Talk:Proton-pump inhibitor

Clostridium difficile

New article/research on PPI and Clostridium difficile infection (CDI). Medscape registration is free. C difficile Infection Linked to Proton Pump Inhibitors

Marginata (talk) 15:23, 26 July 2013 (UTC)

Classification of Proton Pump Inhibitor?

PPIs are the class - there isn't really any need for classification. Techelf 07:01, 10 Nov 2004 (UTC)

In last week's JAMA there was some proof that PPIs increase the risk of pneumonia. Shall we put it in? JFW | T@lk 17:44, 10 Nov 2004 (UTC)

Thanks for pointing out the JAMA article, I've put a brief spiel in the main article which you can expand if you like. Techelf 07:52, 11 Nov 2004 (UTC)

Pneumonia

Uncontrolled or insufficiently controlled Gastroesophageal Reflux Disease can cause Pulmonary aspiration which may lead to pneumonia. Interesting that the current favoured treatment for GERD is for associated with increased risk of community-aquired pneumonia.

See above. JFW | T@lk 20:25, 15 Jun 2005 (UTC)

Template

The above template is available; I think it should probably be used on this page? I didn't want to duplicate the information already there, but removing the present list would lose the brand name reference. -- Mithent 20:50, 20 Jun 2005 (UTC)

Interstitial nephritis

... is very rare, usually affects the elderly, rarely progresses to dialysis and takes more than 6 months to heal doi:10.1111/j.1365-2036.2007.03407.x JFW | T@lk 19:00, 1 August 2007 (UTC)

Don't worry about B12

doi:10.1111/j.1365-2036.2008.03601.x - after reports about metformin causing B12 deficiency and concerns about calcium absorption in PPI treatment it was probably time we looked at B12, deficiency of which can cause haematological and neurological complications. No problems there. Good. JFW | T@lk 21:21, 13 January 2008 (UTC)

doi:10.1016/j.amjmed.2009.04.014 - review of all the long-term adverse effects. JFW | T@lk 12:33, 27 September 2009 (UTC)

Or maybe worry about B12?

doi:10.1001/jamaneurol.2015.4791 - http://jamanetwork.com/journals/jamaneurology/fullarticle/2487379 From Abstract: "Medications that influence the risk of dementia in the elderly can be relevant for dementia prevention. Proton pump inhibitors (PPIs) are widely used for the treatment of gastrointestinal diseases but have also been shown to be potentially involved in cognitive decline." From Introduction: "There is evidence that PPI use might affect cognition. Lam et al10 report a significant association of previous and current PPI use with vitamin B12 deficiency in a population-based sample. Vitamin B12 deficiency has been shown to be associated with cognitive decline.11 In another study,12 PPIs were observed to enhance β-amyloid (Aβ) levels in the brains of mice by affecting the enzymes β- and γ-secretase."

Reported associations of long-term PPI use with B12 deficiency and dementia are here, but we use secondary sources (reviews) such as ref 23 and 24. In WP, we aim for a balanced, long-term view rather than reporting every new primary study, particularly as animal research does not always have relevance for human medical conditions. Jrfw51 (talk) 10:28, 9 September 2017 (UTC)

Drug Interactions ?

After talking to a pharmacist, it came to my attention that PPIs could affect the up-take of some drugs (eg. supplements, oral contraceptives, anticonvulsants, etc.). Suppose a patient were to take their PPI at the same time as any other drugs they were taking. It stands to reason that if PPIs change the acid content of the stomach then many other drugs would not be absorbed properly since they rely on the pH of the stomach to be absorbed at the proper rate. However, I can't seem to find a reliable source for these interactions (other than a pharmacist). It seems like something that people should know about PPis. Does anyone know of any sources for this? Jubbacca (talk) 04:52, 11 March 2009 (UTC)

Here is one link I found where you can check drug interactions between PPIs and other drugs. A lot of reliable interaction checkers are found within specialized commercial pharmacy/medical software, but these aren't free. You could also look at the package insert (easily found online for brand name PPIs) for the specific PPI, and it should list some interactions under the drug interactions section. 72.229.156.157 (talk) 09:31, 26 February 2010 (UTC)

The topic of drug interactions with PPIs merits its own section in the article. There are many drugs that are best absorbed in an acidic environment (e.g., ketoconazole, itraconazole) and taking PPIs can interfere with their absorption. TylerDurden8823 (talk) 05:28, 2 March 2013 (UTC)

