Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new prilosec research articles will be listed here shortly after becoming available to us.
Medical research on prilosec
Drug Metab Dispos. 2010 Mar 11;
Kearns GL, Leeder JS, Gaedigk A
The impact of the CYP2C19*17 allele on the pharmacokinetics of pantoprazole and omeprazole in previously studied children (n=40) was explored. When pantoprazole AUC was examined as a function of CYP2C19 genotype, a significantly lower AUC was observed for subjects identified as CYP2C19*1/*1 and *1/*17. For pantoprazole, a statistically significant relationship was observed between CYP2C19 genotype and both dose-corrected AUC (p
[Effect of yiqi huoxue formula on healing quality and recurrence rate of peptic ulcer]
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2009 Dec; 29(12): 1081-4
Zhang WP, Ge HN, Guo JW
OBJECTIVE: To study the effect of yiqi huoxue formula (YHF) on healing and recurrence of peptic ulcer. METHODS: Adopting randomized and controlled principle, the 46 patients with active peptic ulcer were randomly allocated into the treated group and the control group, they received respectively the treatment of YHF + Omeprazole and Omeprazole alone for 5 weeks. If exhibiting positive Hp, the Trigeminy one-week eradicating treatment, using Omeprazole, Clarithromycin and Amoxicillin, was applied firstly, after then, followed with the prescriptive treatment. Gastroscopy was performed before and after treatment to assess the status of Hp eradicating and the endoscopic and histological maturity of regenerated mucosa. Meanwhile, the changes of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) levels were detected with ELISA. Patients with ulcer healed were followed up for 6 months to observe the condition of recurrence. RESULTS: The percentage of Sc phase maturity and excellent histological maturity of regenerated mucosa obtained in the treated group were more than those in the control group respectively (P < 0.05), and levels of VEGF and bFGF increased significantly in the treated group after treatment (P < 0.05). But the difference of ulcer recurrence rate between the two groups in the 6-month follow-up study showed no statistically significance. However, the recurrence rate in patients with excellent histological maturity of regenerated mucosa was lower than that with good histological maturity (P < 0.05); and it was decreasing along with the progressing of regenerated mucosa endoscopic maturity, i.e., Sc < Sb < Sa (P < 0.01). CONCLUSION: YHF can improve the quality of ulcer healing, and its mechanism is possibly related to the increase of VEGF and bFGF expressions. The higher the quality of ulcer healing, the lower the recurrence rate.
Omeprazole induces gastric transmucosal permeability to the peptide bradykinin.
World J Gastroenterol. 2010 Mar 7; 16(9): 1097-103
Gabello M, Valenzano MC, Zurbach EP, Mullin JM
AIM: To investigate omeprazole-induced transepithelial gastric leak and its effects on the permeability of the peptides bradykinin and oxytocin. METHODS: Rat gastric corpus tissue was isolated and mounted in an Ussing chamber apparatus to evaluate the permeability of (3)H-bradykinin, (3)H-oxytocin, and (14)C-EDTA in the presence or absence of omeprazole. Thin-layer chromatography was performed to identify any metabolic breakdown products of the peptides resulting from permeation through the gastric tissue, and thereby calculate the true flux of the peptide. RESULTS: The flux rate of intact (3)H-bradykinin increased substantially after omeprazole addition (109.5%) compared to the DMSO vehicle control (14%). No corresponding change in flux of intact (3)H-oxytocin was observed under the same conditions (11.9% and 6.4% in the DMSO- and omeprazole-treated conditions, respectively). After exposure to omeprazole, the flux rate of (14)C-EDTA also increased dramatically (122.3%) compared to the DMSO condition (36.3%). CONCLUSION: The omeprazole-induced gastric leak allows for transmucosal permeability to charged molecules as well as non-electrolytes. This induced leak will allow certain peptides to permeate.
Drug utilisation among older inpatients in a teaching hospital in Western Nepal.
