Omeprazole-induced galactorrhea in kidney transplant patients—a case report

Abstract

Background Omeprazole belongs to the pharmacological classifications of proton pump inhibitors and is a widely used medicine. All proton pump inhibitors have a common mechanism of action and are prodrugs that require activation in an acidic environment. Omeprazole is extensively metabolized in the liver by cytochrome 2C19 and cytochrome 3A4, which are responsible for drug interactions. Omeprazole-induced galactorrhea is a rare adverse event of drug metabolism and is often underreported. Case presentation This is a case of a 26-year-old unmarried Asian (Bhutanese) female who underwent kidney transplant and was administered standard antirejection medication (tacrolimus, prednisolone, and leflunomide) along with an antihypertensive agent. She came to the emergency department with complaints of nausea, vomiting, abdominal pain, chronic gastritis, anemia, hypertension, and loss of appetite. The tacrolimus trough level was in the subtherapeutic range at admission. The tacrolimus dose was adjusted, and oral omeprazole was administered. After 3 days, she experienced milk production from her left breast, which according to the patient was her second incidence after omeprazole ingestion. Conclusion Causality assessment using Naranjo’s algorithm and recovering from galactorrhea after stopping omeprazole and omeprazole rechallenge with the reappearance of galactorrhea confirmed omeprazole as the causative agent. Tacrolimus interferes with omeprazole metabolism and increases tacrolimus levels in the blood. Caution needs to be taken when omeprazole is administered with other drugs that interfere with metabolizing enzymes.

Gastroprotective effects of Polygonatum odoratum in rodents by regulation of apoptotic proteins and inflammatory cytokines

“…While, protective factors of the stomach include any molecules that induce gastric mucus secretion and preserve intact mucosa in case of changes in the pH, temperature, and microbial infection that can stimulate the inflammatory process ( Bitar and Moussa, 2022 ). Synthetic chemicals (Omeprazole) is a well-known proton pump inhibitor (PPI) used widely for gastric disorders, but recent studies have reported several adverse effects of this drug including osteoporotic fracture ( Lespessailles and Toumi, 2022 ), heart attack ( Oo and Lim, 2022 ), and galactorrhea in kidney transplant cases ( Dorji et al, 2022 ). Recently, a population based-study revealed that significant correlation between intake duration intake and dose-dependence of administering PPI with the increasing incidence of stomach cancer ( Cheung et al, 2018 ).…”