Skip to main content
Log in

Properly prescribed, proton pump inhibitors are largely safe, but precautions are needed to prevent potential problems, overuse and misuse

  • Drug Reactions and Interactions
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Adverse events have been widely reported in users of popular proton pump inhibitors (PPIs). Most data come from observational studies, with clear causation rarely demonstrated. Evidence linking PPIs to gastrointestinal infections is stronger and some drug interactions are important. The use of PPI is often prolonged, without a clear reason for continued therapy. PPIs should be prescribed after a careful assessment of risks and benefits and their use reviewed regularly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Elias E, Targownik LE. The clinician’s guide to proton pump inhibitor related adverse events. Drugs. 2019;79(7):715–31.

    Article  PubMed  Google Scholar 

  2. Sanduleanu S, Jonkers D, De Bruine A, et al. Non-Helicobacter pylori bacterial flora during acid-suppressive therapy: differential findings in gastric juice and gastric mucosa. Aliment Pharmacol Ther. 2001;15(3):379–88.

    Article  CAS  PubMed  Google Scholar 

  3. Sharma BK, Santana IA, Wood EC, et al. Intragastric bacterial activity and nitrosation before, during, and after treatment with omeprazole. BMJ. 1984;289(6447):717–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Parsons BN, Ijaz UZ, D’Amore R, et al. Comparison of the human gastric microbiota in hypochlorhydric states arising as a result of Helicobacter pylori-induced atrophic gastritis, autoimmune atrophic gastritis and proton pump inhibitor use. PLoS Pathog. 2017;13(11):e1006653.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lundell L, Vieth M, Gibson F, et al. Systematic review: the effects of long-term proton pump inhibitor use on serum gastrin levels and gastric histology. Aliment Pharmacol Ther. 2015;42(6):649–63.

    Article  CAS  PubMed  Google Scholar 

  6. Koop H, Klein M, Arnold R. Serum gastrin levels during long-term omeprazole treatment. Aliment Pharmacol Ther. 1990;4(2):131–8.

    Article  CAS  PubMed  Google Scholar 

  7. van Leeuwen RWF, Jansman FGA, Hunfeld NG, et al. Tyrosine kinase inhibitors and proton pump inhibitors: an evaluation of treatment options. Clin Pharmacokinet. 2017;56(7):683–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Drugs.com. Drug interaction checker. https://www.drugs.com/drug_interactions.html. Accessed 20 Aug 2019.

  9. Tariq R, Singh S, Gupta A, et al. Association of gastric acid suppression with recurrent Clostridium difficile infection: a systematic review and meta-analysis. JAMA Intern Med. 2017;177(6):784–91.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kwok CS, Arthur AK, Anibueze CI, et al. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol. 2012;107(7):1011–9.

    Article  CAS  PubMed  Google Scholar 

  11. Loo VG, Bourgault AM, Poirier L, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011;365(18):1693–703.

    Article  CAS  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. Husebye E, Skar V, Hoverstad T, et al. Fasting hypochlorhydria with gram positive gastric flora is highly prevalent in healthy old people. Gut. 1992;33(10):1331–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Terg R, Casciato P, Garbe C, et al. Proton pump inhibitor therapy does not increase the incidence of spontaneous bacterial peritonitis in cirrhosis: a multicenter prospective study. J Hepatol. 2015;62(5):1056–60.

    Article  CAS  PubMed  Google Scholar 

  15. Tergast TL, Wranke A, Laser H, et al. Dose-dependent impact of proton pump inhibitors on the clinical course of spontaneous bacterial peritonitis. Liver Int. 2018;38(9):1602–13.

    Article  CAS  PubMed  Google Scholar 

  16. Xu HB, Wang HD, Li CH, et al. Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis. Genet Mol Res. 2015;14(3):7490–501.

    Article  CAS  PubMed  Google Scholar 

  17. Dam G, Vilstrup H, Watson H, et al. Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites. Hepatology. 2016;64(4):1265–72.

    Article  CAS  PubMed  Google Scholar 

  18. Hassing RJ, Verbon A, de Visser H, et al. Proton pump inhibitors and gastroenteritis. Eur J Epidemiol. 2016;31(10):1057–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Verhaegh BP, de Vries F, Masclee AA, et al. High risk of drug-induced microscopic colitis with concomitant use of NSAIDs and proton pump inhibitors. Aliment Pharmacol Ther. 2016;43(9):1004–13.

    Article  CAS  PubMed  Google Scholar 

  20. Kuipers EJ, Lundell L, Klinkenberg-Knol EC, et al. Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication. N Engl J Med. 1996;334(16):1018–22.

    Article  CAS  PubMed  Google Scholar 

  21. Brusselaers N, Wahlin K, Engstrand L, et al. Maintenance therapy with proton pump inhibitors and risk of gastric cancer: a nationwide population-based cohort study in Sweden. BMJ Open. 2017;7(10):e017739.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Martin FC, Chenevix-Trench G, et al. Systematic review with meta-analysis: fundic gland polyps and proton pump inhibitors. Aliment Pharmacol Ther. 2016;44(9):915–25.

    Article  CAS  PubMed  Google Scholar 

  23. Blank ML, Parkin L, Paul C, et al. A nationwide nested case-control study indicates an increased risk of acute interstitial nephritis with proton pump inhibitor use. Kidney Int. 2014;86(4):837–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Yang Y, George KC, Shang WF, et al. Proton-pump inhibitors use, and risk of acute kidney injury: a meta-analysis of observational studies. Drug Des Dev Ther. 2017;11:1291–9.