Singapore Med J. 2010 Jan; 51(1): 28-34
Shankar PR, Upadhyay DK, Subish P, Bhandari RB, Das B
INTRODUCTION: The proportion of the elderly population in Nepal, though low, is steadily increasing. Studies on drug utilisation among geriatric patients in Western Nepal, a region with the highest proportion of the elderly in all of Nepal, are lacking. The present study was carried out at the Manipal Teaching Hospital, a 700-bed teaching hospital in Pokhara, Western Nepal. METHODS: The study was carried out from June 1, 2005 to May 31, 2006 using case records of discharged patients aged 60 years and older. This was an observational study that utilised a retrospective case notes review methodology. The microorganisms isolated on culture and their antibiotic sensitivity patterns were studied. Drug consumption was measured by the defined daily dose (DDD) per 100 bed-days. The mean cost of the drugs was calculated. The percentage of drugs prescribed by generic name and the percentages of fixed-dose combinations used were noted. The basic demographic information of older inpatients, drug utilisation patterns, drug consumption using DDD, organisms isolated and their antibiotic sensitivity patterns, and the mean cost of the drugs were studied. RESULTS: A total of 548 patients were admitted. Hypertension, acute exacerbation of chronic obstructive pulmonary disease and cancer were the most common illnesses among the patients. The mean number of drugs consumed by each patient was 7.73. Escherichia coli and Pseudomonas aeruginosa were the most common microorganisms isolated. Ranitidine, multivitamins, amlodipine, ipratropium and dextrose normal saline were most commonly prescribed. The DDD per 100 bed-days of ranitidine and omeprazole (highest values) was 33.48 and 3.51, respectively. The mean cost of drugs was USD26.6, and antibiotics accounted for around 40 percent of the cost. CONCLUSION: The use of a high number of drugs, and of parenteral drugs and intravenous fluids, is a common problem. The prescription of generic drugs is low. Guidelines for the use of drugs in the elderly are required and further studies are needed on this issue.
Evaluation of Myrtus communis Linn.berries (common myrtle) in experimental ulcer models in rats.
Hum Exp Toxicol. 2010 Mar 2;
Sumbul S, Ahmad MA, Asif M, Saud I, Akhtar M
The present study was conducted to investigate the protective effect of the dried berries of Myrtus communis L. in gastric ulcer against ethanol, indomethacin and pyloric ligation induced models in Wistar rats. Two doses of aqueous extracts of M. communis (AE1 and AE2) at the dose 105 and 175 mg/kg, respectively, and methanolic extracts (ME1 and ME2) at the dose of 93 and 154 mg/kg, respectively, were administered orally to animals prior to the exposure of ulcerogens. The parameters taken to assess anti-ulcer activity were ulcer index, gastric juice volume, gastric pH, total acidity, gastric wall mucus and histopathological studies. Oral administration of AE1 and AE2 significantly reduced the ulcer index in all models of ulcers. Low dose of aqueous extract and high dose of methanolic extract of M. communis exhibited more significant effect in comparison to omeprazole (standard drug) in ethanol-induced ulcer model. Both the doses of aqueous and methanolic extracts also reduced the gastric juice volume, total acidity and increased the gastric pH and gastric wall mucus content in all the models of ulcers used in the present study. Histopathological examinations of gastric tissues of rats treated with the aqueous and methanolic extracts in indomethacin-induced ulcer exhibited significant ulcer-protective effect at both the dose levels.
A Case Series of Proton Pump Inhibitor-Induced Hypomagnesemia.
