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Edinoff AN, Wu NW, Parker K, Dudossat E, Linquest L, Flanagan CJ, Dharani A, Patel H, Willett O, Cornett EM, Kaye AM, Kaye AD. Proton Pump Inhibitors, Kidney Damage, and Mortality: An Updated Narrative Review. Adv Ther 2023; 40:2693-2709. [PMID: 37140707 PMCID: PMC10157135 DOI: 10.1007/s12325-023-02476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/20/2023] [Indexed: 05/05/2023]
Abstract
Since their approval by the Food and Drug Administration (FDA) in 1989, proton pump inhibitors (PPIs) have become one of the most highly utilized drugs in the United States, assuming a position as one of the top 10 most prescribed medications in the country. The purpose of PPIs is to limit the amount of gastric acid secreted by the parietal cells via irreversible inhibition of the H+/K+-ATPase pump, therefore maintaining an elevated gastric acid pH of greater than 4 for 15-21 h. Even though PPIs have many clinical uses, they are not without their adverse effects, mimicking achlorhydria. Besides electrolyte abnormalities and vitamin deficiencies, long-term use of PPIs has been linked to acute interstitial nephritis, bone fractures, poor COVID-19 infection outcomes, pneumonia, and possibly an increase in all-cause mortality. The causality between PPI use and increased mortality and disease risk can be questioned since most studies are observational. Confounding variables can greatly affect an observational study and explain the wide-ranging associations with the use of PPIs. Patients on PPIs are generally older, obese, sicker with a higher number of baseline morbidities, and on more medications than the compared PPI non-users. These findings suggest that PPI users are at a higher risk of mortality and complications based on pre-existing conditions. This narrative review aims to update readers on the concerning effects that proton pump inhibitor use can have on patients and give providers a resource to create informed decisions on appropriate PPI use.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Natalie W. Wu
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103 USA
| | - Katelyn Parker
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103 USA
| | - Edwin Dudossat
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103 USA
| | - Lauren Linquest
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103 USA
| | - Chelsi J. Flanagan
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, USA
| | - Anam Dharani
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, USA
| | - Hirni Patel
- Louisiana State University Health Sciences Center at Shreveport, LSU New Orleans, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, 71103 USA
| | - Olga Willett
- Louisiana State University Health Sciences Center at Shreveport, LSU New Orleans, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, 71103 USA
| | - Elyse M. Cornett
- Louisiana State University Health Sciences Center at Shreveport, LSU New Orleans, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, 71103 USA
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211 USA
| | - Alan D. Kaye
- Louisiana State University Health Sciences Center at Shreveport, LSU New Orleans, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, 71103 USA
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Abomasal Ulcers: Do ranitidine or omeprazole prevent phenylbutazone-induced lesions in sheep? Small Rumin Res 2022. [DOI: 10.1016/j.smallrumres.2022.106782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Raffee LA, Alawneh KZ, Ababneh MJ, Hijazi HH, Al Abdi RM, Aboozour MM, Alghzawi FA, Al-Mistarehi AH. Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective study. Int J Emerg Med 2022; 15:23. [PMID: 35619089 PMCID: PMC9137132 DOI: 10.1186/s12245-022-00422-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elevated potassium level is a common and reversible peri-arrest condition. Diagnosis and management of hyperkalemia in a short time is critical, where electrocardiogram (ECG) alterations might be helpful. We aimed to investigate the role of clinical features and ECGs in early diagnosing and treating hyperkalemia. METHODS Prospectively, adult patients who presented to the emergency department (ED) from July 2019 to March 2020 with hyperkalemia (serum potassium ≥5.5mmol/L) were included. History was obtained, and laboratory investigations and ECGs were performed at the presentation and before initiating hyperkalemia therapy. Hyperkalemia severity was divided into mild (5.5-5.9mmol/L), moderate (6.0-6.4mmol/L), and severe (≥6.5mmol/L). A cardiologist and emergency physician blinded to laboratory values, study design, and patients' diagnoses interpreted ECGs and presenting symptoms independently to predict hyperkalemia. RESULTS Sixty-seven hyperkalemic patients with a mean (±SD) serum potassium level of 6.5±0.7mmol/L were included in this study. The mean age was 63.9±15.1, and 58.2% were females. Hyperkalemia was mild in 10.4%, moderate in 40.3%, and severe in 49.3%. Almost two thirds of patients (71.6%) had hypertension, 67.2% diabetes, and 64.2% chronic kidney disease. About one-quarter of patients (22.4%) were asymptomatic, while fatigue (46.3%), dyspnea (28.4%), and nausea/vomiting (20.9%) were the most common presenting symptoms. Normal ECGs were observed in 25.4% of patients, while alterations in 74.6%. Atrial fibrillation (13.4%), peaked T wave (11.9%), widened QRS (11.9%), prolonged PR interval (10.5%), and flattening P wave (10.5%) were the most common. Peaked T wave was significantly more common in severe hyperkalemia (87.5%) than in mild and moderate hyperkalemia (12.5%, 0.0%, respectively) (p=0.041). The physicians' sensitivities for predicting hyperkalemia were 35.8% and 28.4%, improved to 51.5% and 42.4%, respectively, when limiting the analyses to severe hyperkalemia. The mean (±SD) time to initial hyperkalemia treatment was 63.8±31.5 min. Potassium levels were positively correlated with PR interval (r=0.283, p=0.038), QRS duration (r=0.361, p=0.003), peaked T wave (r=0.242, p=0.041), and serum levels of creatinine (r=0.347, p=0.004), BUN (r=0.312, p=0.008), and CK (r=0.373, p=0.039). CONCLUSIONS The physicians' abilities to predict hyperkalemia based on ECG and symptoms were poor. ECG could not be solely relied on, and serum potassium tests should be conducted for accurate diagnosis.
