Recent safety concerns with proton pump inhibitors

Joan Chen, Yuhong Cathy Yuan, Grigorios I. Leontiadis, Colin Howden

Research output: Contribution to journalReview article

76 Citations (Scopus)

Abstract

There have been recent concerns about the safety of proton pump inhibitors (PPIs). We focus here on 3 specific concerns-the possible interaction between PPIs and clopidogrel, the postulated link between PPI use and fractures, and the possibility that long-term PPI use might lead to hypomagnesemia. There is evidence for an in vitro interaction between clopidogrel and at least some PPIs. The Food and Drug Administration (FDA) has warned against the use of certain PPIs by patients on clopidogrel. However, a randomized controlled trial that compared clopidogrel alone with the combination of clopidogrel and omeprazole found no increase in adverse cardiovascular outcomes and a reduction in the rate of adverse gastrointestinal outcomes attributable to omeprazole. PPI use may be a weak risk factor for certain fractures, but the quality of evidence is relatively poor and there is a strong possibility of confounding. The mechanism whereby PPI use might increase fracture risk is unknown. Currently, no additional measures concerning calcium supplementation or bone mineral density monitoring are recommended for patients on a PPI. The FDA has suggested monitoring serum magnesium levels in patients on PPI therapy. The mechanism and frequency of PPI-induced hypomagnesemia are unclear. PPI treatment should not be withheld from patients who genuinely require it, but the PPI should be taken in the lowest effective dose and only for as long as clinically indicated. The same is, of course, true for all medicines. The benefits of PPI therapy greatly outweigh the risks.

Original languageEnglish (US)
Pages (from-to)93-114
Number of pages22
JournalJournal of Clinical Gastroenterology
Volume46
Issue number2
DOIs
StatePublished - Feb 1 2012

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Proton Pump Inhibitors
clopidogrel
Safety
Omeprazole
United States Food and Drug Administration
Physiologic Monitoring
Bone Density
Magnesium

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Recent safety concerns with proton pump inhibitors. / Chen, Joan; Yuan, Yuhong Cathy; Leontiadis, Grigorios I.; Howden, Colin.

In: Journal of Clinical Gastroenterology, Vol. 46, No. 2, 01.02.2012, p. 93-114.

Research output: Contribution to journalReview article

Chen, Joan ; Yuan, Yuhong Cathy ; Leontiadis, Grigorios I. ; Howden, Colin. / Recent safety concerns with proton pump inhibitors. In: Journal of Clinical Gastroenterology. 2012 ; Vol. 46, No. 2. pp. 93-114.
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