Am J Kidney Dis. 2010 Feb 25;
Hoorn EJ, van der Hoek J, de Man RA, Kuipers EJ, Bolwerk C, Zietse R
Proton pump inhibitor (PPI)-induced hypomagnesemia has been recognized since 2006. Our aim was to further characterize the clinical consequences and possible mechanisms of this electrolyte disorder using 4 cases. Two men (aged 63 and 81 years) and 2 women (aged 73 and 62 years) had been using a PPI (esomeprazole, pantoprazole, omeprazole, and rabeprazole, 20-40 mg) for 1-13 years. They developed severe hypomagnesemia (magnesium, 0.30 +/- 0.28 mEq/L; reference, 1.40-2.10 mEq/L) with hypocalcemia (calcium, 6.4 +/- 1.8 mg/dL), relative hypoparathyroidism (parathyroid hormone, 43 +/- 6 pg/mL), and extremely low urinary calcium and magnesium excretion. One patient was admitted with postanoxic encephalopathy after a collapse likely caused by arrhythmia. The others had electrocardiogram abnormalities (prolonged QT interval, ST depression, and U waves). Concomitant hypokalemia (potassium, 2.8 +/- 0.1 mEq/L) was considered the trigger for these arrhythmias. Hypomagnesemia-induced kaliuresis (potassium excretion, 65 +/- 24 mEq/L) was identified as the cause of hypokalemia. This series of PPI-induced hypomagnesemia shows that this is a generic effect. It also indicates that hypomagnesemia may occur within 1 year of PPI therapy initiation and can have serious clinical consequences, likely triggered by the associated hypokalemia. A high index of suspicion is required in PPI users for unexplained hypomagnesemia, hypocalcemia, hypokalemia, or associated symptoms.
[Prevalence of rebleeding from peptic ulcer in patients treated with proton pump inhibitors.]
Med Clin (Barc). 2010 Feb 25;
Garrido A, Isabel Iborra M, Saperas E, de Sousa M,
BACKGROUND AND OBJECTIVE: The aim of this study is to assess the prevalence of peptic ulcer rebleeding by comparing patients who received omeprazole versus pantoprazole i.v. as well as to study the costs of each treatment. PATIENTS AND METHODS: Retrospective and observational study. Information was gathered on sex and age of the patients, the diagnosis of upper gastrointestinal bleeding (UGB) according to the classification of Forrest, the type of proton pump inhibitor (PPI) i.v. used and the treatment regimen, presence or absence of rebleeding, mortality and data on health costs through a pharmacoeconomic cost-effectiveness analysis. RESULTS: We included 807 patients, 490 of whom (60.7%) received pantoprazole and 317 (39.3%) omeprazole. There was no difference between the average age of both groups, 61.2 years vs 62.3, p=0.544; sex, 71% men vs 68.6%, P=.78; the percentage of patients within Forrest I was 35.1% vs 42%, P=.05, in grade II was 50.2% vs 40.4%, P=.006 and in grade III was 14.7% vs 17.7%, P=.259. The number of vials per day of treatment was significantly lower in the pantoprazole group from the third to fifth day, with no differences in the first two days and the sixth. There was rebleeding in 8.2% of patients treated with pantoprazole and 11.7% with omeprazole, P=.098. 2.2% of patients treated with pantoprazole died vs 2.6% treated with omeprazole, P=.086. The expected cost of a patient treated with pantoprazole was 2188.25euro vs 3279.02euro with omeprazole, P
Aliment Pharmacol Ther. 2010 Feb 20;
Molina-Infante J, Perez-Gallardo B, Fernandez-Bermejo M, Hernandez-Alonso M, Vinagre G, Dueñas C, Mateos-Rodriguez JM, Gonzalez-Garcia G, Abadia EG, Gisbert JP
ABSTRACT BACKGROUND: Helicobacter pylori eradication rates with standard triple therapy have declined to unacceptable levels. AIM: To compare clarithromycin and levofloxacin in triple and sequential first-line regimens. METHODS: 460 patients were randomized into four 10-day therapeutic schemes (115 patients per group): (1) standard OCA, omeprazole, clarithromycin and amoxicillin; (2) triple OLA, omeprazole, levofloxacin and amoxicillin; (3) sequential OACM, omeprazole plus amoxicillin for 5 days, followed by omeprazole plus clarithromycin plus metronidazole for 5 days, and (4) modified sequential OALM, using levofloxacin instead of clarithromycin. Eradication was confirmed by 13C-urea breath test. Adverse effects and compliance were assessed by a questionnaire. RESULTS: Per protocol cure rates were: OCA (66%; 95%CI: 57-74%), OLA (82.6%; 75-89%), OACM (80.8%; 73-88%), and OALM (85.2%; 78-91%). Intention to treat cure rates were: OCA (64%; 55-73%), OLA (80.8%; 73-88%), OACM (76.5%; 69-85%), and OALM (82.5%; 75-89%). Eradication rates were lower with OCA than with all the other regimens (p
Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients.