Delete "Well tolerated"

Given that, as stated with reference, all of these: " headache, nausea, diarrhea, abdominal pain, fatigue, dizziness" are "common" [reference 8] adverse effects, it does not make sense to claim that "in general, proton pump inhibitors are "well tolerated" I suggest some of the more regular maintainers of this page delete the assertion of "generally...well tolerated" Just let the referenced statements listing "common" (as well as the 'uncommon' and 'rare') adverse effects, speak for themselves and let people judge the extent to which it's well tolerated or not.--Harel (talk) 04:39, 15 November 2009 (UTC)

Indeed and there is a recent longitudinal observational cohort study of US veterans which suggests that use of PPIs carries an increased risk of death. Richwil (talk) 12:43, 27 July 2017 (UTC)

References

Pharmacogenomics in ethnically Asian populations

Is it true that proton pump inhibitors are more efficacious in the Asian population? Should this also be mentioned in the article? 72.229.156.157 (talk) 03:31, 24 February 2010 (UTC)

The issue is finding sources. If you have a source which talks about this then share. Blue Rasberry (talk) 15:18, 14 September 2012 (UTC)

In any population there are some people who are "Slow Metabolisers" of PPIs which means that they nretain the PPIs longer in their system which makes it more dose effective ast the same dose rates. Asian populations have a higher proportion of " Slow Metabolisers than Caucasians. ResearchScientist007 — Preceding unsigned comment added by ResearchScientist007 (talk • contribs) 05:24, 3 December 2012 (UTC)

Risk of fractures

I don't remember reading anything about increased risk of fractures. The paragraph about that is unsourced. Does anyone have a source? Thanks. 174.99.120.98 (talk) 00:54, 20 August 2011 (UTC) There are sources there now. The first review is of about 15000 fractures and 150,000 control cases. It seems to have been cited lots of times and resulted in follow-up studies. It is not a review article but it seems worth including to me. Blue Rasberry (talk) 15:18, 14 September 2012 (UTC)

Yes osteoporosis is listed as an adverse risk in the BNF, it should be included. — Preceding unsigned comment added by Mat8989 (talk • contribs) 08:44, 4 April 2013 (UTC)

14 Day Course OTC

Reading the FDA source, it indicates that 3 x 14 day per 365 days max for OTC treatment, doesn't carry that warning for people taking under the advisement of a physician. This should be changed in the article to reflect this. There IS a risk of fracture, but many people are on physician-ordered doses of PPI's for longer terms. 174.95.209.14 (talk) 00:20, 11 November 2011 (UTC)

Merge discussion

I propose merging Discovery and development of proton pump inhibitors here. That article contains a lot of valuable material that is not related to discovery and development, so I think the main article would profit from a merger. --ἀνυπόδητος (talk) 18:58, 9 February 2012 (UTC)

I do not support this, but I do support greater interlinking of the articles. That article is part of a series on "discovery and development" of every class of drugs. You can see all these articles in this template. There is a large and significant field which focuses on drug development without talking about the drug class itself as this article does. Blue Rasberry (talk) 15:13, 14 September 2012 (UTC)

I do not support this and agree with Blue rasberry. I've included the section title and a referral to make it more obvious this information is available on wiki in the article. Mat8989 (talk) 08:42, 4 April 2013 (UTC)

But the two articles now point to each other, each one saying the other approach has now surpassed it - setting aside the actual situation / science, both of the statements can't be true - brilliant circular statements. I can see not combining but the articles need editing to be in agreement. The history makes it clear which is correct but why should a reader who presumably faces taking a new prescription med have to do this analysis?70.211.3.255 (talk) 04:32, 14 June 2013 (UTC)

Also against the merge, though editing both articles to be better is always a good plan. Hwttdz (talk) 14:36, 12 July 2013 (UTC)

I think you should merge because wikipedia is full of rule following nazis 50.132.103.137 (talk) 20:55, 20 June 2013 (UTC)

Oppose Indeed there is much material on Discovery and development of proton pump inhibitors that should be copied or moved to Proton-pump inhibitor but both the articles should remain. Each has its own significance. Besides, merging both will make Proton-pump inhibitor excessively long. Diptanshu^Talk 01:59, 10 November 2013 (UTC)

"NHS of Great Britain recommended the use of a probiotic, Lactobacillus casei"

