Practical Guide to Safety of PPIs What to Tell Your Patient. Proton Pump Inhibitors
|
|
- Ronald Higgins
- 5 years ago
- Views:
Transcription
1 Practical Guide to Safety of PPIs What to Tell Your Patient Joel E Richter, MD, FACP, MACG Professor and Director Division of Digestive Diseases and Nutrition Joy Culverhouse Center for Esophageal Diseases University of South Florida Tampa, Florida Proton Pump Inhibitors Over 20 years of extensive use throughout the world 2 nd most used class of drugs behind statins Sales of PPIs > $20 billion per year world wide Over 720 million prescription risks Diarrhea and headache are well known side effects, but the class is very well tolerated However, even rare PPI complications could affect many patients with their very common use 1
2 Mechanisms of PPI Side Effects Inhibition of acid secretion and resulting hypergastrinemia Immunosuppression Idiosyncratic reactions Metabolic interactions with hepatic cytochrome P450 Potential Side Effects of PPIs Cancer risk gastric carcinoids/polyps and colon cancer Infections pneumonia and enteric infections Small bowel bacterial overgrowth Vitamins and minerals calcium and osteoporosis vitamin B12 iron magnesium Acute interstitial nephritis Interaction with PPIs and clopidogrel 2
3 Increase in PPI Safety Articles Published Yang YX and Metz DC Gastroenterology 2010 Stay Calm and Stay the Course Most of the following reports are retrospective case control studies with the inherent limitations due to bias and/or confounding factors This data only demonstrates very modest association not causality No large prospective randomized trials to substantiate these claims BUT these have caused some patient concerns, confused the cardiologists and the FDA is quite reactionary to this data (black box warning) 3
4 Fundic Gland Polyps and Long-term PPIs 599 patients, 322 on PPIs No PPI use: 277 (32%-fundic polyps) PPIs< 1 yr: 162 (18%) PPIs> 1 yr: 160 (57%) Risk increases over time: < 1 yr: OR % CI: yr: OR % CI: > 5 yr: OR % CI: Low grade dysplasia found in 1 fundic gland polyp Jalving M et al. Aliment Pharmacol Ther 2006 Pneumonia PPIs diminish defense mechanisms allowing gastric colonization of oral flora 2 Dutch case controlled studies reported 50-80% increase in community acquired pneumonias with current PPI use (1,2) but inverse relationship with duration of use UK General Practice Database found no overall risk and highest association with PPI use in past 48 hours (3) Possible protopathic bias drugs given for early sxs may be associated with subsequent illness 1. Labej et al JAMA Gulmez et al Arch Intern Med Sakar et al Ann IM
5 Association between Duration 0f Acid Suppression and Risk of Pneumonia Eom CS et al. CMAJ 2011 RCTs with PPIs and Pneumonia Sultan N et al Can Journal Gastroenterol published trials with 2586 pts followed 1-6months --no significant difference Estborn l and Joelson S Drug Safety trials with 28,627 pts followed 1-6 months --no significant ifi differences between PPIs and placebo for respiratory tract infections or pneumonia --BUT study done by Astra-Zeneca using their safety database from II-IV randomized controlled studies 5
6 Infections Community-acquired pneumonia PPIs: RR % CI: H2RAs: RR % CI: Enteric infections C. difficile: OR: % CI: Salmonella, Campylobacter and others: OR: % CI: Spontaneous bacterial peritonitis: OR: % CI: Laheij RJF et al JAMA 2004 Leonard J Am J Gastroenterol 2007 Bajaj J et al. Am J Gastroenterol 2009 Clostridium difficile Rates in the UK Practice Research Database 1672 patients identified over 10 years Dial S, et al. JAMA
7 Increased Incidence of Small Bowel Bacterial Overgrowth with PPI Therapy Lombardo et al. Clinical Gastroenterology and Hepatology 2010 Severity of Small Bowel Overgrowth Symptoms Increase with PPI Duration Lombardo et al. Clinical Gastroenterology and Hepatology
8 Potential Pathways for PPI Therapy to Decrease Bone Strength Low Power Yang and Metz, Gastroenterology 2010 Hip Fracture Risk Linked to Duration of PPI Therapy Adjusted odds ratios based on an analysis of 13,566 cases matched to 135,386 outpatient controls in the United Kingdom General Practice Research Database Yang YX, et al. JAMA
9 Risk of Spine Fracture with PPI or H 2 RA Use Kwok CS, et al. J Bone 2010 Risk of Hip Fracture with PPI or H 2 RA Use Kwok CS et al J Bone
10 Risk of Any Fracture with PPI or H 2 RA Use Kwok CS, et al. J Bone 2010 Risk of Any Fracture Comparing Longer and Shorter Duration of PPI Exposure Kwok CS, et al. J Bone
