A Prospective, Placebo‐Controlled Pilot Evaluation of the Effect of Omeprazole on Serum Calcium, Magnesium, Cobalamin, Gastrin Concentrations, and Bone in Cats

Abstract

BackgroundChronic proton pump inhibitor administration has been associated with electrolyte and cobalamin deficiency, disrupted bone homeostasis, hypergastrinemia, and rebound acid hypersecretion in humans. It is unknown if this occurs in cats.ObjectivesProlonged oral omeprazole results in altered bone mineral density or content, serum calcium, magnesium, cobalamin, and gastrin concentrations in healthy cats.AnimalsSix healthy adult DSH cats.MethodsIn a within subjects, before and after design, cats received placebo followed by omeprazole (0.83–1.6 mg/kg PO q12h) for 60 days each. Analysis of serum calcium, magnesium, cobalamin, and gastrin concentrations was performed on days 0, 30, and 60. Bone density and content were evaluated on days 0 and 60 of each intervention. Continuous data were analyzed using a two‐way ANOVA (α = 0.006). On day 60 of omeprazole administration, continuous intragastric pH monitoring was performed in 2 cats to evaluate the effects of abrupt withdrawal of omeprazole.ResultsNo significant changes were detected between treatments for any variables, except serum gastrin, which was significantly higher during omeprazole treatment in comparison to placebo (P = 0.002). Evidence of gastric hyperacidity was seen in both cats in which intragastric pH monitoring was performed following cessation of omeprazole.Conclusions and Clinical ImportanceAlthough further studies with larger populations of cats will be needed to draw any definitive conclusions, these preliminary results suggest that prolonged PPI treatment results in hypergastrinemia and abrupt PPI withdrawal might result in RAH in cats.

Repeated Famotidine Administration Results in a Diminished Effect on Intragastric pH in Dogs

“…Radiographic guidance to place pH capsules was used in this study, as reported in cats . The procedure was quick and easy to perform under sedation and obviated the need for the use of general anesthesia for pH capsule placement in the gastric fundus.…”

“…The location of each pH capsule was kept consistent in each dog within and between treatment groups by utilizing the measurements on the capsule delivery device to measure the distance from the maxillary canine teeth to the area of capsule placement. On day 12 of both treatment periods as well as baseline (day 0) of the second treatment group, pH capsules were placed by radiographic guidance under sedation with dexmedetomidine and butorphanol, as previously described, to eliminate the need for repeated general anesthesia. Briefly, after sedation, dogs were placed in left lateral recumbency.…”

“…The development of adverse effects depends on the duration of exposure to the drug with some adverse effects occurring within days to weeks (eg, CDAD) and others developing after years of chronic use (eg, hypomagnesemia). Omeprazole administration for 60 days can result in hypergastrinemia, withdrawal‐induced rebound gastric acid hypersecretion, and potentially decreased bone mineral content in cats . Additionally, aggressive acid suppression is not always warranted.…”

ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats

“…No benefit was detected in MPT intragastric pH ≥ 3 and 4 in healthy dogs when famotidine was administered concurrently with IV pantoprazole . Proton pump inhibitors should be gradually tapered after administration for ≥4 weeks to avoid rebound gastric acid hypersecretion (RAH) . The dose can be decreased by 50% on a weekly basis, with cessation of evening dosing during the first week.…”

“…A similar practice of inappropriate prescription of acid suppressants is commonplace in veterinary medicine. Judicious use of acid suppressants is warranted, considering recent studies documenting adverse effects of long‐term PPI supplementation in people and animals …”