Safety of acid-suppressing drugs

Abstract

There is an extensive literature on the adverse effects of drugs that inhibit gastric acid secretion. This study presents a critical examination of interactions between antisecretory drugs and other compounds, the frequency of serious adverse effects relating to various body systems, the safety of antisecretory drugs in pregnancy, and longer-term safety data from postmarketing surveillance studies. While interactions with some other drugs, alcohol, and certain carcinogens are of potential concern, in practice clinically significant reactions appear to be rare if they occur at all. A small number of major side-effects have been documented, but they occur rarely, and postmarketing surveillance has not detected other longer-term sequelae. Safety of these drugs in pregnancy is not established, as data are so few. It is concluded that antisecretory agents, by comparison with most other classes of drugs, are remarkably well tolerated.

Lansoprazole 30 mg daily versus ranitidine 150 mg b.d. in the treatment of acid‐related dyspepsia in general practice

“…The superior symptom relief afforded by lansoprazole was accompanied by lower antacid consumption and an incidence rate of sideeffects comparable with other studies involving both drugs. 10 These results indicate that lansoprazole is a potentially useful and effective agent in the initial treatment of patients presenting in general practice with dyspeptic symptoms. In patients with a documented history of an acid-related disorder, including gastrooesophageal re¯ux disease and peptic ulcer, lansoprazole 30 mg daily offers a useful alternative to the H 2 -receptor antagonists as an initial treatment for symptom relapse.…”

Variable omeprazole kinetics in healthy Jordanian adults

“…In the case of omeprazole AUC is a reflection of efficacy since the extent of acid secretion correlates with AUC rather than plasma level [1,9].…”

“…The degree of acid secretion is dose dependent. Due to the very short half-life of omeprazole, studies on acid secretion were related to the drug's bioavailability (AUC) rather than to plasma levels [6][7][8][9]. Omeprazole is successfully used in the treatment of various gastric acid-related disorders.…”

Peptic Ulcer Disease

“…Because of the wide safety margin of PPIs, the major clinical implication is that acid secretory inhibition will be modest in rapid metabolizers and exaggerated in slow metabolizers, as the degree of acid inhibition reflects the AUC. CYP2C19 is also the site of interaction between diazepam and either omeprazole or cimetidine; however, with the wide therapeutic range for diazepam and marginal effects of the interactions, clinical implications are minimal [210,237]. For example, healing of GU is more rapid at 2 weeks in slow metabolizers, with comparable healing found at 8 weeks in rapid metabolizers [235].…”