PPI Interactions Contemporary Clinicians Should Know

January 13th 2016

It is pivotal for the contemporary clinician to understand the drug–drug interactions of medications used for the most common conditions seen in primary care settings.

A thorough review of medications and medication history is essential for patients presenting to the contemporary clinic. As part of the assessment provided for each patient, medication counseling and instruction can improve patient outcomes, regardless of the chief complaint at the time of clinic visit.

Understanding the patients’ medication history will help guide the clinician in reviewing important information on adherence and potential drug—drug interactions. It is pivotal for the contemporary clinician to understand the drug–drug interactions of medications used for the most common conditions seen in primary care settings, such as gastroesophageal reflux disease (GERD).

As a starting point, GERD refers to reflux in both the stomach and esophagus. This reflux refers to the back flow of acid into the esophageal tract as a result of abnormal digestive functions.

In normal digestion, the esophageal sphincter opens for digestion of food. GERD occurs when this sphincter relaxes or weakens.1

Proton pump inhibitors (PPIs) are the most widely used medications for the treatment of GERD. They are used to treat the underlying bacterial infection that causes GERD, known asHelicobacter pylori.

Because GERD is a chronic condition, PPIs are usually prescribed long-term for patients. In light of this, it is important to be mindful of potential drug—drug interactions with PPIs, which many patients with GERD are unaware of when they present to the contemporary clinic.

This patient education is especially important because PPIs can elevate intragastric pH, which reduces drug solubility and decreases the bioavailability of many different medications. In fact, PPIs are associated with a 50% reduction in systemic clearance of drugs like diazepam and phenytoin.1

Being aware of this reduced clearance is important when recommending PPI treatment to a GERD patient. Addressing this potential interaction at the time of the clinic visit will help inform the patient to work with his or her clinician to monitor drug levels as appropriate.

The potential interaction between PPIs and blood thinners such as aspirin and clopidogrel is also vital to address when managing patients with concurrent GERD and cardiovascular disease. This is especially significant in older adults, as adverse drug effects occur more prominently in the elderly population.2

In addition, PPIs are known to interact with antiretroviral therapy. In fact, chronic PPI use in HIV-infected patients on antiretroviral therapy can result in inadequate drug exposure,3which is important to consider when managing GERD in HIV-infected patients.

Being aware of the patients’ medication history is essential to address concerns about potential drug—drug interactions. In the convenient care setting, the clinician is perfectly situated to determine and address potential risks during an episodic visit. By reviewing medication history with each and every patient, the convenient care clinician provides a safety net for both the patient and his or her primary care provider, ensuring that the patient’s medication and health promotion needs are addressed in an efficient and timely fashion.

Kristene Diggins, FAANP, CNE, NEA-BC, DNP, DCC, MBA, is the manager of professional practice at MinuteClinic and faculty attheUniversity of Phoenix.She has worked as a provider in convenient care for 8 years and she enjoys international medical opportunities, as her career goal is to enhance health care access, globally.

References

1. Ogawa R, Echizen H. Drug-drug interaction profiles of proton pump inhibitors.Clin Pharmacokinet. 2010 Aug;49(8):509-33. doi: 10.2165/11531320-000000000-00000.

2. Marengoni A, Pasina L, Concoreggi C, et al. Understanding adverse reactions in older adults through drug to drug interactions.Eur J Intern Med. 2014 Nov;25(9):843-6. doi: 10.1016/j.ejim.2014.10.001. Epub 2014 Oct 11.

3. McCabe S, Smith P, Ma Q, Morse GD. Drug interactions between proton pump inhibitors and antiretroviral drugs.Expert Opin Drug Metab Toxicol. 2007 Apr;3(2):197-207.

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