Drug Safety

, Volume 40, Issue 10, pp 895–909 | Cite as

Muscular Adverse Drug Reactions Associated with Proton Pump Inhibitors: A Disproportionality Analysis Using the Italian National Network of Pharmacovigilance Database

  • Alice Capogrosso Sansone
  • Irma Convertino
  • Maria Teresa Galiulo
  • Stefano Salvadori
  • Stefania Pieroni
  • Tamara Knezevic
  • Stefania Mantarro
  • Alessandra Marino
  • Manfred Hauben
  • Corrado Blandizzi
  • Marco Tuccori
Original Research Article



Proton pump inhibitors (PPIs) have been implicated in the occurrence of moderate to severe myopathies in several case reports.


This study was performed to assess the reporting risk of muscular adverse drug reactions (ADRs) associated with PPIs in the Italian National Network of Pharmacovigilance database.


A disproportionality analysis (case/non-case) was performed using spontaneous reports collected in the database between July 1983 and May 2016. Reporting odds ratio (ROR) and 95% confidence intervals (CIs) were calculated as a measure of disproportionality. In a secondary and tertiary analysis, we explored the association of PPIs with muscular ADRs after taking into account the masking effect of statins. Moreover, the possibility of an interaction between PPIs and statins, leading to the occurrence of muscular ADRs, was also tested.


The study was carried out on 274,108 reports. The ROR of muscular ADRs for PPIs, adjusted for age and gender, was 1.484 (95% CI 1.204–1.829; p < 0.001), whereas the ROR for rhabdomyolysis was 0.621 (95% CI 0.258–1.499). Similar results were obtained in the secondary analysis. The tertiary analysis, where PPIs were considered regardless of whether their role was suspected or concomitant, showed a potential disproportionate reporting for the combination PPIs–rhabdomyolysis (ROR 1.667, 95% CI 1.173–2.369; p < 0.01). The PPIs–statins combination was not associated with an enhanced ROR of muscular ADRs/rhabdomyolysis compared with statins alone.


This explorative study suggests that the class of PPIs could be involved in reports of muscular ADRs, rather than any other ADR, more frequently than any non-statin drug. Our results must be corroborated by further studies.


Compliance with Ethical Standards


No funding was used for the preparation of this manuscript.

Conflicts of interest

Manfred Hauben is a full-time employed of Pfizer Inc. and receives part of his compensation in the form of stock options and restricted stock units. He has also declared he owns stocks in other pharmaceutical companies that, like Pfizer Inc., manufacture and/or market statins and PPIs. Marco Tuccori, Alice Capogrosso Sansone, Irma Convertino, Maria Teresa Galiulo, Stefano Salvadori, Stefania Pieroni, Tamara Knezevic, Stefania Mantarro, Alessandra Marino and Corrado Blandizzi have no conflicts of interest that are directly relevant to the content of this study.

Ethical Approval and Patient Consent

Ethical approval and patient consent are not required for this kind of study.

Supplementary material

40264_2017_564_MOESM1_ESM.pdf (358 kb)
Supplementary material 1 (PDF 357 kb)


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Alice Capogrosso Sansone
    • 1
  • Irma Convertino
    • 1
  • Maria Teresa Galiulo
    • 1
  • Stefano Salvadori
    • 2
  • Stefania Pieroni
    • 2
  • Tamara Knezevic
    • 2
  • Stefania Mantarro
    • 1
  • Alessandra Marino
    • 1
  • Manfred Hauben
    • 3
    • 5
  • Corrado Blandizzi
    • 1
    • 4
  • Marco Tuccori
    • 4
  1. 1.Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
  2. 2.Institute of Clinical PhysiologyNational Research CouncilPisaItaly
  3. 3.Pfizer Inc.New YorkUSA
  4. 4.Unit of Adverse Drug Reactions Monitoring, Tuscan Regional Centre of PharmacovigilanceUniversity Hospital of PisaPisaItaly
  5. 5.Department of MedicineNew York University School of MedicineNew YorkUSA

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