Proton Pump Inhibitors
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2021 ◽  
Salman Hussain ◽  
Ambrish Singh ◽  
Benny Antony ◽  
Jitka Klugarova ◽  
Miloslav Klugar

Preeclampsia is one of the common complications of pregnancy and is characterized by high blood pressure. Proton pump inhibitors (PPIs) are commonly used for the management of gastroesophageal reflux disease among pregnant women. Recently, multiple epidemiological studies suggested the association between PPIs use and the risk of preeclampsia. This study aims to review the evidence and meta-analyse the pooled risk of preeclampsia in PPI users from epidemiological studies. Databases- MEDLINE, Embase, Scopus, Web of Science Core Collection, Emcare, and CINAHL (EBSCO) as well as sources of grey literature, ProQuest Dissertations & Theses Global, and WHO International Clinical Trials Registry Platform will be searched to identify the epidemiological studies assessing the association between PPIs use and the risk of preeclampsia. Study selection, data extraction, and quality assessment will be performed by two independent authors. The risk of bias among included studies will be evaluated by using the Newcastle-Ottawa scale. The pooled effect of PPIs use on the risk of preeclampsia in pregnant women is the primary outcome of interest. Meta-analysis will be performed using Review Manager version 5.4.

Naiara Fernandez-Arroyabe ◽  
Gaspar García-Meléndez ◽  
Ana Raquel De Castro-Almeida ◽  
Francisca Escalona-Perez ◽  
Almudena Pérez-Lara ◽  

2021 ◽  
Vol 11 (1) ◽  
Myung Jin Song ◽  
Seok Kim ◽  
Dachung Boo ◽  
Changhyun Park ◽  
Sooyoung Yoo ◽  

AbstractProton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear. In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. After propensity matching, 935 patients from each treatment group (PPI or H2RA) were selected. The PPI group had a significantly higher 90-day mortality than the H2RA group (relative risk: 1.28; P = 0.01). However, no significant inter-group differences in the risk of clinically important gastrointestinal bleeding were observed. Moreover, there were no significant differences between the groups concerning the risk of pneumonia or Clostridioides difficile infection, which are known potential adverse events related to these drugs. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population. These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit.

2021 ◽  
Udo Bonnet ◽  
BenediktBernd Claus ◽  
Martin Schaefer ◽  
Jens Kuhn ◽  
Peter Nyhuis ◽  

Abstract Introduction Several psychiatric and somatic medications are assumed to improve COVID-19-symptoms. These include antidepressants, antipsychotics, and anticonvulsants as well as anticoagulants, statins, and renin-angiotensin-aldosterone-system (RAAS)-inhibitors for somatic comorbid conditions. All these agents may reduce the hyperinflammatory response to SARS/CoV-2 or the related negative cardio-cerebrovascular outcomes. Methods In a retrospective longitudinal, multi-center inpatient study, we sought to explore the influence of psychiatric medications on COVID-19, comprising the period from diagnosing SARS/CoV-2-infection via PCR (nasopharyngeal swab) up to the next 21 days. Ninety-six psychiatric inpatients (mean age [SD] 65.5 (20.1), 54% females) were included. The primary outcome was the COVID-19-duration. Secondary outcomes included symptom severity and the presence of residual symptoms. Results COVID-19-related symptoms emerged in 60 (62.5%) patients, lasting 6.5 days on average. Six (6.3%) 56–95 years old patients died from or with COVID-19. COVID-19-duration and residual symptom-presence (n=22, 18%) were not significantly related to any substance. Respiratory and neuro-psychiatric symptom-load was significantly and negatively related to prescription of antidepressants and anticoagulants, respectively. Fatigue was negatively and positively related to RAAS-inhibitors and proton-pump-inhibitors, respectively. These significant relationships disappeared with p-value adjustment owed to multiple testing. The mean total psychiatric burden was not worsened across the study. Discussion None of the tested medications was significantly associated with the COVID-19-duration and -severity up to the end of post-diagnosing week 3. However, there were a few biologically plausible and promising relationships with antidepressants, anticoagulants, and RAAS-inhibitors before p-value adjustment. These should encourage larger and prospective studies to re-evaluate the influence of somatic and psychiatric routine medications on COVID-19-related health outcomes.

2021 ◽  
Xia Li ◽  
Haomeng Wu ◽  
Ting Chen ◽  
Beihua Zhang ◽  
Xiaoshuang Shi ◽  

