Journal of Literature Pharmacy Sciences

Proton Pompası İnhibitörlerinin Olası İlaç Etkileşimleri ve Mikrobiyota Üzerine Etkileri
The Effect of Proton Pump Inhibitors on Possible Drug Interactions and Microbiota
Fatma Betül İSPİRa, Şaziye Sezin PALABIYIK YÜCELİKa,b, Terken BAYDARc
aAtatürk Üniversitesi, Eczacılık Fakültesi, Farmasötik Toksikoloji ABD, Erzurum, TÜRKİYE
bKlinik Araştırma, Geliştirme ve Tasarım Uygulama ve Araştırma Merkezi, Atatürk Üniversitesi, Erzurum, TÜRKİYE
cHacettepe Üniversitesi Eczacılık Fakültesi, Toksikoloji ABD, Ankara, TÜRKİYE
J Lit Pharm Sci. 2020;9(2):197-207
doi: 10.5336/pharmsci.2019-73153
Article Language: TR
Full Text
ÖZET
 Proton pompası inhibitörleri (PPİ), gastrik asit ilişkili rahatsızlıkların tedavisi için uzun süreli olarak tüm dünyada sıklıkla kullanılmaktadır. Günümüzde gastroözofageal reflü, peptik ülser ve Zollinger-Ellison sendromu tedavisinde tercih edilmekte olup, peptik ülser hastalarında Helicobacter pylori eradikasyonunda 3'lü tedavide anahtar rolündedir. Buna ek olarak, stres ve nonsteroidal antiinflamatuar ilaç (NSAİİ)lar ile indüklenen peptik ülserde de proflaktik olarak kullanılmaktadır. PPİ'ler endikasyonu olan hastalıklar uzun süreli tedavi gerektirdiğinden, bu ilaçlarla birlikte diğer ilaçları kullanan hastalarda klinik olarak önemli ilaç etkileşimlerinin görülme olasılığı artmaktadır. PPİ'lerin midede pH'ı artırması, bu grup ilaçların diğer ilaçlarla etkileşimleri altındaki mekanizmalardan biridir. Bir diğer mekanizma ise karaciğerde sitokrom P450 enzim sistemi ile metabolize olan PPİ'lerin, aynı enzim sistemi ile biyotransforme olan ilaçlarla birlikte alınmaları durumunda oluşan ilaç etkileşimleridir. PPİ'ler tarafından gastrik asit baskılanması, ince bağırsakta bakteri kompozisyonu üzerinde olumsuz etki göstermektedir. Mide asidinin baskılanmasıyla mide pH'ının artmasına ek olarak PPİ'ler, bakteri ve mantar proton pompalarını doğrudan hedef alarak mide mikro çevresini etkilemektedir. Genişletilmiş PPİ'lerin kullanımı normal gastrik floranın baskılanmasına ve patojenik bakteri fazlalığına yol açar. Sunulan bu çalışmada, PPİ'lerin etkisi güncel literatür bilgileri ile derlenmiştir.

Anahtar Kelimeler: Proton pompası inhibitörleri; ilaç-ilaç etkileşimi; mikrobiyota
ABSTRACT
 Proton pump inhibitors (PPIs) have been frequently used worldwide for the treatment of gastric acid related disorders long-term. It is currently preferred for gastroesophageal reflux, peptic ulcer and Zollinger-Ellison syndrome and the key to triple treatment of Helicobacter pylori eradication in patients with peptic ulcer. In addition, it is used prophylactically in stress and nonsteroidal antiinflammatory drugs (NSAIDs) induced peptic ulcer. As PPIs indications require long-term treatment, the likelihood of clinically significant drug interactions increases in patients using these drugs in combination with other drugs. Increasing the pH in the stomach is one of causative mechanism of the interaction of PPIs with other drugs. Another mechanism is the drug interactions that occur when the PPIs metabolized by the cytochrome p450 enzyme system in the liver are taken together with drugs that are bio-transformed with the same enzyme system. Gastric acid suppression by PPIs has a negative effect on bacterial composition in the small intestine. In addition to increased gastric pH by suppression of gastric acid by PPIs directly targeted bacteria and fungi proton pumps to affect the gastric microenvironment. The use of extended PPIs may result in the suppression of normal gastric flora and an excess of pathogenic bacteria. In this article, the effects of PPIs have been reviewed with the current literature.

