Proton pump inhibitors and their drug interactions: an evidence-based approach.
The proton pump inhibitors (PPIs) are the most effective antisecretory agents used to treat acid-related disorders. As such, they are frequently prescribed for patients who are concurrently using other medications. PPIs may interact with other drugs through numerous mechanisms. The most important include competitive inhibition of hepatic cytochrome P (CYP) 450 enzymes involved in drug metabolism, and alteration of the absorption of other drugs via 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 been reported for the PPIs. Nevertheless, caution is indicated when certain drugs are co-prescribed with these agents. The incidence of clinically significant drug interactions increases proportionately with the number of drugs taken and with the age of the patient. The drug interaction with the greatest clinical importance is the reduction in benzodiazepine clearance by omeprazole.
Gerson
L B
LB
Division of Gastroenterology, Stanford University School of Medicine, CA,  USA.
Triadafilopoulos
G
G
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001189:Aryl Hydrocarbon Hydroxylases; D001562:Benzimidazoles / Q000494:pharmacology; D065731:Cytochrome P-450 CYP2C19; D065690:Cytochrome P-450 CYP2D6 Inhibitors; D051544:Cytochrome P-450 CYP3A; D065607:Cytochrome P-450 Enzyme Inhibitors; D004347:Drug Interactions; D004791:Enzyme Inhibitors / Q000494:pharmacology*; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D006801:Humans; D064747:Lansoprazole; D006899:Mixed Function Oxygenases / Q000037:antagonists & inhibitors; D009853:Omeprazole / Q000031:analogs & derivatives / Q000494:pharmacology; D000077402:Pantoprazole; D054328:Proton Pump Inhibitors; D064750:Rabeprazole; D013454:Sulfoxides / Q000494:pharmacology
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001562:Benzimidazoles; D065690:Cytochrome P-450 CYP2D6 Inhibitors; D065607:Cytochrome P-450 Enzyme Inhibitors; D004791:Enzyme Inhibitors; D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors; D013454:Sulfoxides; D064747:Lansoprazole; D064750:Rabeprazole; D000077402:Pantoprazole; D006899:Mixed Function Oxygenases; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; C104464:CYP3A protein, human; D065731:Cytochrome P-450 CYP2C19; D051544:Cytochrome P-450 CYP3A; D009853:Omeprazole