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Affiliation(s)
- Liqaa A Raffee
- Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 630001, Irbid, 22110, Jordan.
| | - Khaled Z Alawneh
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Muhannad J Ababneh
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Heba H Hijazi
- Chair of Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rabah M Al Abdi
- Department of Biomedical Engineering, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Mahmoud M Aboozour
- Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 630001, Irbid, 22110, Jordan
| | - Fadi A Alghzawi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 630001, Irbid, 22110, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 630001, Irbid, 22110, Jordan.
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Hussain MS, Mazumder T. Long-term use of proton pump inhibitors adversely affects minerals and vitamin metabolism, bone turnover, bone mass, and bone strength. J Basic Clin Physiol Pharmacol 2021; 33:567-579. [PMID: 34687598 DOI: 10.1515/jbcpp-2021-0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/01/2021] [Indexed: 11/15/2022]
Abstract
Notwithstanding, proton pump inhibitors (PPIs) are one of the most excellent options for different anti-secretory therapy in terms of improved symptomatic outcomes, numerous epidemiological and cohort studies provide evidence of an association between long-term proton PPIs use and increased fracture risk among users. The present attempt aimed to summarize the effect of long-term use of PPIs on musculoskeletal systems by considering the recent claims of different research groups to understand the risk of osteopenia and osteoporosis and to determine the risk factors associated with these complications. We extracted data from various systematic reviews and meta-analyses, cross-sectional studies, prospective studies, case-control studies, cohort studies, and in-vivo and in-vitro studies to observe the consequence of long-term PPIs uses over the patient's bone health. Recent findings suggested that long-term use of PPIs plays an introductory and cabalistic role in the development of osteoporosis mostly hip fractures by disturbing numerous biological pathways and thus able to set up a link between over-prescription of PPIs and bone loss. Frequent administration of PPIs is associated with a significantly worse outcome to bone mineral density (BMD) profile and produce a negative impression on bone health. Since, there are limited data to determine the association of PPIs use and change in BMD, recommending further studies to find out this dissertation.
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Affiliation(s)
- Md Saddam Hussain
- Department of Pharmacy, Faculty of Science, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Tanoy Mazumder
- Department of Pharmacy, Faculty of Science, Noakhali Science and Technology University, Noakhali, Bangladesh
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Famouri F, Derakhshani F, Madihi Y, Shahsanai A. Electrolyte disturbances in children receiving omeprazole for gastroesophageal reflux disease. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:106. [PMID: 33824671 PMCID: PMC8019125 DOI: 10.4103/jrms.jrms_637_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 08/26/2019] [Accepted: 07/13/2020] [Indexed: 01/21/2023]
Abstract
Background Gastroesophageal reflux disease (GERD) is one of the common gastrointestinal diseases with various side effects. Proton pump inhibitor (PPI) drugs are widely used for their treatment and long-term ingestion, which results in an electrolyte imbalance. This study investigates the changes in serum magnesium, calcium, sodium, and potassium after long-term use of omeprazole in children. Materials and Methods This cross-sectional study was conducted in 2016-2017 on 97 children and adolescents, aged 1-15 years, with GERD, in Isfahan, Iran. Enrolled were patients visiting a referral pediatric gastroenterology clinic (Imam Hossein and Amin Hospitals) examined by an academic pediatric gastroenterologist. Before and 4 weeks after omeprazole administration, clinical manifestations including lethargy, muscle spasm, dyspnea, nausea, vomiting, abnormal heartbeat and deep tendon reflexes, and Chvostek and Trousseau signs were recorded in a data-gathering form. In addition, fasting serum magnesium, calcium, sodium, and potassium were measured. Results The McNemar test results showed that omeprazole can reduce sodium, calcium, and magnesium levels statistically significantly (P < 0.05), but potassium levels do not have a meaningful reduction (P > 0.05). Conclusion Consumption of omeprazole might cause asymptomatic hypomagnesemia, hypocalcemia, and hypernatremia in children. Such side effects should be considered in the follow-up of children under treatment with this medication.