11 Other Vitamins and Minerals Vitamin B 12: Acid important for B 12 absorption --releases bound dietary B12 to bind with intrinic factor --prevents small bowel overgrowth Studies of long-term PPI users are conflicting May be useful to check B12 level in elderly PPI user Iron: Acid is most important luminal factor for reducing ferric iron (food form) absorption in duodenum Little human data ZES pts on PPIs for 6 yrs had no iron deficiency Dharmarajan et al Nature GI 2008 Stewart et all APT 1998 Magnesium the Newest Threat At least 23 cases of severe magnesium deficiency with life threatening tetany, seizures, and arrhythmias No evidence of GI malabsorption or renal wasting Some recalcitrant to high dose IV Mg replacement Resolved after stopping PPIs for 1 wk or switch to H2RAs Several cases recurred with rechallenge Mechanism is unknown FDA Black Box warning in March 2011 for all PPIs in pts taking PPIs for over year Broeren et al Ann Int Med
12 Acute Interstitial Nephritis Humoral and cell mediated hypersensitivity reaction resulting in renal inflammation First report with omeprazole in 1992 over 100 cases reported to date Not dose-dependent and usually recurs with rechallenge New Zealand PPIs most common cause of acute interstitial nephritis Stop PPIs in unexplained acute renal deterioration Clopidogrel and PPIs Biotransformation of clopidogrel to active metabolite requires cytochrome P450 isoform CYP2C19 Meta-analysis: analysis: 23 studies with 93,278 patients --propensity matched or randomized trials showed NO associated cardiovascular risks with PPIs --other observational studies generally showed a significant association --No studies showed significant association between PPIs and increased mortality (RR 1.09, 95% CI: ) Nov 2009 FDA warning on potential for reduced effectives of clopidogrel taken with omeprazole/esomeprazole Kwok CS, et al. Aliment Pharmacol Ther
13 Patients on PPIs Have More Concurrent Medical Problems Ho PM et al. JAMA 2009 Clopidogrel / ASA and Omeprazole in CAD Primary GI Events Omp-1.1% Plac-2.9% HR: 0.34 CI: Bhatt DL, et al. NEJM
14 Clopidogrel / ASA and Omeprazole in CAD Primary Cardiovascular Events Omp-4.9% Plac-5.7% HR, 0.99 CI: Bhatt DL, et al. NEJM 2010 Influence of Esomeprazole on Platelet Aggregation Clopidogrel/esomeprazole 20mg vs. clopidogrel 253 patients with history of peptic ulcer disease Ulcer recurrence at 6 mo Clopidogrel 11% Clopid/Eso---1.2% p=.009 Hsu P, et al. Gastroenterology
15 ACG and American Heart Association Consensus on Concomitant Use of PPIs and Thienopyridines Routine use of PPIs/H2RAs not recommended with clopidogrel for patients with low risk of GI bleeding Clinical decisions to use PPIs/clopidogrel together must balance overall GI/cardiovascular risks and benefits Pharmacokinetic studies suggest that concomitant use of a PPI and clopidogrel reduces its antiplatelet effects --the strongest evidence for this interaction is with omeprazole/esomeprazole Because of short plasma half-lives (<2 hrs) of both drugs, interaction between PPIs and thienopyridines might be minimized by separating the timing of drug administration Abraham NS, et al. Am J Gastroenterology 2010 Appropriate Use of PPIs Keep Calm and Carry On Prescribe PPIs only when there is an appropriate clinical indication Lowest effective dose and avoid BID dosing unless confirmed indication: persistent esophagitis abnormal ph test on PPI On-demand PPIs or drug holidays Appropriate maintenance dose when needed 15
Perplexed by PPI s Should I be Worried? James R Gray Gastroenterology Vancouver
Perplexed by PPI s Should I be Worried? James R Gray Gastroenterology Vancouver Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationSafety Of. long-term PPI. Layli Eslami, MD Tehran, 1393
Safety Of long-term PPI Layli Eslami, MD Tehran, 1393 n The introduction of PPIs in the late 1980s optimized the medical treatment of acidrelated disorders n In some cases such as GERD patients given the
More informationCYP2C19-Proton Pump Inhibitors
CYP2C19-Proton Pump Inhibitors Cameron Thomas, Pharm.D. PGY2 Clinical Pharmacogenetics Resident St. Jude Children s Research Hospital February 1, 2018 Objectives: CYP2C19-PPI Implementation Review the
More informationAppropriate Use of Proton Pump Inhibitors (PPIs) Anderson Mabour, Pharm.D., BCPS Clinical Pharmacy Specialist
Appropriate Use of Proton Pump Inhibitors (PPIs) Anderson Mabour, Pharm.D., BCPS Clinical Pharmacy Specialist Disclosures I have no actual or potential conflicts of interest to report in relation to this
More informationMY PATIENT HAS READ THAT HIS PPI S MAY BE TROUBLE. NOW WHAT?
MY PATIENT HAS READ THAT HIS PPI S MAY BE TROUBLE. NOW WHAT? Clarence Wong MD FRCPC Associate Professor FACULTY/PRESENTER DISCLOSURE Faculty: Clarence Wong Relationships with commercial interests: Grants/Research
More informationLONG -TERM USE OF PPIS: INDICATIONS, BENEFITS AND HARMS. Jihane Naous, M.D.