    Article  CAS  Google Scholar 

  25. Lazarus B, Chen Y, Wilson FP, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med. 2016;176(2):238–46.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zhou B, Huang Y, Li H, et al. Proton-pump inhibitors and risk of fractures: an update meta-analysis. Osteoporos Int. 2016;27(1):339–47.

    Article  CAS  PubMed  Google Scholar 

  27. Attwood SE, Ell C, Galmiche JP, et al. Long-term safety of proton pump inhibitor therapy assessed under controlled, randomised clinical trial conditions: data from the SOPRAN and LOTUS studies. Aliment Pharmacol Ther. 2015;41(11):1162–74.

    Article  CAS  PubMed  Google Scholar 

  28. Lam JR, Schneider JL, Quesenberry CP, et al. Proton pump inhibitor and histamine-2 receptor antagonist use and iron deficiency. Gastroenterology. 2017;152(4):821e1–829e1.

    Article  CAS  Google Scholar 

  29. Lambert AA, Lam JO, Paik JJ, et al. Risk of community-acquired pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis. PLoS One. 2015;10(6):e0128004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Fohl AL, Regal RR. Proton pump inhibitor-associated pneumonia: not a breath of fresh air after all? World J Gastrointest Pharmacol Ther. 2011;2(3):17–26.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013;310(22):2435–42.

    Article  CAS  PubMed  Google Scholar 

  32. O’Donoghue ML, Braunwald E, Antman EM, et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a protonpump inhibitor: an analysis of two randomised trials. Lancet. 2009;374(9694):989–97.

    Article  CAS  PubMed  Google Scholar 

  33. Simon T, Steg PG, Gilard M, et al. Clinical events as a function of proton pump inhibitor use, clopidogrel use, and cytochrome P450 2C19 genotype in a large nationwide cohort of acute myocardial infarction: results from the French Registry of Acute ST-Elevation and non-STElevation Myocardial Infarction (FAST-MI) registry. Circulation. 2011;123(5):474–82.

    Article  CAS  PubMed  Google Scholar 

  34. Sun J, Ilich AI, Kim CA, et al. Concomitant administration of proton pump inhibitors and capecitabine is associated with increased recurrence risk in early stage colorectal cancer patients. Clin Colorectal Cancer. 2016;15(3):257–63.

    Article  PubMed  Google Scholar 

  35. Chu MP, Hecht JR, Slamon D, et al. Association of proton pump inhibitors and capecitabine efficacy in advanced gastroesophageal cancer: secondary analysis of the TRIO-013/LOGIC randomized clinical trial. JAMA Oncol. 2017;3(6):767–73.

    Article  PubMed  Google Scholar 

  36. Chu MP, Ghosh S, Chambers CR, et al. Gastric acid suppression is associated with decreased erlotinib efficacy in non-small-cell lung cancer. Clin Lung Cancer. 2015;16(1):33–9.

    Article  CAS  PubMed  Google Scholar 

  37. Ha VH, Ngo M, Chu MP, et al. Does gastric acid suppression affect sunitinib efficacy in patients with advanced or metastatic renal cell cancer? J Oncol Pharm Pract. 2015;21(3):194–200.

    Article  CAS  PubMed  Google Scholar 

  38. Tomilo DL, Smith PF, Ogundele AB, et al. Inhibition of atazanavir oral absorption by lansoprazole gastric acid suppression in healthy volunteers. Pharmacotherapy. 2006;26(3):341–6.

    Article  CAS  PubMed  Google Scholar 

  39. Tapper EB, Bacon BR, Curry MP, et al. Evaluation of proton pump inhibitor use on treatment outcomes with ledipasvir and sofosbuvir in a real-world cohort study. Hepatology. 2016;64(6):1893–9.

    Article  CAS  PubMed  Google Scholar 

  40. Zimmermann T, Yeates RA, Riedel KD, et al. The influence of gastric pH on the pharmacokinetics of fluconazole: the effect of omeprazole. Int J Clin Pharmacol Ther. 1994;32(9):491–6.

    CAS  PubMed  Google Scholar 

  41. Chin TW, Loeb M, Fong IW. Effects of an acidic beverage (Coca–Cola) on absorption of ketoconazole. Antimicrob Agents Chemother. 1995;39(8):1671–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Gjestad C, Westin AA, Skogvoll E, et al. Effect of proton pump inhibitors on the serum concentrations of the selective serotonin reuptake inhibitors citalopram, escitalopram, and sertraline. Ther Drug Monit. 2015;37(1):90–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Heidelbaugh JJ, Goldberg KL, Inadomi JM. Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. Am J Manag Care. 2010;16(9):e228–34.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Consortia

Ethics declarations

Funding

The preparation of this review was not supported by any external funding.

Conflict of interest

The article was adapted from Drugs 2019;79(7):715–31 [1] by employees of Adis International Ltd./Springer Nature, who are responsible for the article content and declare no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adis Medical Writers. Properly prescribed, proton pump inhibitors are largely safe, but precautions are needed to prevent potential problems, overuse and misuse. Drugs Ther Perspect 35, 550–556 (2019). https://doi.org/10.1007/s40267-019-00671-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-019-00671-3

Navigation