Drug reference

Pariet

Proton Pump Inhibitor · Antiulcer Agent

Proton Pump InhibitorAntiulcer Agent

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

4 major

incl. contraindicated

PREGNANCY

Manufacturer advises caution—no

FDA category + note

Top interactionssee all 12 →

AtazanavirContraindicatedTextbookG&G 14e · p1245-1266
LedipasvirSevereTextbookG&G 14e · p1238, p1242
RilpivirineSevereTextbookG&G 14e · p1245-1266
VelpatasvirSevereTextbookG&G 14e · p1239, p1242

Mechanism

Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system (the ‘proton pump’) of the gastric parietal cell.

Indications

Gastric and duodenal ulcersEradication of Helicobacter pylori (in combination with antibacterials)Reduction of rebleeding risk and need for surgery following endoscopic treatment of severe peptic ulcer bleeding (intravenous, high-dose)DyspepsiaGastro-oesophageal reflux diseasePrevention and treatment of NSAID-associated ulcersReduction of degradation of pancreatic enzyme supplements in patients with cystic fibrosisControl of excessive secretion of gastric acid in Zollinger–Ellison syndrome

Dosing

Adult: syndrome; high doses are often required. BNF 80 Proton pump inhibitors f Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system (the ‘proton pump’) of the gastric parietal cell.…

Side effects

Serious

Subacute cutaneous lupus erythematosus (SCLE)
Increased risk of fractures (particularly with high doses for over a year in the elderly)
Increased risk of gastro-intestinal infections (including Clostridioides difficile infection)
May mask the symptoms of gastric cancer (in adults)

Pregnancy & lactation

Pregnancy

Manufacturer advises caution—no

Drug interactions

Atazanavir

Contraindicated

Textbook

Substantially reduced atazanavir concentrations, leading to loss of antiviral effectiveness.

Proton pump inhibitors should be avoided in patients receiving atazanavir without ritonavir.

Source: G&G 14e · p1245-1266

Ledipasvir

Severe

Textbook

Reduced ledipasvir concentrations, potentially leading to treatment failure/relapse.

If PPIs must be used, their doses should not exceed the equivalent of 20 mg omeprazole once daily. Omeprazole must be administered simultaneously with LDV/SOF in the fasted state.

Source: G&G 14e · p1238, p1242

Rilpivirine

Severe

Textbook

Reduced absorption and plasma concentrations of rilpivirine, potentially leading to loss of efficacy.

Should not be given with proton pump inhibitors.

Source: G&G 14e · p1245-1266

Velpatasvir

Severe

Textbook

Reduced velpatasvir concentrations, potentially leading to treatment failure.

PPI doses should not exceed the equivalent of 20 mg omeprazole daily. SOF/VEL should be taken with food 4 hours prior to a PPI dose. Velpatasvir requires acidic gastric pH.

Source: G&G 14e · p1239, p1242

Aceclofenac + Paracetamol

Moderate

Textbook

Increased risk of small intestine damage, despite reducing duodenal and gastric ulceration.

Consider the overall GI risk, including small intestine, when coadministering.

Source: G&G 14e · p834

Aceclofenac

Moderate

Textbook

Increased risk of small intestine damage, despite reducing duodenal and gastric ulceration.

Consider the overall GI risk, including small intestine, when coadministering.