LONG -TERM USE OF PPIS: INDICATIONS, BENEFITS AND HARMS Jihane Naous, M.D. Objectives Identify the conditions supported by AGA/ACG guidelines necessitating long-term use of daily PPIs, Recognize which
More information11/19/2012. Comparison between PPIs G CELL. Risk ratio (95% CI) Patient subgroup. gastrin. S-form of omeprazole. Acid sensitive. coated.
REGULATION OF GASTRIC ACID SECRETION Comparison between PPIs Omeprazole Lansoprazole Rabeprazole Pantoprazole Esomeprazole gastrin G CELL + Acid sensitive Yes T1/2 30-60 minutes Main elimination Enteric
More informationRefractory GERD. Kenneth R. DeVault, MD, FACG President American College of Gastroenterology Chair Department of Medicine Mayo Clinic Florida
Refractory GERD Kenneth R. DeVault, MD, FACG President American College of Gastroenterology Chair Department of Medicine Mayo Clinic Florida Objectives Define the terminology associated with refractory
More informationPPIs: Good or Bad? 1. Basics of PPIs. Gastric Acid Basics. Outline. Gastric Acid Basics. Proton Pump Inhibitors (PPI)
Outline Quick basics on Proton Pump Inhibitors (PPIs) PPIs: Good or Bad? What are potential risks of PPI therapy? How to approach your patients American Gastroenterology Association (AGA) recommendations
More informationA C A D E M I C D E TA I L I N G C H O O S I N G W I S E LY C O N F E R E N C E O C T 2 1, PA M M C L E A N - V E Y S E Y B S C P H A R M D R
PPI DEPRESCRIBING Canadian Deprescribing Network (CaDeN) goals are to: Reduce harm by raising awareness and cutting risky prescriptions for seniors by 50% by 2020. Promote health by ensuring access to
More informationRisk of GI Bleeding and Use of PPIs
Risk of GI Bleeding and Use of PPIs ESC 211 August 28, 211 Marc S. Sabatine, MD, MPH Chairman, TIMI Study Group Associate Physician, Cardiovascular Division, BWH Associate Professor of Medicine, Harvard
More informationComplications of Proton Pump Inhibitor Therapy. Gastroenterology 2017; 153:35-48 발표자 ; F1 김선화
Complications of Proton Pump Inhibitor Therapy Gastroenterology 2017; 153:35-48 발표자 ; F1 김선화 Background Proton pump inhibitors (PPIs) are among the most commonly prescribed medicines for gastroesophageal
More informationTHE EFFECTS OF LONG- TERM PROTON PUMP INHIBITORS USE AND MISUSE
THE EFFECTS OF LONG- TERM PROTON PUMP INHIBITORS USE AND MISUSE CONTENTS Overview Indications Over-prescribed in inappropriate conditions Side effects of long-term PPI use Conclusion OVERVIEW INDICATIONS
More informationAcid Control and Healing of EE are Related. Disclosures. Perspectives on the Risk-Benefit Ratio of PPI Therapy. Risk-Benefit Ratio of PPIs
Perspectives on the Risk-Benefit Ratio of PPI Therapy David C. Metz. MD Professor of Medicine Division of Gastroenterology University of Pennsylvania School of Medicine Disclosures Grant/Research Support
More informationProton Pump Inhibitors:
Proton Pump Inhibitors: How bad could they be? Andrea Flanagan, Pharm.D. Iowa City VA Medical Center PGY-1 Pharmacy Resident Objectives for Pharmacists At the end of this presentation PHARMACISTS should
More informationProton Pump Inhibitors- Questions & Controversies. Farah Kablaoui, PharmD, BCPS, BCCCP
Proton Pump Inhibitors- Questions & Controversies Farah Kablaoui, PharmD, BCPS, BCCCP Disclosure Information Proton Pump Inhibitors: Questions & Controversies Farah Kablaoui I have no financial relationship
More informationStressed Out: Evaluating the Need for Stress Ulcer Prophylaxis in the ICU
Stressed Out: Evaluating the Need for Stress Ulcer Prophylaxis in the ICU Josh Arnold, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds November 8, 2016 2016 MFMER slide-1 Objectives Identify the significance
More informationProton Pump Inhibitors. Description. Section: Prescription Drugs Effective Date: July 1, 2014
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.09.01 Subject: Proton Pump Inhibitors Page: 1 of 7 Last Review Date: June 12, 2014 Proton Pump Inhibitors
More informationProton Pump Inhibitors. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.50.01 Subject: Proton Pump Inhibitors Page: 1 of 6 Last Review Date: June 24, 2015 Proton Pump Inhibitors
More informationProton Pump Inhibitors increase Cardiovascular risk in patient taking Clopidogrel
Proton Pump Inhibitors increase Cardiovascular risk in patient taking Clopidogrel Dr.A.K.M. Aminul Hoque Assoc. Prof. of Medicine. Dhaka Medical College. Clopidogrel Metabolism Clopidogrel is an inactive
More informationAm J Gastroenterol 2010;105:
ACCF/ACG/AHA 2010 Expert Consensus Document Expert Consensus Document on the Concomitant Use of Proton Pump Inhibitors and Thienopyridines: A Focused Update of the ACCF/ACG/AHA 2008 Expert Consensus Document
