Proton pump inhibitors and their drug interactions: an evidence-based approach

The proton pump inhibitors (PPIs) are the most effective antisecretory agen ts used to treat acid-related disorders, As such, they are frequently presc ribed for patients who are concurrently using other medications, PPIs may i nteract with other drugs through numerous mechanisms. The most important in clude competitive inhibition of hepatic cytochrome P (CYP) 450 enzymes invo lved in drug metabolism, and alteration of the absorption of other drugs vi a changes in gastric pH levels, Poor metabolizers, who lack CYP2C19, may be particularly predisposed to drug interactions, Although the potential for drug interactions is high, few clinically significant interactions have bee n reported for the PPIs, Nevertheless, caution is indicated when certain dr ugs are co-prescribed with these agents, The incidence of clinically signif icant drug interactions increases proportionately with the number of drugs taken and with the age of the patient, The drug interaction with the greate st clinical importance is the reduction in benzodiazepine clearance by omep razole, Eur J Gastroenterol Hepatol 13:611-616 (C) 2001 Lippincott Williams & Wilkins.