World J Gastroenterol. 2010 Feb 28; 16(8): 982-6
Nasser SC, Nassif JG, Dimassi HI
AIM: To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS: Data collection was performed prospectively during a 6-mo period on 340 patients who received omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS: Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which, only 17% met the guideline criteria for SUP indication, 14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis, while the remaining 69% were identified as having an unjustified indication for PPI use. The initiation of IV PPIs was appropriate in 55% of patients. Half of these patients were candidates for switching to the oral dosage form during their hospitalization, while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%, P = 0.003). The cost analysis associated with the appropriateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17,732.5 and $14,571, respectively. CONCLUSION: This study highlights the over-utilization of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.
J Manag Care Pharm. 2010 Mar; 16(2): 114-21
Khalili H, Dashti-Khavidaki S, Hossein Talasaz AH, Tabeefar H, Hendoiee N
BACKGROUND: Stress ulcers are acute superficial inflammatory lesions of the gastric mucosa induced when an individual is subjected to unusually high physiologic demands. In recent years, use of acid suppression therapy (AST) for stress ulcer prophylaxis (SUP) in inpatient settings other than intensive care has become increasingly common, leading to increased drug cost and an avoidable increased risk of adverse events such as hospitalacquired pneumonia. OBJECTIVE: To assess the effects of a clinical pharmacist intervention including AST prescribing and adherence to a SUP guideline that was developed by clinical pharmacists for use in the infectious disease ward of a teaching hospital based on the 1999 American Society of Health-System Pharmacists (ASHP) guidelines for use of SUP. METHODS: This was an exploratory, prospective pre- and post-intervention study of all patients admitted to the infectious disease ward of Imam Khomeini Hospital, the major referral hospital for infectious disease patients in Iran, which is affiliated with Tehran University of Medical Sciences. The study intervention consisted of the use of an internal guideline for SUP that was prepared by clinical pharmacists in accordance with ASHP guidelines, followed by education provided to the physicians who monitored and visited the hospitalized patients in the infectious disease ward. For the 4-month pre-intervention (August 1, 2008, to December 1, 2008) and post-intervention (February 1, 2009, to June 1, 2009) periods, the following data were collected: admitting diagnoses, number and type of SUP risk factors for AST, and type of AST medication used (omeprazole or ranitidine). Exclusions included (a) patients using AST for appropriate gastrointestinal diagnoses at admission (n = 4 in each period), and (b) patients who died during the hospital stay because of a cause other than a gastrointestinal disorder (n = 3 pre-intervention and n = 1 post-intervention). Rates of AST use were measured for the sample overall, and for patients with and without an indication for SUP. Appropriate use was defined as 1 primary (absolute) risk factor (i.e., coagulopathy, mechanical ventilation, or history of gastrointestinal bleed in the last 12 months) or 2 or more secondary (relative) risk factors (e.g., use of heparin). Pre- and post-intervention results were compared using the Pearson chi-square test. RESULTS: AST use declined from 80.9% (212 of 262) infectious disease ward patients in the pre-intervention period to 47.1% (113 of 240) patients in the post-intervention period (P < 0.001). Of 23 patients in the preintervention period with an indication for SUP according to our ASHP-based guideline, 78.3% (n = 18) received AST versus 85.7% (n = 12 of 14) in the post-intervention period (P = 0.575). Of the patients without an indication for SUP, 194 of 239 (81.2%) received AST in the pre-intervention period versus 101 of 226 (44.7%) in the post-intervention period (P < 0.001). Of the patients who received AST, 194 of 212 (91.5%) did not have an indication for SUP in the pre-intervention period versus 101 of 113 (89.4%) in the post-intervention period (P = 0.528). CONCLUSION: In this pre- and post-intervention study without a comparison group, the introduction by pharmacists of a treatment guideline for SUP in the infectious disease ward of Imam Khomeini Hospital was associated with reduction in use of AST overall and in patients without an absolute indication for SUP. However, there was no significant change in either the proportion of patients with an indication for SUP who received AST or in the proportion who received AST without an indication for SUP.