More informationCytochrome P450 interactions
Cytochrome P450 interactions Learning objectives After completing this activity, pharmacists should be able to: Explain the mechanism of action of clopidogrel-ppi interaction Assess the risks and benefits
More informationHoward K. Gogel, MD Southwest Gastroenterology Associates November 2017
Howard K. Gogel, MD Southwest Gastroenterology Associates November 2017 PPI indications and Overuse of PPIs Association vs causation (relative risk, odds ratios) Problems: Hypergastrinemia: ECL hyperplasia,
More informationSurveying the Landscape of Oral Antiplatelet Therapy in Acute Coronary Syndrome Management
Surveying the Landscape of Oral Antiplatelet Therapy in Acute Coronary Syndrome Management Jeffrey S Berger, MD, MS Assistant Professor of Medicine and Surgery Director of Cardiovascular Thrombosis Disclosures
More informationFamily Medicine Clinical Pharmacy Forum Vol. 3, Issue 1 (January/February 2007)
1 Family Medicine Clinical Pharmacy Forum Vol. 3, Issue 1 (January/February 2007) Family Medicine Clinical Pharmacy Forum is a brief bi-monthly publication from the Family Medicine clinical pharmacists
More informationProton pump inhibitors: balancing the benefits and risks of long-term use
Proton pump inhibitors: balancing the benefits and risks of long-term use Chenlu (Maria) Tian, MD Assistant Professor Digestive and Liver Disease University of Texas Southwestern Medical Center This is
More informationRisky Business: Kicking the PPI Habit
Conflict of Interest Risky Business: Kicking the PPI Habit I have no actual or potential conflict of interest to disclose. Jason Morell, PharmD, BCPS Pharmacist Rush University Medical Center Objectives
More informationProton Pump Inhibitors (PPIs) (Sherwood Employer Group)
Proton Pump Inhibitors (PPIs) (Sherwood Employer Group) BCBSKS will review Prior Authorization requests Prior Authorization Form: https://www.bcbsks.com/customerservice/forms/pdf/priorauth-6058ks-st-ippi.pdf
More informationPROTON PUMP INHIBITOR AND CLOPIDOGREL INTERACTION: Am J Gastroenterol Jan;105(1): Epub 2009 Nov 10.
PROTON PUMP INHIBITOR AND CLOPIDOGREL INTERACTION: FACT OR FICTION? 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權 Am J Gastroenterol. 2010 Jan;105(1):34-41. Epub 2009 Nov 10. Introduction Current consensus
More informationDrug Class Monograph
Drug Class Monograph Class: Proton Pump Inhibitors Drugs: Aciphex Sprinkle (rabeprazole), Dexilant (dexlansoprazole), Lansoprazole, Nexium (esomeprazole capsule, esomeprazole granules), Omeprazole, Pantoprazole,
More informationProton Pump Inhibitors Drug Class Prior Authorization Protocol
Proton Pump Inhibitors Drug Class Prior Authorization Protocol Line of Business: Medi-Cal P&T Approval Date: November 15, 2017 Effective Date: January 1, 2018 This policy has been developed through review
More informationEU RISK MANAGEMENT PLAN (EU RMP)
EU RISK MANAGEMENT PLAN (EU RMP) Active substance(s) (INN or common name): Esomeprazole Pharmaco-therapeutic group (ATC Code): A02B C05 Name of Marketing Authorisation Holder or Applicant: Strength and
More informationBleeding Prevention in an Era of Expanding Combination Antithrombotic Therapies
Bleeding Prevention in an Era of Expanding Combination Antithrombotic Therapies Muthiah Vaduganathan, MD MPH Cardiovascular Medicine Brigham and Women s Hospital December 8 th, 2017 Disclosures None Key
More informationProton Pump Inhibitor De-prescribing Guidance
Amendment History Proton Pump Inhibitor De-prescribing Guidance VERSION DATE AMENDMENT HISTORY 1.0 2013 Previous version 2.0 September 2015 Comments Amendment to Flow chart and addition of Rationale page
More informationVimovo (delayed-release enteric-coated naproxen with esomeprazole)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.17.01 Subject: Vimovo Page: 1 of 5 Last Review Date: September 18, 2015 Vimovo Description Vimovo (delayed-release
More information0BCore Safety Profile. Pharmaceutical form(s)/strength: Gastro-resistant capsules (10, 20, 40 mg) NL/H/PSUR/0058/001 Date of FAR:
0BCore Safety Profile Active substance: Omeprazole Pharmaceutical form(s)/strength: Gastro-resistant capsules (10, 20, 40 mg) P-RMS: NL/H/PSUR/0058/001 Date of FAR: 10.04.2013 CSP Drug Substance Omeprazole
More informationGASTROINTESTINAL AND ANTIEMETIC DRUGS. Submitted by: Shaema M. Ali
GASTROINTESTINAL AND ANTIEMETIC DRUGS Submitted by: Shaema M. Ali GASTROINTESTINAL AND ANTIEMETIC DRUGS by: Shaema M. Ali There are four common medical conditions involving the GI system 1) peptic ulcers
