Proton pump inhibitors: Risks of long‐term use

Abstract

Proton pump inhibitors are among the most commonly prescribed classes of drugs, and their use is increasing, in particular for long-term treatment, often being over-prescribed and used for inappropriate conditions. In recent years, considerable attention has been directed towards a wide range of adverse effects, and even when a potential underlying biological mechanism is plausible, the clinical evidence of the adverse effect is often weak. Several long-term side effects have been investigated ranging from interaction with other drugs, increased risk of infection, reduced intestinal absorption of vitamins and minerals, and more recently kidney damage and dementia. The most recent literature regarding these adverse effects and their association with long-term proton pump inhibitor treatment is reviewed, and the mechanisms through which these possible complications might develop are discussed.

Lansoprazole inhibits the cysteine protease legumain by binding to the active site

“…Inhibitory effects of PPIs have also been observed in the renal collecting duct, in osteoclast resorptive pits and on lysosomal enzymes . The short‐term use of PPIs causes only mild side effects, whereas long‐term exposure has been associated with osteoporosis and bone fractures . In fact, since 2010, all manufacturers of PPIs in the USA are required by the Food and Drugs Agency (FDA) to label the drugs with a warning about possible hip, wrist and spine fractures when used in high doses or for an extended period of time (>1 year)…”

Renal Safety of Proton Pump Inhibitors

“…Высокая частота необоснованного назначения ИПП и длительности их применения послужили основа-нием для проведения крупномасштабных популя-ционных исследований, посвященных изучению их безопасности [12][13][14].…”

“…[26] изучили данные 290 592 больных старше 66 лет, получавших ИПП, и такое же количество лиц группы контроля. Ча-стота развития ОПП (13,49 против 5,46; отноше-ние рисков (ОР)=2,52, 95% ДИ 2,27-2,79) и ОТИН (0,32 против 0,11; ОР=3,00, 95% ДИ 1, 14) из расчета на 1000 человеко-лет оказалась существенно выше в группе больных, получавших ИПП, в сравне-нии с контролем. Среди представителей ИПП были омепразол, лансопразол и пантопразол.…”

Proton Pump Inhibitors: Are They a Real Threat to the Patient?

“…Even though these results should raise our attention, current evidence is provided by small-sampled studies providing low-quality evidence, and experts recommend against the routine investigation of anemia in patients on PPIs [14]. …”

“…Both experts and national gastroenterology societies reinforce the need to review PPI dose and treatment duration in patients with risk factors for CDI, including those hospitalized or living in nursing facilities, elderly patients, immunodeficient patients, and those exposed to patients with CDI [14, 15]. …”