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Medically reviewed by C. Fookes, BPharm Last updated on May 16, 2018.
Other names: PPIs
PPIs reduce the production of acid by the stomach. They work by irreversibly blocking an enzyme called H+/K+ ATPase which controls acid production. This enzyme is also known as the proton pump and is found in the parietal cells of the stomach wall.
PPIs treat conditions that are caused by either an overproduction of stomach acid or exacerbated by stomach acid. Taking a PPI once a day inhibits around 70% of proton pumps, so a small amount of acid is still available for food digestion.
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All PPIs work in the same way, by inhibiting the proton pump. However, there are differences in their propensity for drug interactions, and in the way they bind to the proton pump. This can affect how long they last for.
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Approximately 3% of Caucasians and 15-20% of Asians are PM. PM take longer to excrete the drug and therefore their response to PPIs is increased several fold. For example, the pH of gastric acid is around 6 in PM after PPIs compared to around 3-4 in extensive metabolizers (where 1 is the most acidic pH). Metabolism is also affected in people of an older age and in those with liver disease. Esomeprazole is the only PPI that is well tolerated by people with liver disease. The extent somebody is able to metabolize a PPI can also affect their risk of drug interactions.
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When taken at the recommended dosage for the recommended duration of time, PPIs are considered safe. However, they have been associated with several serious the 1 last update 05 Jul 2020 adverse effects including:When taken at the recommended dosage for the recommended duration of time, PPIs are considered safe. However, they have been associated with several serious adverse effects including:
In addition, there is a risk that the use of PPIs may mask the symptoms of gastric cancer. All patients with a suboptimal response to PPIs or whose symptoms recur following PPI withdrawal should have additional diagnostic testing, and an endoscopy should be considered in older people before treatment initiation.
Patients should only take PPIs as directed by their doctor or according to the instructions on the packet if bought over the counter.
PPIs are generally well tolerated. The more common side effects reported with their use include:
For a complete list of side effects, please for 1 last update 05 Jul 2020 refer to the individual drug monographs.For a complete list of side effects, please refer to the individual drug monographs.
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