More information2018 CONSENSUS UPDATES + RISKS/BENEFITS OF PPI USE
2018 CONSENSUS UPDATES + RISKS/BENEFITS OF PPI USE IN INFANT GERD SWEDISH MEDICAL CENTER JONAH ESSERS, MD, MPH OBJECTIVES Highlight the 2018 updates to infant GERD recommendations Provide an update on
More informationMeasuring and Evaluating Indicators of Appropriate Prescribing in Older. Populations
HRB PhD Scholar Division of Population Health Sciences RCSI Measuring and Evaluating Indicators of Appropriate Prescribing in Older Cost-Effective Proton Pump Populations Potential Strategies for more
More informationOptimal Drugs for ICU Stress Ulcer Prophylaxis: Other. Grand Rounds Monday August 9, 2010 Teresa Jones R2
Optimal Drugs for ICU Stress Ulcer Prophylaxis: Other Grand Rounds Monday August 9, 2010 Teresa Jones R2 Outline Options besides PPIs Comparison to PPIs Negative Effects of PPIs Conclusion Do we really
More informationClopidogrel Use in ACS and PCI: Clinical Trial Update
Clopidogrel Use in ACS and PCI: Clinical Trial Update Matthew J. Price MD Director, Cardiac Catheterization Laboratory, Scripps Clinic, La Jolla, CA Assistant Professor, Scripps Translational Science Institute
More informationCARDIOVASCULAR RISK and NSAIDs
CARDIOVASCULAR RISK and NSAIDs Dr. Syed Ghulam Mogni Mowla Assistant Professor of Medicine Shaheed Suhrawardy Medical College, Dhaka INTRODUCTION NSAIDs are most commonly prescribed drugs Recent evidence
More informationOral proton pump inhibitors (PPIs)
Treatment Guideline Oral proton pump inhibitors (PPIs) Introduction The high efficacy and low toxicity of proton pump inhibitors (PPIs) has contributed to their frequent prescription worldwide, often without
More informationDisclosure. Overview. Objectives. Five Noteworthy Outpatient Publications. Factors Affecting Antibiotic Prescribing 7/24/2013
47 th Annual Meeting August 2-4, 2013 Orlando, FL Five Noteworthy Outpatient Publications R. Vandervoort, Pharm.D. Disclosure I do not have a vested interest in or affiliation with any corporate organization
More informationPrescribing of anti-osteoporotic therapies following the use of Proton Pump Inhibitors in general practice
Prescribing of anti-osteoporotic therapies following the use of Proton Pump Inhibitors in general practice B. McGowan, K. Bennett, J. Feely Department of Pharmacology & Therapeutics, Trinity Centre for
More informationAN ARGUMENT FOR SURGERY FOR GASTRINOMA. Lauren Wilson R1 General Surgery
AN ARGUMENT FOR SURGERY FOR GASTRINOMA Lauren Wilson R1 General Surgery WHAT IS A GASTRINOMA? Gastrin secreting cells derived from multipotential stem cells of endodermal origin or enteroendocrine cells
More informationOriginal Policy Date
MP 2.04.38 Genetic Testing for Helicobacter pylori Treatment Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return
More informationGERD DIAGNOSIS & TREATMENT DISCLOSURES 4/18/2018
GERD DIAGNOSIS & TREATMENT Subhash Chandra MBBS Assistant Professor CHI Health Clinic Gastroenterology Creighton University, School of Medicine April 28, 2018 DISCLOSURES None 1 OBJECTIVES Review update
More informationIs Rabeprazole A Safe Treatment for Gastroesophageal Reflux Disease in Children Ages 1-16 years?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2015 Is Rabeprazole A Safe Treatment for Gastroesophageal
More informationNONSTEROIDAL ANTI- INFLAMMATORY DRUGS
NONSTEROIDAL ANTI- INFLAMMATORY DRUGS MRS. M.M. HAS A 3 YR. HX OF PROGRESSIVE RIGHT HIP PAIN. THE PAIN INCREASES WITH WEIGHT BEARING ACTIVITY. PT. HAS BEEN ON ACETAMINOPHEN WITHOUT RELIEF. PERTINENT LABS
More informationOVERALL SUMMARY OF THE SCIENTIFIC EVALUATION OF LOSEC AND ASSOCIATED NAMES (SEE ANNEX I)
ANNEX II SCIENTIFIC CONCLUSIONS AND GROUNDS FOR AMENDMENT OF THE SUMMARY OF PRODUCT CHARACTERISTICS, LABELLING AND PACKAGE LEAFLET PRESENTED BY THE EMEA 21 SCIENTIFIC CONCLUSIONS OVERALL SUMMARY OF THE
More informationUpdate in Hospital Medicine. Update in Hospital Medicine 2009
2009 Bradley A. Sharpe, MD UCSF Division of Hospital Medicine PE in Acute COPD Exacerbations Question: What is the prevalence of PE in patients with COPD who need hospitalization? Design: Systematic review,
More informationSession Objectives. Clopidogrel Resistance. Clopidogrel (Plavix )
Session Objectives New Antithrombotics and Real Time Genetic Testing: Their Role in the Vascular Patient Margaret C. Fang, MD, MPH Associate Professor of Medicine Division of Hospital Medicine Medical
More informationNexium 24HR. Tools and information for you and your pharmacy team NOW OTC FOR FREQUENT HEARTBURN. Consumer Healthcare Pfizer Inc.