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Affiliation(s)
- Fatemeh Famouri
- Department of Pediatric, Isfahan University of Medical Sciences, Isfahan, Iran.,Child Growth and Development , Research Center, Research Institute for Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Pediatric, Imam Hossein Children's Hospital, Isfahan, Iran
| | - Forough Derakhshani
- Department of Pediatric, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Pediatric, Imam Hossein Children's Hospital, Isfahan, Iran
| | - Yahya Madihi
- Department of Pediatric, Isfahan University of Medical Sciences, Isfahan, Iran.,Child Growth and Development , Research Center, Research Institute for Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Pediatric, Imam Hossein Children's Hospital, Isfahan, Iran
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Desbuissons G, Deray G, Mercadal L. [Proton pump inhibitors and kidney]. Nephrol Ther 2017; 14 Suppl 1:S115-S124. [PMID: 29274872 DOI: 10.1016/j.nephro.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/25/2017] [Indexed: 01/15/2023]
Abstract
Assumed for a long time to be very well tolerated, proton pump inhibitors (PPIs) are widely prescribed for inpatients and outpatients; often beyond their validated indications. Nevertheless, many very varied side effects (pneumopathy, ischemic heart disease, dementia) have been associated with the PPIs during the last decade. Renal toxicity is mainly the occurrence of acute interstitial nephritis (AIN), related to a drug-class effect, involving cellular immunity. AINs, which occur especially in elderly patients, can be difficult to diagnose, with frequently isolated acute kidney injury, appearing with variable delay after the introduction of PPIs. Although sensitive to steroid therapy, patients frequently have an incomplete recovery of the kidney function. Very recently, the risk of chronic kidney disease (CKD) and the risk of progression of CKD among PPIs users have been well demonstrated in several large independent epidemiological studies. It is a low, but a significant side effect because of the millions of PPI prescriptions. Although further studies are needed to investigate the pathophysiological mechanisms leading the use of PPI to CKD, it is appropriate for the physicians to limit PPIs to their correct indications and to monitor renal function during these treatments.
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Affiliation(s)
- Geoffroy Desbuissons
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Gilbert Deray
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Lucile Mercadal
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Abdel-Kawy HS. Chronic pantoprazole administration and ischemia--reperfusion arrhythmias in vivo in rats--antiarrhythmic or arrhythmogenic? Cardiovasc Ther 2015; 33:27-34. [PMID: 25677801 DOI: 10.1111/1755-5922.12107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The safety of all proton pump inhibitors (PPIs) in patients with intrinsic cardiac disease has not been well studied. In the present study, the effect of PPI pantoprazole on ventricular arrhythmias induced by either ischemia or ischemia-reperfusion (I/R) was studied. METHODS The left main coronary artery (LAD) was ligated for 30 or 10 min followed by a 30-min reperfusion in anesthetized rats. Rats were pretreated with pantoprazole (1.3 mg/kg) or vehicle by gastric gavage (daily for 3 weeks) before ligation. Serum electrolytes levels were measured by the end of the third week before coronary ligation. Lactate dehydrogenase (LDH) activity and nitric oxide (NO) concentrations were measured at the end of the ischemia and IR injury. RESULTS Pantoprazole caused significant hyperkalemia by the end of third week compared with vehicle-treated rats. After LAD ligation (30 min), ventricular premature contractions (VPC), ventricular tachycardia (VT) and ventricular fibrillation (VF) were recorded in rats of the vehicle ischemia group. Pantoprazole pretreatment aggravate these arrhythmias and increased mortality. A 10-min period of ischemia followed by a 30-min reperfusion induced high incidence of VT (100%) and VF (80%) in the vehicle-treated group. The group of rats administered pantoprazole had significantly lower incidence and durations of VT and VF together with reduction of mortality rate. Pantoprazole significantly reduced serum LDH activity and NO release from myocardial tissue after both ischemia and I/R injury. CONCLUSION Pantoprazole aggravated ischemia-induced arrhythmias but had a significant antiarrhythmic effect on I/R-induced ventricular arrhythmias.
