Omeprazole-Associated Necrotizing Pancreatitis

Kathi, Pradeep; Smith, Scott M.; Rabadi, Raja; Thammineni, Nikhila; Mutchníck, Milton G.

doi:10.1097/mjt.0000000000000999

Cited by 5 publications

(2 citation statements)

References 5 publications

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“…Pancreatitis is a rare complication of proton pump inhibitor therapy and has been reported with omeprazole [ 23 , 24 ] and pantoprazole [ 25 ]. It has been suggested that patients with acute pancreatitis and hypocalcemia commonly have magnesium deficiency and that magnesium deficiency can play a significant role in the pathogenesis of hypocalcemia in patients with acute pancreatitis [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Severe Electrolyte Disturbances Due to Proton Pump Inhibitor Therapy: An Underrecognized Problem with Potentially Severe Sequelae

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2022

Am J Case Rep

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Patient: Female, 55-year-old Final Diagnosis: Convulsions and confusion due to electrolyte disturbances Symptoms: Confusion • convulsions Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Unusual clinical course Background: Proton pump inhibitors are increasingly being recognized as a cause of multiple electrolyte disturbances, including hypomagnesemia, hypocalcemia, hypophosphatasemia, hypokalemia and hyponatremia, particularly in persons on long-term therapy. The mechanisms, consequences, and management of these electrolyte disturbances are discussed below. Case Report: A 55-year-old woman was seen by various clinicians, with a variety of clinical presentations, over the space of a couple of years. During each visit, she had electrolyte disturbances and was on proton pump inhibitor therapy, which were either continued or changed to a different proton pump inhibitor. She had presented variously with diarrhea and weight loss due to microscopic colitis, confusion, and grand mal seizures on separate occasions. Changing the proton pump inhibitor did not alleviate her profound electrolyte disturbances, which completely resolved shortly after stopping drug therapy. Conclusions: It is important for clinicians to be aware of the electrolyte disturbances that can be caused by these medications, and to actively monitor patients on long-term therapy for these disturbances, thus avoiding potentially severe consequences. Electrolyte disturbances are more likely to arise in patients who are prescribed concomitant diuretic treatment or who overuse alcohol. The incidental finding of hypocalcemia in persons on proton pump inhibitors may be secondary to hypomagnesemia, and hypomagnesemia may be a consequence of an underlying otherwise symptomless genetic disorders. Clinicians should be encouraged to deprescribe these drugs after 4 weeks of treatment in patients with mild symptoms or mild disease.

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Section: Discussionmentioning

confidence: 99%

Severe Electrolyte Disturbances Due to Proton Pump Inhibitor Therapy: An Underrecognized Problem with Potentially Severe Sequelae

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2022

Am J Case Rep

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“…Although OPZ has a high frequency of use and good therapeutic effect, there are still some irrational prescribing habits and drug abuse. Some adverse reactions have been also found to occur clinically, such as acute pancreatitis, visual hallucinations, cytotoxicity, genotoxicity, , nephrotoxicity, − and impairment of liver function. Some patients receiving OPZ displayed reportedly various degrees of liver damage.…”

Section: Introductionmentioning

confidence: 99%

Evidence for Metabolic Activation of Omeprazole In Vitro and In Vivo

Zhao

Sun

et al. 2022

Chem. Res. Toxicol.

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Omeprazole (OPZ) is a proton pump inhibitor commonly used for the treatment of gastric acid hypersecretion. Studies have revealed that use of OPZ can induce hepatotoxicity, but the mechanisms by which it induces liver injury are unclear. This study aimed to identify reactive metabolites of OPZ, determine the pathways of the metabolic activation, and define the correlation of the bioactivation with OPZ cytotoxicity. Quinone imine-derived glutathione (GSH), N-acetylcysteine (NAC), and cysteine (Cys) conjugates were detected in OPZ-fortified rat and human liver microsomal incubations captured with GSH, NAC, or Cys. The same GSH conjugates were detected in bile of rats and cultured liver primary cells after exposure to OPZ. Similarly, the same NAC conjugates were detected in urine of OPZ-treated rats. The resulting quinone imine was found to react with Cys residues of hepatic protein. CYP3A4 dominated the metabolic activation of OPZ. Exposure to OPZ resulted in decreased cell survival in cultured primary hepatocytes. Pretreatment with ketoconazole attenuated the susceptibility of hepatocytes to the cytotoxicity of OPZ.

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Omeprazole

2020

Reactions Weekly

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Omeprazole-Associated Necrotizing Pancreatitis

Cited by 5 publications

References 5 publications

Severe Electrolyte Disturbances Due to Proton Pump Inhibitor Therapy: An Underrecognized Problem with Potentially Severe Sequelae

Severe Electrolyte Disturbances Due to Proton Pump Inhibitor Therapy: An Underrecognized Problem with Potentially Severe Sequelae

Evidence for Metabolic Activation of Omeprazole In Vitro and In Vivo

Omeprazole

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