NOW OTC FOR FREQUENT HEARTBURN w e N Nexium 24HR P H A R M A S S I S T K I T Tools and information for you and your pharmacy team 2014 Pfizer Inc. NXM041468 05/14 Q: What is the indication for Nexium 24HR
More informationThe presence and development of gastric ulcers. Evaluation of Stress Ulcer Prophylaxis in a Family Medicine Residency Inpatient Service
Evaluation of Stress Ulcer Prophylaxis in a Family Medicine Residency Inpatient Service Heather A. Kehr, PharmD, BCPS, Carrie L. Griffiths, PharmD, R. Wesley Haynes, PharmD, Sonia Everhart, PharmD, BCPS,
More informationTOP 5 DRUGS.. TO AVOID IN THE ELDERLY
TOP 5 DRUGS.. TO AVOID IN THE ELDERLY Debbie Kwan, BScPhm., MSc., FCSHP Canadian Geriatrics Society, April 20, 2013 Disclosure of Potential for Conflict of Interest: Financial Disclosure: None Mar 26,
More informationPolicy Evaluation: Proton Pump Inhibitors (PPIs)
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationManagement of Dyspepsia
MPharm Programme Management of Dyspepsia Slide 1 of 28 Learning Objectives Understand the principles and wider implications underpinning evidence based therapeutics in the key clinical specialities Objectively
More informationStress Ulcer Prophylaxis In The ICU. Scott W. Wolf Anesthesiology Critical Care Medicine
Stress Ulcer Prophylaxis In The ICU Scott W. Wolf Anesthesiology Critical Care Medicine Some history Stress Ulceration described in ICU patients as long as 45 years ago Patients had a constellation of
More informationDisclosures. Proton Pump Inhibitors Deprescribing? Deprescribing PPI Objectives. Deprescribing. Proton Pump Inhibitors (PPI) 5/28/2018.
Proton Pump Inhibitors Deprescribing? None Disclosures Chad Burski, MD Assistant Professor of Medicine UAB Gastroenterology Deprescribing PPI Objectives AR Why? Who? How? The mechanism of action of Proton
More informationSpectrum of Diverticular Disease. Outline
Spectrum of Disease ACG Postgraduate Course January 24, 2015 Lisa Strate, MD, MPH Associate Professor of Medicine University of Washington, Seattle, WA Outline Traditional theories and updated perspectives
More informationMisuse of Bisphosphonates. Dr Rukhsana Parvin Associate Professor Department of Medicine Enam Medical College & Hospital
Misuse of Bisphosphonates Dr Rukhsana Parvin Associate Professor Department of Medicine Enam Medical College & Hospital Introduction Bisphosphonates are chemically stable analogues of pyrophosphate compounds.
More informationS. Sandberg-Lewis, ND, DHANP
Functional Gastroenterology Webinar One 6-28-13 S. Sandberg-Lewis, ND, DHANP Proton pump inhibitors- Effects on: secretion gastric mucosa food allergy bile reflux Barrett metaplasia and dysplasia esophageal
More informationPART III: PATIENT MEDICATION INFORMATION READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE
PART III: PATIENT MEDICATION INFORMATION READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE Pr SANDOZ PANTOPRAZOLE Pantoprazole Delayed-Release Tablets 20 mg and 40 mg Pantoprazole (as pantoprazole
More informationREAD THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION. rabeprazole sodium tablets
READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION Pr RABEPRAZOLE EC rabeprazole sodium tablets Read this carefully before you start taking RABEPRAZOLE EC and each time
More informationFARMACI E ALTE VIE DIGESTIVE NELL ANZIANO: UTILITÀ E LIMITI
FARMACI E ALTE VIE DIGESTIVE NELL ANZIANO: UTILITÀ E LIMITI Edoardo V. Savarino, MD, PhD Professor of Gastroenterology Department of Surgery, Oncology and Gastroenterology University of Padua Italy COMMON
More informationEDITOR S PICK SHOULD I BE CONCERNED WITH THE LONG-TERM USE OF PROTON PUMP INHIBITOR THERAPY?