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Ahrens D, Behrens G, Himmel W, Kochen MM, Chenot JF. Appropriateness of proton pump inhibitor recommendations at hospital discharge and continuation in primary care. Int J Clin Pract 2012; 66:767-773. [PMID: 22805269 DOI: 10.1111/j.1742-1241.2012.02973.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Inappropriate prescriptions of proton pump inhibitors (PPI) in hospital and primary care have been widely reported. Recommendations from hospital have been implicated as one reason for inappropriate prescriptions of PPI in primary care. Objective: To quantify the amount of appropriate PPI recommendations in hospital discharge letters and the influence of these recommendations on general practitioners' (GPs') PPI-prescriptions. Materials and Methods: This is an observational study in 31 primary care practices. We identified patients discharged from hospital with PPI recommendation between 2006 and 2007 and assessed practice records and PPI prescription six months prior and after hospital admission. Hospital recommendation for continuous PPI-treatment and continuation by GPs was classified as appropriate, inappropriate or uncertain. Logistic regression analysis was used to calculate factors associated with indicated and non-indicated PPI continuation. Results: In 263 (58%) out of 506 patients discharged from 35 hospitals with a PPI recommendation no indication could be found. Non-indicated PPIs were continued by GPs in 58% for at least 1 month. Indicated PPIs were discontinued in 33%. Two thirds of non-indicated PPIs were initiated in hospital. The strongest factor associated with non-indicated continuation was a PPI-prescription prior to hospital admission [OR: 3.0; 95% confidence interval (CI): 1.7-5.4]. This was also the strongest factor for continuation of an indicated PPI medication (OR: 3.2; 95% CI: 1.4-7.5). Conclusions: We found a strong influence of hospital recommendations and previous prescriptions on PPI prescriptions after discharge. Hospitals should critically review their practice of recommending PPI and document indications. GPs should carefully assess hospital recommendations and their medication prior to admission to avoid over- and under-prescribing.
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Affiliation(s)
- D Ahrens
- Department of Family Practice, Göttingen University Medical Center, Göttingen, Germany Department of Family Practice, University Medicine Greifswald, Institute for Community Medicine, Greifswald, Germany
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Gau JT, Yang YX, Chen R, Kao TC. Uses of proton pump inhibitors and hypomagnesemia. Pharmacoepidemiol Drug Saf 2012; 21:553-9. [PMID: 22337212 DOI: 10.1002/pds.3224] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/02/2012] [Accepted: 01/04/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE Hypomagnesemia associated with proton pump inhibitor (PPI) therapy has been documented in case reports. We performed a cross-sectional study to examine the association between PPI use and serum magnesium (Mg) levels or hypomagnesemia. METHODS Data were extracted from hospitalized adults with basic metabolic panels and/or serum magnesium levels available during the hospital stays. The first Mg value was used for data analysis. Hypomagnesemia is defined as levels less than 1.7 mg/dL (or 0.70 mmol/L). Multiple linear and logistic regression analyses were used to assess the association between PPI use and Mg levels or hypomagnesemia, respectively. RESULTS Among study patients, PPI users (n = 207) had a mean Mg level of 1.91[SD = 0.34] mg/dL, and non-users (n = 280) 2.00 (0.30) mg/dL, p = 0.004. PPI use was associated with lower serum Mg levels (adjusted coefficient β = -0.10, 95% CI = [-0.16, -0.04]) after adjusting for confounders. PPI use was associated with risk of hypomagnesemia after adjusting for confounders (adjusted OR = 2.50, 95% CI = [1.43, 4.36]). Both standard (1) and high (2 or higher) defined daily dose units of PPI therapy were associated with hypomagnesemia. CONCLUSIONS PPI use was associated with lower serum Mg levels and hypomagnesemia in a population of hospitalized adult patients. Our study supports the general notion that long-term PPI use could be associated with sub-clinical Mg insufficiency or deficiency status.
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Affiliation(s)
- Jen-Tzer Gau
- Department of Geriatric Medicine/Gerontology, Ohio University Heritage College of Osteopathic Medicine (OU-HCOM), Athens, OH 45701, USA.