Did the NHS of Great Britain recommend the use of probiotics? I can find no evidence of this. It seems unlikely given this was announced earlier in the same year. http://www.nutraingredients.com/Regulation/EFSA-slams-door-on-probiotic-health-claims-again-Prunes-pass. Good news about the prunes though. - Dave Crosby (talk) 08:34, 23 February 2013 (UTC)

Primary source

IO Device in this dif you added a bunch of content based on this source. PloS classifies that as a "research paper" not a review. As of today it is not even indexed in pubmed yet. I reverted on the basis that is a primary source, per MEDRS. Jytdog (talk) 03:40, 11 June 2015 (UTC)

Cardiovascular risks

The primary PLoSone source [PMID 26061035] above was used by another new editor again and was reverted. I have updated the cardiovascular risks with reviews, consensus and publicly available secondary sources indicating the complex and confounding problems to any associations. The PLoSone article may be incorporated in future reviews but here is one author's comment on that paper if we want a balanced view. Jrfw51 (talk) 14:17, 20 August 2015 (UTC)

JAMA IM

Here's a nice editorial in JAMA Internal Medicine accompanying the article on PPIs and kidney disease, which also reviews all the other major adverse effects of PPIs. The table summarizes it very well. The usual caveats about association vs. causation apply.

http://archinte.jamanetwork.com/article.aspx?articleid=2481153
Editorial | February 2016
Adverse Effects Associated With Proton Pump Inhibitors
Adam Jacob Schoenfeld, MD1; Deborah Grady, MD, MPH1,2
JAMA Intern Med. 2016;176(2):172-174. doi:10.1001/jamainternmed.2015.7927.

Table. Evidence Supporting the Potential Adverse Effects of Proton Pump Inhibitor Drugs

CONCLUSIONS Available evidence suggests that PPI use is associated with an increased risk of both acute and chronic kidney disease, hypomagnesemia, C difficile infection, and osteoporotic fractures.

--Nbauman (talk) 03:05, 17 February 2016 (UTC)

Chronic exposure to PPIs reduce Telomere length.

http://circres.ahajournals.org/content/118/12/e36.abstract "Chronic exposure to PPIs impaired endothelial function and accelerated human endothelial senescence by Reducing Telomere length".

ee1518 (talk) 06:11, 5 July 2016 (UTC)

Long-term use

doi:10.1053/j.gastro.2017.01.031 JFW | T@lk 14:56, 24 March 2017 (UTC)

More recent study says there are long-term risks, so why the reversion? Viciouslies (talk) 10:36, 12 July 2017 (UTC)

As said to you before, please read and follow WP:MEDRS. If you don't understand it after reading it, please ask. Jytdog (talk) 21:00, 12 July 2017 (UTC)

Thank you for your guidance, though you sent it to me six hours after I posted my above comment, so it wasn't actually "as said to you before." I know we're both committed to accuracy on here, so let's keep it real.

I now understand the reluctance to rely on a single, primary, peer-reviewed journal article as a source for medical information. One such article started the whole "anti-vax because autism" non-sense and I can appreciate the reasoning behind not wanting to contribute to that. That said, there are now multiple primary studies that point to adverse health outcomes caused by long-term PPI use. At the very least, it seems disingenuous to have statements implying a "lack of data" is the reason we plead ignorance to long-term health effects when the data is out there.

I propose that we change the sentence about adverse effects of long term use to read something more like "Long-term use of PPIs has been less studied than short-term use, and initial studies have had conflicting outcomes, positive (cite studies that found no adverse effect) and negative (cite studies that found an adverse effect)." This would still communicate that the science is far from settled while eliminating the idea that it's from lack of studies and giving those who want to know more the ability to investigate further. Viciouslies (talk) 06:49, 15 July 2017 (UTC)

Nonsense. There are no "conflicting" outcomes. PPIs work for preventing reflux, but are otherwise bad, through and through. --Acyclic (talk) 20:04, 15 July 2017 (UTC)

Source for the proposed content? Jytdog (talk) 20:59, 15 July 2017 (UTC)

To begin with, this change (or some version of it) is supported by the current sources. The existing citation (Corleto, 2014) supporting "and the lack of data makes it difficult to make definitive statements" actually states in conclusion "Long-term PPI use may complicate health conditions by various mechanisms linked to PPIs and/or to hypochlorhydria" which seems like a definitive statement. The FDA warning cited in the article also states that long-term and/or high dose PPI use can increase the risk of bone fractures.