Keywords: Proton pump inhibitors; drug-drug interactions; microbiota
REFERENCES:
  1. Guignard B, Bonnabry P, Perrier A, Dayer P, Desmeules J, Samer CF. Drug-related problems identification in general internal medicine: the impact and role of the clinical pharmacist and pharmacologist. Eur J Intern Med. 2015;26(6):399-406. [Crossref]  [PubMed] 
  2. Marengoni A, Pasina L, Concoreggi C, Martini G, Brognoli F, Nobili A, et al. Understanding adverse drug reactions in older adults through drug-drug interactions. Eur J Intern Med. 2014;25(9):843-6. [Crossref]  [PubMed] 
  3. Blume H, Donath F, Warnke A, Schug BS. Pharmacokinetic drug interaction profiles of proton pump inhibitors. Drug Saf. 2006;29(9):769-84. [Crossref]  [PubMed] 
  4. Shih CJ, Chen YT, Ou SM, Li SY, Chen TJ, Wang SJ. Proton pump inhibitor use represents an independent risk factor for myocardial infarction. Int J Cardiol. 2014;177(1):292-7. [Crossref]  [PubMed] 
  5. Marlicz W, Loniewski I, Grimes DS, Quigley EM. Nonsteroidal anti-inflammatory drugs, proton pump inhibitors, and gastrointestinal injury: contrasting interactions in the stomach and small intestine. Mayo Clin Proc. 2014;89(12):1699-709. [Crossref]  [PubMed] 
  6. Wallace J, Paauw DS. Appropriate prescribing and important drug interactions in older adults. Med Clin North Am. 2015;99(2):295-310. [Crossref]  [PubMed] 
  7. Jaruratanasirikul S, Sriwiriyajan S. Effect of omeprazole on the pharmacokinetics of itraconazole. Eur J Clin Pharmacol. 1998;54(2):159-61. [Crossref]  [PubMed] 
  8. Suzuki Y, Suzuki H, Umetsu R, Uranishi H, Abe J, Nishibata Y, et al. Analysis of the interaction between clopidogrel, aspirin, and proton pump inhibitors using the FDA Adverse Event Reporting System Database. Biol Pharm Bull. 2015;38(5):680-6. [Crossref]  [PubMed] 
  9. Leonard CE, Bilker WB, Brensinger CM, Flockhart DA, Freeman CP, Kasner SE, et al. Comparative risk of ischemic stroke among users of clopidogrel together with individual proton pump inhibitors. Stroke. 2015;46(3):722-31. [Crossref]  [PubMed]  [PMC] 
  10. Frelinger 3rd AL, Lee RD, Mulford DJ, Wu J, Nudurupati S, Nigam A, et al. A randomized, 2-period, crossover design study to assess the effects of dexlansoprazole, lansoprazole, esomeprazole, and omeprazole on the steady-state pharmacokinetics and pharmacodynamics of clopidogrel in healthy volunteers. J Am Coll Cardiol. 2012;59(14):1304-11. [Crossref]  [PubMed] 
  11. Nagata N, Niikura R, Aoki T, Sakurai T, Moriyasu S, Shimbo T, et al. Effect of proton-pump inhibitors on the risk of lower gastrointestinal bleeding associated with NSAIDs, aspirin, clopidogrel, and warfarin. J Gastroenterol. 2015;50(11):1079-86. [Crossref]  [PubMed] 
  12. Würtz M, Grove EL, Kristensen SD, Hvas AM. The antiplatelet effect of aspirin is reduced by proton pump inhibitors in patients with coronary artery disease. Heart. 2010;96(5):368-71. [Crossref]  [PubMed] 
  13. Trifirò G, Parrino F, Sultana J, Giorgianni F, Ferrajolo C, Bianchini E, et al. Drug interactions with levothyroxine therapy in patients with hypothyroidism: observational study in general practice. Clin Drug Investig. 2015;35(3):187-95. [Crossref]  [PubMed] 
  14. Irving SA, Vadiveloo T, Leese GP. Drugs that interact with levothyroxine: an observational study from the Thyroid Epidemiology, Audit and Research Study (TEARS). Clin Endocrinol (Oxf). 2015;82(1):136-41. [Crossref]  [PubMed] 
  15. Reid T, Yuen A, Catolico M, Carlson RW. Impact of omeprazole on the plasma clearance of methotrexate. Cancer Chemother Pharmacol. 1993;33(1):82-4. [Crossref]  [PubMed] 
  16. Beorlegui B, Aldaz A, Ortega A, Aquerreta I, Sierrasesúmega L, Giráldez J. Potential interaction between methotrexate and omeprazole. Ann Pharmacother. 2000;34(9):1024-7. [Crossref]  [PubMed] 
  17. Bezabeh S, Mackey AC, Kluetz P, Jappar D, Korvick J. Accumulating evidence for a drug-drug interaction between methotrexate and proton pump inhibitors. Oncologist. 2012;17(4):550-4. [Crossref]  [PubMed]  [PMC] 
  18. McBride A, Antonia SJ, Haura EB, Goetz D. Suspected methotrexate toxicity from omeprazole: a case review of carboxypeptidase G2 use in a methotrexate-experienced patient with methotrexate toxicity and a review of the literature. J Pharm Pract. 2012;25(4):477-85. [Crossref]  [PubMed] 
