EurekaMag.com logo
+ Site Statistics
References:
53,623,987
Abstracts:
29,492,080
+ Search Articles
+ Subscribe to Site Feeds
EurekaMag Most Shared ContentMost Shared
EurekaMag PDF Full Text ContentPDF Full Text
+ PDF Full Text
Request PDF Full TextRequest PDF Full Text
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter
Follow on LinkedInFollow on LinkedIn

+ Translate

Treatment of acid-related diseases in the elderly with emphasis on the use of proton pump inhibitors



Treatment of acid-related diseases in the elderly with emphasis on the use of proton pump inhibitors



Drugs & Aging 19(12): 911-927



Proton pump inhibitors (PPIs) have revolutionised the treatment of acid-related disorders, and they have also made it possible to define the spectrum of acid inhibition required for optimal treatment in each disorder. Five PPIs are now available: the older drugs, omeprazole, lansoprazole and pantoprazole, and the two newest, rabeprazole and esomeprazole. These agents have predominantly been developed in the younger adult population, and data for the elderly population are limited. Subtle differences have emerged between the old and the new PPIs in their pharmacokinetic, pharmacodynamic and efficacy profiles. The degree of clinical relevance of these differences in the adult population is in question. However, according to this review, based on the available data for the elderly and by inference from the adult population, the differences are highly relevant in the elderly population. Studies of the pharmacokinetics of older PPIs demonstrated considerable variation in drug clearance that was reflected in a wide range of efficacy related to acid suppression with standard dosages. The newer PPIs offer several advantages over older agents, particularly in terms of rapid, profound and consistent acid inhibition. Consistent acid inhibition is particularly important in the elderly since clinical response is often difficult to judge in this patient group. An individual's cytochrome P450 (CYP) 2C19 genotype predicts the degree of acid suppression and consequently the clinical efficacy of the PPIs. The older PPIs are predominantly metabolised by CYP2C19, with this being of more importance for omeprazole and lansoprazole than pantoprazole. The hepatic metabolism of rabeprazole is predominantly by nonenzymatic reactions and minimally by CYP-mediated reactions, which therefore confers an advantage over older PPIs in that genetic polymorphisms for CYP2C19 do not significantly influence rabeprazole clearance, clinical efficacy or potential for drug interactions. The metabolism of esomeprazole involves CYP2C19 but to a lesser extent than its predecessor omeprazole. Furthermore, esomeprazole has a more rapid onset of action and less variation in clearance rates than omeprazole. Drug clearance decreases with age independently of CYP2C19 status, exaggerating some of the differences between the PPIs and increasing the risk of drug interactions.

(PDF same-day service: $19.90)

Accession: 035980705

Download citation: RISBibTeXText

PMID: 12495367

DOI: 10.2165/00002512-200219120-00003



Related references

Acid-related diseases: are higher doses of proton pump inhibitors more effective in the treatment of Helicobacter pylori infection?. Gastroenterologia Y Hepatologia 31(8): 546-547, 2008

Prescribing proton pump inhibitors for initial treatment of acid-related gastrointestinal diseases in a managed care population. American Journal of Managed Care 10(7 Pt 1): 433-441, 2004

Proton pump inhibitors and acid-related diseases. PharmacoTherapy 17(1): 22-37, 1997

Proton-pump inhibitors in acid-related diseases. American Journal of Health-System Pharmacy 55(21): 2289-2298, 1998

Proton pump inhibitors: update on their role in acid-related gastrointestinal diseases. International Journal of Clinical Practice 59(6): 709-715, 2005

A safety review of proton pump inhibitors to treat acid-related digestive diseases. Expert Opinion on Drug Safety: 1-10, 2018

The efficacy of proton-pump inhibitors in the treatment of acid-dependent diseases. Likars'ka Sprava: 30-35, 1997

Proton-pump inhibitors are the treatment of choice in acid-related disease. European Journal of Gastroenterology & Hepatology 8 Suppl 1: S9-13, 1996

New-generation proton pump inhibitors: progress in the treatment of peptic acid diseases?. Presse Medicale 33(11): 746-754, 2004

Acid-related diseases. What is the current rescue treatment of choice for Helicobacter pylori: quadruple therapy (proton pump inhibitor, bismuth, tetracycline and metronidazole) or triple therapy with proton pump inhibitor, amoxicillin and levofloxacin?. Gastroenterologia Y Hepatologia 31(6): 400-401, 2008

Use of acid suppressive therapy more than 10 years after the endoscopic diagnosis of reflux esophagitis with specific emphasis to trademark and generic proton pump inhibitors. Journal of Gastroenterology and Hepatology 27(2): 368-371, 2012

Recent advances in the treatment of GERD in the elderly: focus on proton pump inhibitors. International Journal of Clinical Practice 59(10): 1204-1209, 2005

Revealing the Mechanistic Pathway of Acid Activation of Proton Pump Inhibitors To Inhibit the Gastric Proton Pump: A DFT Study. Journal of Physical Chemistry. B 120(51): 13031-13038, 2016

Proton-pump inhibitors for gastric acid-related disease. Cleveland Clinic Journal of Medicine 65(1): 27-34, 1998

New proton pump inhibitors. Advances in the therapy of acid-induced diseases. Der Internist 35(9 Suppl): 1-8, 1994