In addition, this review article from U.S. Pharmacist (https://www.uspharmacist.com/article/longterm-consequences-of-chronic-proton-pump-inhibitor-use) finds connections between long-term PPI use and both nutritional malabsorption and C. diff infection (which the FDA has also issued a warning about - https://www.fda.gov/drugs/drugsafety/ucm290510.htm). And, of course, the most recent study linking chronic PPI use to an increased rate of early death. Viciouslies (talk) 00:26, 16 July 2017 (UTC)

Almost forgot: There are also a number of recent studies linking long-term PPI use to kidney disease: http://www.medscape.com/viewarticle/857060 http://www.kidney-international.org/article/S0085-2538(17)30005-4/fulltext Viciouslies (talk) 00:32, 16 July 2017 (UTC)

the US Pharmacist article is not MEDRS. The medscape piece is news (not MEDRS) and the kidney international article is a primary source. You are still not proposing specific content with specific sources. I am not trying to be "dr no" here but it is impossible to respond to vague proposals. Please do read MEDRS and make sure the refs are good. (recent reviews in decent journals, statements by major medical/scientific bodies, and yes the drug label are all fine). And we don't cite studies - we just see what reviews say and summarize them... Jytdog (talk) 02:23, 16 July 2017 (UTC)

Don't get fooled by the trio of Jytdog, Alexbrn, and Zefr. They ask for MEDRS, but when you figure it out and provide a proper Pubmed-index secondary source, they come back at you with the likes Talk:Hydroxytyrosol#Role_in_human_health. Together the three support each other and force their agenda through. It's all a big scam, possibly to maintain sales and market share of hazardous pharmaceuticals. --Acyclic (talk) 02:59, 16 July 2017 (UTC)

Unfortunate, Acyclic. Please use talk pages to discuss content. I am sorry that you don't like MEDRS but it has broad and deep consensus in the community, for lots of reasons. Jytdog (talk) 03:18, 16 July 2017 (UTC)

Oh I can live with the requirement of wanting secondary sources, even for them to be Pubmed-indexed (with some difficulty), but most definitely not with the excessive burden and lawyering imposed beyond it (as for example was the case for the hydroxytyrosol article). Selectively suppressing content from journals that are not among the very top is a crooked thing, and reeks of an ulterior agenda. --Acyclic (talk) 03:46, 16 July 2017 (UTC)

I understand that you are not familiar with how the medical literature is structured. I am sorry that is causing you frustration. Jytdog (talk) 05:19, 16 July 2017 (UTC)

Systematic reviews aren't always available or current. I do not consider it wise to ignore the available articles in such a case. Ignoring knowledge comes with its own costs. Yes, you could always come back at me with, "but Wikipedia is an encyclopedia, not a knowledge-base", although this would be missing the point which is that it's read by users as if it were a knowledge-base. --Acyclic (talk) 23:13, 16 July 2017 (UTC)

I have updated with two recent MEDRS compliant reviews [1] and [2] discussing the balance of benefits and risks. These are well worth careful reading. Jrfw51 (talk) 17:19, 16 July 2017 (UTC)

Thanks for doing that! Jytdog (talk) 02:28, 17 July 2017 (UTC)

irreversibly

Article says "They do so by irreversibly inhibiting the stomach's H+/K+ ATPase proton pump." While the source cited says the same thing, surely this is an error in the source. Otherwise, it would seem you would take a PPI once and never need it again. Bcostley (talk) 18:59, 28 October 2021 (UTC)

Should probably say "pumps". Some of the pumps are replaced every day (according to this article 20%). So yes, each pump is irreversibly inhibited for as long as it exists.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855237/

Article could be clearer.Ploversegg (talk) 19:27, 28 October 2021 (UTC)

I was curious about this too, https://www.sciencedirect.com/topics/medicine-and-dentistry/proton-pump-inhibitor seems to suggest there are two categories of Proton Pump Inhibitors, irreversible and reversible covalent inhibitors. This wikipedia article may need tweaking to distinguish between the two as a result.

Although I also take issue with the use of the word "irreversible" because it appears that the effect is long-lasting but not truly irreversible. Simsarmy (talk) 01:51, 1 January 2024 (UTC)

Thanks! — Preceding unsigned comment added by Bcostley (talk • contribs) 00:31, 29 October 2021 (UTC)

Alzheimer's association

There is fairly new emerging evidence of a low but statistically significant alzheimer's risk of particularly long term ppi use. This article should summarise it for completeness. 37.152.237.108 (talk) 09:12, 23 July 2024 (UTC)