Omeprazole therapy

Which is preferred between Omeprazole and Pantoprazole in the treatment of gastroesophageal reflux disease (GERD)?

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Gastroesophageal reflux disease (GERD) is a commonly diagnosed digestive disorder characterised by the regurgitation of gastric contents into the oesophagus. Histamine (H2) receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) are the primary acid-suppressive medicines used in this condition.[1] Both Omeprazole and Pantoprazole are PPIs approved by the Food and Drug Administration Agency (FDA) for the treatment of GERD.

Clinical studies have revealed that the efficacy of Pantoprazole (20 mg) and Omeprazole (20 mg) were comparable in maintaining endoscopic and symptomatic remission in patients with healed erosive oesophagitis. The efficacy and tolerability of Pantoprazole (40 mg) and Omeprazole multiple unit pellet system (MUPS) (40 mg) were explored in patients with moderate to severe GERD. It was observed that both these drugs were equivalent in healing after 4 and 8 weeks of treatment in patients with reflux oesophagitis grade II/III. The tolerability and safety of the drugs were also comparable. Another study also reported that the efficacy of Omeprazole MUPS 20 mg and Pantoprazole 40 mg were similar in the management of reflux oesophagitis. The patient satisfaction for these two drugs was also comparable. 

While treating GERD in the geriatric population, other comorbid conditions and concomitant medications should be taken into consideration. Therefore, the drug interaction profile of these drugs needs to be screened to ensure safer therapeutics for the patients. It has been reported that Omeprazole has a higher risk for drug interactions as compared to Pantoprazole. Therefore, Pantoprazole is considered to be safe for elderly patients receiving multiple medications.

Long term Omeprazole therapy.

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Long term Omeprazole therapy ..
Omeprazole is one of the most widely prescribed drug s internationally used in the treatment of gastro esophageal reflux disease, peptic ulcer, and other conditions caused by excess stomach acid. Omeprazole (Prilosec, Zegerid) belongs to group of drugs called proton pump inhibitors. It decreases the amount of acid produced in the stomach. As well as its needed effects, Omeprazole may cause unwanted side effects that require medical attention especially in long term use:
1) Atrophic gastritis: Long-term omeprazole therapy has caused atrophic gastritis (identified by biopsy.
2) Carcinoma: In long-term (2-year) studies in rats, omeprazole produced a dose-related increase in gastric carcinoid tumor. Gastric polyposis have been reported in three of eleven patients treated with long-term omeprazole therapy (20 to 40 mg daily). Hyperplastic and fundic gland polyps developed in the stomach of these patients.
3) Clostridium difficile-associated diarrhea (CDAD): Use of proton pump inhibitors (PPIs) may increase risk of CDAD, especially in hospitalized patients; consider CDAD diagnosis in patients with persistent diarrhea that does not improve. Use the lowest dose and shortest duration of PPI therapy appropriate for the condition being treated.
4) Fractures: Increased incidence of osteoporosis-related bone fractures of the hip, spine, or wrist may occur with proton pump inhibitor (PPI) therapy. Patients on high-dose (multiple daily doses) or long-term (≥1 year) therapy should be monitored. Use the lowest effective dose for the shortest duration of time, use vitamin D and calcium supplementation, and follow appropriate guidelines to reduce risk of fractures in patients at risk.
5) Hypomagnesemia: Reported rarely, usually with prolonged PPI use of >3 months (most cases >1 year of therapy). May be symptomatic or asymptomatic; severe cases may cause tetany, seizures, and cardiac arrhythmias. Consider obtaining serum magnesium concentrations prior to beginning long-term therapy, especially if taking concomitant digoxin, diuretics, or other drugs known to cause hypomagnesemia.
6) Interstitial nephritis: Acute interstitial nephritis has been observed in patients taking PPIs; may occur at any time during therapy and is generally due to an idiopathic hypersensitivity reaction. Discontinue if acute interstitial nephritis develops.
 7) Vitamin B12 deficiency: Prolonged treatment (≥2 years) may lead to vitamin B12 malabsorption and subsequent vitamin B12 deficiency. The magnitude of the deficiency is dose-related and the association is stronger in females and those younger in age (<30 years); prevalence is decreased after discontinuation of therapy .