What are the adverse reactions of proton pump inhibitors and how to optimize them?

Author: Gao Lili This article is published by Yimaitong authorized by the author, please do not reprint without authorization
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Use of proton pump inhibitors Proton pump (H+-K+-ATPase) inhibitors (PPI) are weakly alkaline benzimidazole compounds that can inhibit central or peripheral mediated by acting on H+-K+-ATPase Gastric acid secretion, and inhibit the secretion of gastric acid caused by basic and various reasons.
It has a fast onset, complete acid suppression, strong and long-lasting acid suppression, and its acid suppression ability is much greater than traditional acid suppression such as H2 receptor antagonists (H2RA) Drugs
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 At present, the commonly used PPIs in China are omeprazole, pantoprazole, lansoprazole, rabeprazole, esomeprazole and ilaprazole, which can be used clinically to treat and prevent acid-related diseases such as stomach esophageal reflux disease (of GERD), chronic gastritis, peptic ulcer, upper gastrointestinal bleeding, Zhuoai syndrome, acid indigestion, drug-related gastrointestinal mucosal injury, stress ulcer
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Optimization recommendations for PPI adverse reactions Common adverse reactions of PPI include gastrointestinal symptoms (nausea, diarrhea, abdominal pain, flatulence, constipation), dry mouth, headache, tinnitus, myalgia, arthralgia, muscle weakness, blurred vision, allergies disease, interstitial nephritis, and can cause hepatic dysfunction, pancytopenia, thrombocytopenia, agranulocytosis psychosis
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 Omeprazole has a mild anti-androgen effect.
For men, breast growth and decreased libido may occur after long-term medication, and for women, galactorrhea may occur after long-term medication, and it can return to normal after stopping the medication
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 Long-term use of PPI (usually defined as more than 6 months), be alert to potential adverse effects associated with PPI, such as osteoporosis and fractures, pneumonia, small intestinal bacterial overgrowth, Clostridium difficile infection, spontaneous bacterial peritonitis, vitamins B12 and iron malabsorption, hypomagnesemia, kidney disease, tumor, dementia, myocardial infarction, atrophic gastritis, etc.

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The optimization of the combination of PPI and other drugs suggests that PPI has a strong and long-lasting acid suppression effect, which leads to an increase in gastric pH.
At the same time, PPI is mainly metabolized by CYP2C19 and CYP3A4 (except for rabeprazole), and it has an effect on CYP2C19, CYP3A4, and p-glycoprotein.
The other transporters have different degrees of inhibition, so PPI may interact with other drugs by affecting the absorption, metabolism or excretion of other drugs
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