Abstract Background: Non-erosive reflux disease (NERD) is characterized by typical gastroesophageal reflux symptoms, such as heartburn and regurgitation, but an absence of oesophageal mucosal damage during upper gastrointestinal endoscopy. Although proton pump inhibitors (PPIs) are the first line therapy, almost 50% of patients with NERD fail to respond to this treatment. Traditional Chinese medicine (TCM) can better relieve the symptoms of NERD. Therefore, a randomized controlled trial (RCT) was designed to investigate the efficiency of TCM granules based on Tongjiang (TJ) methodology combined with PPIs de-escalation therapy for NERD patients who did not respond to PPIs alone. Method: This multicentred, double-blinded, RCT with two parallel groups will recruit 174 participants who will be randomized into the TCM granules combined with PPIs de-escalation group (n=87) and the TCM granules placebo combined with PPIs de-escalation group (n=87). Both groups of participants will receive 6 weeks of treatment and 4 weeks of follow-up, and all participants will be assessed for related symptoms, mental health status and quality of life at each visit. The primary outcome measurements include Visual Analogue Scale (VAS) for heartburn and regurgitation and the major symptoms scale. The secondary outcome measurements include PPI withdrawal rate, symptom recurrence rate, minor symptoms scale, SF-36, PRO, SAS, SDS, GERD–HRQL and TCM syndromes scales.Discussion: Previous research has shown that TCM is capable to alleviate NERD symptoms. This trial will help to provide a better understanding of the synergistic efficiency of the combination of TCM and PPIs, to explore whether the dosage of PPIs can be reduced after the supplement of TCM granules and to provide a feasible plan to reduce dependencies or withdraw NERD patients from PPIs. The outcome of this trial is expected to reduce the symptom recurrence rates, lessen patients’ physical and psychological burdens, and achieve good social benefits.Trial registration number: NCT04340297

Valeria Dipasquale ◽  
Giuseppe Cicala ◽  
Francesca Laganà ◽  
Paola Cutroneo ◽  
Patrizia Felicetti ◽  

2021 ◽  
Vol 4 (9) ◽  
pp. e2124339
Ahhyung Choi ◽  
Yunha Noh ◽  
So-Hee Park ◽  
Seung-Ah Choe ◽  
Ju-Young Shin


Objective: The present study was aimed to find out the effect of transdermal patches of proton pump inhibitors pantoprazole and esomeprazole on the alteration of pharmacokinetic parameters of these drugs. Methods: The transdermal patches were formulated by the solvent evaporation technique using polymers HPMC E5 with PVP K 30 and HPMC E5 with Eudragit L100 in different ratios. The best formulation from each of the drug pantoprazole and esomeprazole was selected and administered to rabbits and the plasma drug concentration was compared with the marketed formulation. The pharmacokinetic parameters such as maximum plasma concentration (Cmax), time to reach Cmax (tmax), area under the curve (AUC), area under first moment curve (AUMC), elimination rate constant (λz), biological half-life (t1/2), and mean residence time (MRT) were determined. Results: The plasma drug concentration vs time curve shows the extended-release of the drugs pantoprazole and esomeprazole when compared with the marketed formulation. The results show that there is no change in the peak plasma concentration, but a significant difference was observed in all the pharmacokinetic parameters. The AUC showed 6 fold increase for pantoprazole from 8.91 to 55.20 μg*h/ml and 3.5 fold increase for the drug esomeprazole from 7.86 to 28.53 μg*h/ml, and the mean residence time also showed 2 fold increase for the transdermal patches when compared with the marketed formulations. Conclusion: The increase in tmax, AUC, and MRT values of the formulated transdermal patches with the values of the marketed formulation of both the drugs, revealed that the transdermal patches can be used to deliver the drug for an extended period and also can alter the pharmacokinetics of pantoprazole and esomeprazole.

Rizwan Ahmed Memon ◽  
Fazeela Rizwan Memon ◽  
Ali Raza Memon ◽  
Jamshaid Ul Qadir Memon ◽  
Jawaid Hussain Laghari ◽  

Background: Proton Pump inhibitors (PPI) are widely used all over the world as therapeutic agents as well as prophylactic agent at different age groups for multiple gastrointestinal disorders etc. it inhibits the hydrogen potassium pump (H/K ATPase Pump). PPI interferes the calcium absorption and thus disturbs acid secretion which leads to decrease the calcium level in the body. Objective: The present design is to evaluate the effects of PPI on serum calcium level in rabbit model. Study Design: Randomized Control Trial/ Study on Rabbit Model. Place and Duration of Study: This experimental study was done at Department of Pharmacology Isra Medical University Hyderabad (November 2020 to March 2021 Material & Methods: A total 20 healthy male rabbits with weight between 1-2kg were included in this study. While female rabbits, ill rabbits and rabbits with weight less than 1kg were excluded from study. Ten rabbits were given omeprazole sachet of 20mg orally dissolve in water once a day and 10 rabbits were given sachet of esomeprazole of 20mg dissolve in water once a day upto 90 days regularly. At different levels of study blood samples were obtained from vein near ear of rabbits and samples were centrifuged for 10minutes to obtain the serum. Then serum was sent to Isra Diagnostic Laboratory for analysis of serum calcium levels of all samples at different levels of study. Results: Serum calcium levels of all rabbits were analyzed at three different levels of study, at zero level before starting of experiment, at level I after completion of one month of experiment and level II after the completion of three months of experiment. The normal serum calcium level in rabbits is 13-15mg/dl.8There was a significant decline in serum calcium level in Group A (Omeprazole Group), while in Group B (Esomeprazole Group) there was no significant relation between decreased serum calcium levels. Conclusion: The study concluded that there is significant relation of longterm usage of PPI on serum calcium level.

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