Proton pump inhibitors in Iranian population: from clinical regimens to pharmacogenomics

Abstract

Proton pump inhibitors (PPIs) are one of the highly prescribed or over-the-counter available medications among Iranians, mainly to treat conditions such as helicobacter pylori infection, gastroesophageal reflux disease or frequent heartburn. In recent years, several reports have shown potential adverse effects of PPI administration among which cardiovascular adverse events, myocardial infarction and chronic kidney disease are considered as the greatest risks. Recent addition of proton pump inhibitors to the list of medications on Beers Criteria of Potentially Inappropriate Drugs has arisen significant concerns about their safety. This review aims at providing an up-to date overview of PPIs indications and their pharmacogenomics and pharmacokinetics in Iranian population. The focus of this review is on PPIs regimens in Iranian population and then it is compared with the reported studies performed on other ethnic groups around the world. An extensive review of the literature was carried out and data under various sections were identified using a computerized literature search via Pubmed, Web of Science, Google Scholar and some local search engines. All abstracts and full text articles were examined and most relevant papers were selected for inclusion in this review. Also several expert internalists were interviewed for their clinical experiences in this field.

A pilot study evaluating high dose esomeprazole, bismuth subcitrate and amoxicillin for eradicating Helicobacter pylori infection in Iran

“…Studies have shown increased activity of CYP2C19 and therefore, rapid metabolization of PPIs in Americans and central Europe, whereas East Asian population, including Japanese and Chinese, are slow metabolizers 22–26 . Iranian are also considered as rapid metabolizers 27 . However, in our study, we used esomeprazol, a second‐generation of PPIs which is less influenced by CYP2C19 activity 28…”

“…[22][23][24][25][26] Iranian are also considered as rapid metabolizers. 27 However, in our study, we used esomeprazol, a second-generation of PPIs which is less influenced by CYP2C19 activity. 28 Amoxicillin, a beta-lactam antibiotic, is currently extensively employed to treat H. pylori.…”