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Abstract
Proton pump inhibitors (PPIs) act only in the stomach, although the proton pump, H(+),K(+)-ATPase exists and contributes to H(+) and K(+) homeostasis in the kidney. We encountered two hypokalemic cases receiving omeprazole. These cases were women ages 69 and 80 years old. Their serum potassium levels decreased with accelerated urinary potassium excretion with the use of omeprazole, and recovered by potassium-supplement and the discontinuation of omeprazole. Because inhibitory effects of PPIs on H(+),K(+)-ATPase are exerted only in acidic condition, hypokalemia is not generally introduced by PPIs alone. However, in extreme alkalosis or impaired K(+)-recycling system, PPIs may cause hypokalemia unrelated to hypomagnesemia.
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Affiliation(s)
- Yoshitaka Maeda
- Division of Nephrology, Department of Internal Medicine, Toride Kyodo General Hospital (JA Toride Medical Center, renamed on April 1, 2011), Japan.
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Guglin M, Kristof-Kuteyeva O, Novotorova I, Pratap P. Aldosterone Antagonists in Heart Failure. J Cardiovasc Pharmacol Ther 2010; 16:150-9. [DOI: 10.1177/1074248410387606] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Aldosterone antagonists represented by nonselective spironolactone and mineralocorticoid-selective eplerenone are approved for treatment of symptomatic heart failure with reduced systolic function. Their cardioprotective, antifibrotic, and antiarrhythmic effects have been proven in animal experiments, and their effects on morbidity and mortality have been demonstrated in randomized clinical trials. Yet, they remain the most underutilized of all classes of medications for heart failure, primarily because of fear of hyperkalemia. Thorough patient screening and selection is the key for minimizing risks and optimizing benefits from these drugs. Ongoing trials will demonstrate whether the indication for aldosterone antagonists can be expanded to less severe heart failure or patients with preserved systolic function.
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Affiliation(s)
- Maya Guglin
- University of South Florida, Tampa, FL, USA,
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Gau JT, Acharya U, Khan S, Heh V, Mody L, Kao TC. Pharmacotherapy and the risk for community-acquired pneumonia. BMC Geriatr 2010; 10:45. [PMID: 20604960 PMCID: PMC2909244 DOI: 10.1186/1471-2318-10-45] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 07/06/2010] [Indexed: 12/14/2022] Open
Abstract
Background Some forms of pharmacotherapy are shown to increase the risk of community-acquired pneumonia (CAP). The purpose of this study is to investigate whether pharmacotherapy with proton pump inhibitors (PPI), inhaled corticosteroids, and atypical antipsychotics was associated with the increased risk for CAP in hospitalized older adults with the adjustment of known risk factors (such as smoking status and serum albumin levels). Methods A retrospective case-control study of adults aged 65 years or older at a rural community hospital during 2004 and 2006 was conducted. Cases (N = 194) were those with radiographic evidence of pneumonia on admission. The controls were patients without the discharge diagnosis of pneumonia or acute exacerbation of chronic obstructive pulmonary disease (COPD) (N = 952). Patients with gastric tube feeding, ventilator support, requiring hemodialysis, metastatic diseases or active lung cancers were excluded. Results Multiple logistic regression analysis revealed that the current use of inhaled corticosteroids (adjusted odds ratio [AOR] = 2.89, 95% confidence interval [CI] = 1.56-5.35) and atypical antipsychotics (AOR = 2.26, 95% CI = 1.23-4.15) was an independent risk factor for CAP after adjusting for confounders, including age, serum albumin levels, sex, smoking status, a history of congestive heart failure, coronary artery disease, and COPD, the current use of PPI, β2 agonist and anticholinergic bronchodilators, antibiotic(s), iron supplement, narcotics, and non-steroidal anti-inflammatory drugs. The crude OR and the AOR of PPI use for CAP was 1.41 [95% CI = 1.03 - 1.93] and 1.18 [95% CI = 0.80 - 1.74] after adjusting for the above confounders, respectively. Lower serum albumin levels independently increased the risk of CAP 1.89- fold by decreasing a gram per deciliter (AOR = 2.89, 95% CI = 2.01 - 4.16). Conclusion Our study reaffirmed that the use of inhaled corticosteroids and atypical antipsychotics was both associated with an increased risk for CAP in hospitalized older adults of a rural community. No association was found between current PPI use and the risk for CAP in this patient population of our study.
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Affiliation(s)
- Jen-Tzer Gau
- Department of Geriatric Medicine/Gerontology, Ohio University College of Osteopathic Medicine, Athens, OH 45701, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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