EDITOR S PICK In this pertinent paper, Jayaraman et al. examine the exhaustive list of potential side effects of one of the most popularly prescribed drugs for reducing gastric acid secretion: proton pump
More information'Fake News' in GI: Getting to the Truth about Gluten, PEG 3350 and PPIs. Carlo Di Lorenzo, M.D
'Fake News' in GI: Getting to the Truth about Gluten, PEG 3350 and PPIs Carlo Di Lorenzo, M.D Twitter: @carlodilorenzo1 Disclosure I have the following financial relationships with the manufacturer(s)
More informationThe Parsabiv Beginner s Book
The Parsabiv Beginner s Book A quick guide to help you learn about your treatment with Parsabiv and what to expect Indication Parsabiv (etelcalcetide) is indicated for the treatment of secondary hyperparathyroidism
More informationPOCKET HANDBOOK OF GI PHARMACOTHERAPEUTICS
POCKET HANDBOOK OF GI PHARMACOTHERAPEUTICS CLINICAL GASTROENTEROLOGY GEORGE Y. WU, SERIES EDITOR For other titles published in this series, go to www.springer.com/series/7672 POCKET HANDBOOK OF GI PHARMACOTHERAPEUTICS
More informationPrasugrel: Son of Clopidogrel or Distant Cousin? Disclosures. Objectives
Prasugrel: Son of Clopidogrel or Distant Cousin? By John J. Bon, Pharm.D., BCPS Lead Clinical Pharmacist, Critical Care Summa Health System Disclosures I have no actual or potential conflict of interest
More informationPART III: PATIENT MEDICATION INFORMATION READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE. Pantoprazole Magnesium Enteric-Coated Tablets
PART III: PATIENT MEDICATION INFORMATION READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE Pr PANTOPRAZOLE T Pantoprazole Magnesium Enteric-Coated Tablets Read this carefully before you start taking
More informationClass Update: Proton Pump Inhibitors and Histamine 2 Receptor Antagonists
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationHelicobacter pylori. Objectives. Upper Gastrointestinal Bleeding Peptic Ulcer Disease
Upper Gastrointestinal Bleeding Peptic Ulcer Disease Pharmacotherapy Issues in Acute Management and Secondary Prevention Peter J. Zed, B.Sc., B.Sc.(Pharm), Pharm.D. Pharmacotherapeutic Specialist - Emergency
More informationGastroesophageal Reflux in Infants
Gastroesophageal Reflux in Infants Lindsey Albenberg, DO Andrew Grossman, MD The Children s Hospital of Philadelphia 2013 Resident Education Series Reviewed by Jyoti Ramakrishna, MD of the Professional
More informationUpdates in Gastroenterology and Hepatology
Updates in Gastroenterology and Hepatology Jay Jacobs, MD Assistant Professor of Medicine Joy McCann Culverhouse Center for Swallowing Disorders University of South Florida September 7, 2018 Disclosures
More informationFunctional Dyspepsia
Functional Dyspepsia American College of Gastroenterology Boston Massachusetts, June 2015 Brian E. Lacy, PhD, MD, FACG Professor of Medicine Geisel School of Medicine at Dartmouth Chief, Section of Gastroenterology
More informationComplicated issues in GI bleeding for internists? Nonthalee Pausawasdi, M.D. Faculty of Medicine Siriraj Hospital
Complicated issues in GI bleeding for internists? Nonthalee Pausawasdi, M.D. Faculty of Medicine Siriraj Hospital Complicated issues in GI bleeding; Survey results from internists Optimal resuscitation
More informationFood and Drug Administration 2010 Safety News
TABLE OF CONTENTS Food and Drug Administration 2010 Safety News p. 1-3 Medication Errors and Modified Release Dosage Forms p. 3-5 Long Term Adverse Effects of Proton Pump Inhibitors p. 5-7 P & T Committee
More informationACG Clinical Guideline: Diagnosis and Management of Gastroesophageal Reflux Disease
ACG Clinical Guideline: Diagnosis and Management of Gastroesophageal Reflux Disease Philip O. Katz MD 1, Lauren B. Gerson MD, MSc 2 and Marcelo F. Vela MD, MSCR 3 1 Division of Gastroenterology, Einstein
More informationFecal incontinence causes 196 epidemiology 8 treatment 196
Subject Index Achalasia course 93 differential diagnosis 93 esophageal dysphagia 92 95 etiology 92, 93 treatment 93 95 work-up 93 Aminosalicylates, pharmacokinetics and aging effects 36 Antibiotics diarrhea
More informationEffective Health Care
Effective Health Care Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease Executive Summary Background Gastroesophageal reflux disease (GERD), defined as weekly heartburn
More informationDisclosures. Heartburn and Barrett s Esophagus. Heartburn and Barrett s Esophagus. GERD is common in the U.S. None
Heartburn and Barrett s Esophagus None Disclosures Christian Mathy, MD University of California, San Francisco 2015 Heartburn and Barrett s Esophagus Heartburn and GERD GERD therapy Extraesophageal GERD
More informationOn-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding
