of low survival. Our aim is to explain the concrete mechanism in the proliferation and progression of tumours based on tumour microenvironment (TME). The main purpose is to illustrate the mechanism of proton pump inhibitors (PPIs) in affecting acidity, hypoxia, oxidative stress, inflammatory response and autophagy based on the TME to induce apoptosis and enhance the sensitivity of chemoradiotherapy.Findings: TME is the main medium for tumour growth and progression. Acidity, hypoxia, inflammatory response, autophagy, angiogenesis and so on are the main causes of tumour progress. PPIs, as a common clinical drug to inhibit gastric acid secretion, have the advantages of fast onset, long action time and small adverse reactions.Nowadays, several kinds of literature highlight the potential of PPIs in inhibiting tumour progression. However, long-term use of PPIs alone also has obvious side effects. Therefore, till now, how to apply PPIs to promote the effect of radiochemotherapy and find the concrete dose and concentration of combined use are novel challenges.Conclusions: PPIs display the potential in enhancing the sensitivity of chemoradiotherapy to defend against glioma based on TME. In the clinic, it is also necessary to explore specific concentrations and dosages in synthetic applications. | BACKGROUNDGlioma is one of the most aggressive brain tumours. Histologically, the World Health Organization (WHO) classified the tumours of the central nervous system (CNS) into astrocytomas, oligodendrogliomas and ependymoma. In addition, gliomas are classified into four grades according to the degree of malignancy. Types I and II are low-grade gliomas and types III and IV are high-grade gliomas. [1][2][3] The clinical cure rate and 5-year survival rate of patients are all very low. The prognosis is very dismal and the average survival period is only about 1 year. One of the main reasons for the poor prognosis of patients is that glioma is prone to drug resistance to chemoradiation therapy resistance. 4,5 Therefore, it is urgent to explore new strategies for glioma treatment.Pump proton inhibitors (PPIs) are a drug of choice for inhibiting gastric acid secretion. In clinical, they are the first-line option to treat peptic ulcers, gastroesophageal reflux disease, zoai syndrome and upper gastrointestinal bleeding. 6,7 It has become the first-line drug for abnormal gastric acid secretion and related diseases combined with amoxicillin, clarithromycin and other drugs to treat Helicobacter pylori infection. 8,9 PPIs have the advantages of fast onset, strong acid inhibition, long action time, low blood drug concentration and low

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