  19. Abi-Abib RdC, Vaisman M. Is it necessary to increase the dose of levothyroxine in patients with hypothyroidism who use omeprazole? Arq Bras Endocrinol Metabol. 2014;58(7):731-6. [Crossref]  [PubMed] 
  20. Ogawa R, Echizen H. Drug-drug interaction profiles of proton pump inhibitors. Clin Pharmacokinet. 2010;49(8):509-33. [Crossref]  [PubMed] 
  21. Lewis JM, Stott KE, Monnery D, Seden K, Beeching NJ, Chaponda M, et al. Managing potential drug-drug interactions between gastric acid-reducing agents and antiretroviral therapy: experience from a large HIV-positive cohort. Int J STD AIDS. 2016;27(2):105-9. [Crossref]  [PubMed] 
  22. Treiber G, Walker S, Klotz U. Omeprazole‐induced increase in the absorption of bismuth from tripotassium dicitrato bismuthate. Clin Pharmacol Ther. 1994;55(5):486-91. [Crossref]  [PubMed] 
  23. Teichert M, van Noord C, Uitterlinden AG, Hofman A, Buhre PN, De Smet PAGM, et al. Proton pump inhibitors and the risk of overanticoagulation during acenocoumarol maintenance treatment. Br J Haematol. 2011;153(3):379-85. [Crossref]  [PubMed] 
  24. Henriksen DP, Stage TB, Hansen MR, Rasmussen L, Damkier P, Pottegård A. The potential drug-drug interaction between proton pump inhibitors and warfarin. Pharmacoepidemiol Drug Saf. 2015;24(12):1337-40. [Crossref]  [PubMed] 
  25. Ananthakrishnan S, Braverman LE, Levin RM, Magnani B, Pearce EN. The effect of famotidine, esomeprazole, and ezetimibe on levothyroxine absorption. Thyroid. 2008;18(5):493-8. [Crossref]  [PubMed] 
  26. Duursema L, Müller FO, Schall R, Middle MV, Hundt HK, Groenewoud G, et al. Lack of effect of pantoprazole on the pharmacodynamics and pharmacokinetics of warfarin. Br J Clin Pharmacol. 1995;39(6):700-3. [Crossref]  [PubMed]  [PMC] 
  27. Adamopoulos AB, Sakizlis GN, Nasothimiou EG, Anastasopoulou I, Anastasakou E, Kotsi P, et al. Do proton pump inhibitors attenuate the effect of aspirin on platelet aggregation? A randomized crossover study. J Cardiovasc Pharmacol. 2009;54(2):163-8. [Crossref]  [PubMed] 
  28. Singh A, Cresci GA, Kirby DF. Proton pump inhibitors: risks and rewards and emerging consequences to the gut microbiome. Nutr Clin Pract. 2018;33(5):614-24. [Crossref]  [PubMed] 
  29. Freedberg DE, Lebwohl B, Abrams JA. The impact of proton pump inhibitors on the human gastrointestinal microbiome. Clin Lab Med. 2014;34(4):771-85. [Crossref]  [PubMed]  [PMC] 
  30. Imhann F, Vich Vila A, Bonder MJ, Lopez Manosalva AG, Koonen DPY, Fu J, et al. The influence of proton pump inhibitors and other commonly used medication on the gut microbiota. Gut Microbes. 2017;8(4):351-8. [Crossref]  [PubMed]  [PMC] 
  31. Minalyan A, Gabrielyan L, Scott D, Jacobs J, Pisegna JR. The gastric and intestinal microbiome: role of proton pump inhibitors. Curr Gastroenterol Rep. 2017;19(8):42. [Crossref]  [PubMed]  [PMC] 
  32. Linsky A, Gupta K, Lawler EV, Fonda JR, Hermos JA. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med. 2010;170(9):772-8. [Crossref]  [PubMed] 
  33. Cunningham R, Dale B, Undy B, Gaunt N. Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea. J Hosp Infect. 2003;54(3):243-5. [Crossref]  [PubMed] 
  34. Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol. 2007;102(9):2047-56; quiz 2057. [Crossref]  [PubMed] 
  35. Linney S, Fernandes T, Einarson T, Sengar A, Walker JH, Mills A. Association between use of proton pump inhibitors and a Clostridium difficile-associated disease outbreak: case-control study. Can J Hosp Pharm. 2010;63(1):31-7. [Crossref]  [PubMed]  [PMC] 
  36. Jackson MA, Goodrich JK, Maxan ME, Freedberg DE, Abrams JA, Poole AC, et al. Proton pump inhibitors alter the composition of the gut microbiota. Gut. 2016;65(5):749-56. [Crossref]  [PubMed]  [PMC] 
  37. Lo WK, Chan WW. Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clin Gastroenterol Hepatol. 2013;11(5):483-90. [Crossref]  [PubMed] 
  38. Sterbini FP, Palladini A, Masucci L, Cannistraci CV, Pastorino R, Ianiro G, et al. Effects of proton pump inhibitors on the gastric mucosa-associated microbiota in dyspeptic patients. Appl Environ Microbiol. 2016;82(22):6633-44. [Crossref]  [PubMed]  [PMC] 

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