On-Call Upper GI Bleeding John R Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical School Upper Gastrointestinal Bleeding 300,000000 hospitalizations/year
More informationINTERNATIONAL JOURNAL OF PHARMACY & LIFE SCIENCES (Int. J. of Pharm. Life Sci.) Gastrointestinal Bleeding in Cardiac Patients
INTERNATIONAL JOURNAL OF PHARMACY & LIFE SCIENCES (Int. J. of Pharm. Life Sci.) Gastrointestinal Bleeding in Cardiac Patients Jaya Sharma and Prashant Sharma IIP, Indore (MP) - India Abstract Cardiac patients
More informationProton Pump Inhibitors for Prophylaxis of Nosocomial Upper Gastrointestinal Tract Bleeding
ORIGINAL INVESTIGATION LESS IS MORE Proton Pump Inhibitors for Prophylaxis of Nosocomial Upper Gastrointestinal Tract Bleeding Effect of Standardized Guidelines on Prescribing Practice Patrick S. Yachimski,
More informationHigh use of maintenance therapy after triple therapy regimes in Ireland
High use of maintenance therapy after triple therapy regimes in Ireland K Bennett, H O Connor, M Barry, C O Morain, J Feely Department of Pharmacology & Therapeutics Department of Gastroenterology Trinity
More informationBleeds in Cardiovascular Disease
Preventing Gastrointestinal Bleeds in Cardiovascular Disease Patients t on Aspirin i Joel C. Marrs, Pharm.D., BCPS Clinical Assistant Professor OSU/OHSU College of Pharmacy Pharmacy Practice IX (PHAR 766)
More informationPatient and Physician Predictors of Inappropriate Acid-suppressive Therapy (AST) Use in Hospitalized Patients
ORIGINAL RESEARCH Patient and Physician Predictors of Inappropriate Acid-suppressive Therapy (AST) Use in Hospitalized Patients Jagdish S. Nachnani, MD 1 Deepti Bulchandani, MD 2 Jill Moormeier, MD, MPH
More informationDo PPIs Reduce Bleeding in ICU? Revisiting Stress Ulcer Prophylaxis. Deborah Cook
Do PPIs Reduce Bleeding in ICU? Revisiting Stress Ulcer Prophylaxis Deborah Cook ICU-Acquired Upper GI Bleeding Case series of 300 ICU patients describing stressrelated erosive syndrome Frequent Fatal
More informationRABEPRAZOL 10mg and 20mg Gastro-resistant Tablets
PACKAGE LEAFLET: INFORMATION FOR THE USER RABEPRAZOL 10mg and 20mg Gastro-resistant Tablets RABEPRAZOLE This leaflet is a copy of the Summary of Product Characteristics and Patient Information Leaflet
More informationOral Antiplatelet Therapy in Patients with ACS: A Focus on Prasugrel and Ticagrelor
Oral Antiplatelet Therapy in Patients with ACS: A Focus on Prasugrel and Ticagrelor Nicolas W. Shammas, MS, MD, FACC Coronary and Peripheral Interventionalist Cardiovascular Medicine, PC Research Director,
More informationAntiplatelets in cardiac patients with suspected GI bleeding
Antiplatelets in cardiac patients with suspected GI bleeding Acute GI bleeding is a common major medical emergency. In the 2007 UK-wide audit, overall mortality of patients admitted with acute GI bleeding
More informationHyperlipidemia in an Otherwise Healthy 80 Year-Old Patient. Theodore D Fraker, Jr, MD Professor of Medicine
Hyperlipidemia in an Otherwise Healthy Theodore D Fraker, Jr, MD Professor of Medicine Orlando, Florida October 7-9, 2011 80-Year-Old Patient Primary Prevention Issues in the Elderly: Coronary artery disease
More informationComplementary & Alternative Therapies in IBD
Complementary & Alternative Therapies in IBD Laurie Rosales, APRN-CNP OSU Wexner Medical Center Division of Gastroenterology, Hepatology and Nutrition Complementary & Alternative Probiotics Cannabis Fish
More informationOptimal Management of GERD with Dexlansoprazole - Extended plasma concentration and dosing flexibility with a dual delayed release PPI
Optimal Management of GERD with Dexlansoprazole - Extended plasma concentration and dosing flexibility with a dual delayed release PPI Jun Heng Lee, M.D. Samsung Medical Center, Sungkyunkwan University
More informationDisclosures. Theodore A. Bass MD, FSCAI. The following relationships exist related to this presentation. None
SCAI Fellows Course December 10, 2013 Disclosures Theodore A. Bass MD, FSCAI The following relationships exist related to this presentation None Current Controversies on DAPT in PCI Which drug? When to
More informationBranko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center
Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center THE END! CHANGABLE Blood pressure Diabetes Mellitus Hyperlipidemia Atrial fibrillation Nicotine Drug abuse Life style NOT CHANGABLE
More informationPositioning Biologics in Ulcerative Colitis
Positioning Biologics in Ulcerative Colitis Bruce E. Sands, MD, MS Acting Chief, Gastrointestinal Unit Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School Sequential Therapies
More information