When proton pump inhibitors are compared, are there specific cases in which a certain proton pump inhibitors should be particularly preferred?

Abstract

Proton pump inhibitors (PPI) are currently the most commonly used drugs and have risk for drug interactions in people taking multiple medications. When studies on the risk of drug interactions of PPIs are examined in the literature, it is evident that the most studied subject is the interaction of clopidogrel and PPI.Six meta-analyses were found in the literature regarding the concomitant use of PPIs and clopidogrel. Out of these, in the meta-analysis performed by Huang et al. (1) in which the maximum number (32) of studies were evaluated, an increased risk of major cardiac event (HR 1.40, 95% CI 1.19-1.64; OR 1.27, 95% CI 1.13-1.42) and an increased risk of acute coronary syndrome (HR 1.42, 95% CI 1.14-1.77; OR 1.42, 95% CI 1.08-1.87) were reported. No risk increase has been reported for the total mortality (HR 1.30, 95% CI 0.91-1.86; OR 0.92, 95% CI 0.82-1.04) and cardiovascular death (HR 1.21, 95% CI 0.60-2.43). As a result, the concomitant use of clopidogrel and PPIs increases the risk of major cardiac events, but it has not been shown to influence total mortality (1,2). Although there is insufficient data in the literature, omeprazole and esomeprazole with high affinity of CY-P2C19 should be avoided if PPI are required to be used in patients treated with clopidogrel.Theophylline is often used in combination with PPI in advanced-age populations with respiratory diseases. In reference to the conducted studies, theophylline blood levels are not affected by the concomitant use of lansoprazole or pantoprazole with theophylline (3). Lansoprazole, pantoprazole, and omeprazole do not affect the excretion and absorption of theophylline (4). There is no change in theophylline pharmacokinetics with the use of rabeprazole (5). Treatment change is not needed in patients using theophylline together with lansoprazole, pantoprazole, omeprazole, and rabeprazole. There is no data involving esomeprazole.In the concomitant use of warfarin and pantoprazole, it was found that pantoprazole did not change the pharmacokinetics and pharmacodynamics of warfarin. (6) Because omeprazole increases the r-warfarin blood levels and reduces thrombosis by 10%, omeprazole should be avoided in patients taking warfarin (7). There is insufficient data on other PPIs.Limited data suggest that the serum levels of digoxin do not change in the concomitant use of this drug with pantoprazole or rabeprazole (8,9). Omeprazole increases the digoxin blood levels (10). There is no data about the other PPI. S68In the concomitant use of lansoprazole, omeprazole, and esomeprazole with acetylsalicylic acid (ASA), the effectiveness of ASA does not change (11-13). There is no data on the other PPI.It has been shown in studies that the concomitant use of pantoprazole or lansoprazole in patients using diazepam does not affect the metabolism of diazepam (14-16). The use of omeprazole or esomeprazole may increase the effect of diazepam (16,17).We were able to find only one study in the literature regarding the concomitant use of PPI and oral contraceptives in whic...

Drug–Drug Interactions With Over-The-Counter Medicines: Mind the Unprescribed

“…Because of the comparatively low risk of CYP3A4related DDIs, pantoprazole should be considered as the firstline treatment in the OTC setting and should be preferred over other PPIs. [72][73][74] Special attention should be paid to cases receiving critical therapies because certain oral anticancer drugs, oral azole antimycotics, or ART medications show pH-dependent bioavailability. PPI use in these indications should be discussed with the physician.…”