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Vol. 33. Núm. S1.
Actualización en inhibidores de la bomba de protones
Páginas 15-21 (Mayo 2010)
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Vol. 33. Núm. S1.
Actualización en inhibidores de la bomba de protones
Páginas 15-21 (Mayo 2010)
Actualización en inhibidores de la bomba de protones
Acceso a texto completo
Seguridad e interacciones de los inhibidores de la bomba de protones: lecciones aprendidas en millones de pacientes
Safety and interactions of proton pump inhibitors: lessons learned in millions of patients
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Juan V. Espluguesa,b,
Autor para correspondencia
juan.v.esplugues@uv.es

Autor para correspondencia.
, Miguel Martí-Cabreraa,b
a Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, España
b Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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Resumen

Los IBP han demostrado ser fármacos relativamente seguros después de muchos años de una amplia utilización. Las reacciones adversas con las que más frecuentemente se han asociado son leves y con escasa repercusión clínica. Inducen hipergastrinemia pero esta no se ha relacionado con una capacidad para inducir lesiones malignas Parece que pueden facilitar determinadas infecciones bacterianas a nivel digestivo y del aparato respiratorio, aunque este hecho no limita su prescripción dada la facilidad de su tratamiento.

Desde el punto de vista farmacocinético se han descrito la posibilidad de interacciones con otros fármacos a nivel del citocromo P450, pero ello no parece tener mayor trascendencia clínica y terapéutica en general. Sin embargo, recientemente se está incidiendo por las agencias reguladoras en la hipotética interacción de los IBP (sobre todo omeprazol) con el clopidogrel generando una reducción en su efecto antiagregante. Aunque se debe seguir esta recomendación, necesitaria ser evaluado de forma específica para poder determinar su realidad clínica y las posibles alternativas existentes en los pacientes con riesgo de sangrado gastrointestinal.

En último lugar se revisa su administración en situaciones especiales, objeto de discusión, como en la mujer embarazada o durante la lactancia materna.

Palabras clave:
Secreción ácida
inhibidores de la bomba de protones (IBP)
farmacología
seguridad
interacciones
clopidogrel
toxicidad
reacciones adversas
utilización en situaciones especiales
embarazo
lactancia
Abstract

After many years of widespread use, proton pump inhibitors (PPI) have been demonstrated to be relatively safe. The most frequently associated adverse reactions are mild with scarce clinical effects. These agents produce hypergastrinemia but this adverse effect has not been related to the development of malignancies. PPI seem to facilitate certain bacterial infections in the gastrointestinal and respiratory tracts. However, these infections are easily treated and therefore do not limit the prescription of PPI.

From the pharmacokinetic point of view, the possibility of interactions with other drugs metabolized by the cytochrome P450 system has been described but these interactions generally seem to have little clinical or therapeutic importance. However, regulatory agencies are currently stressing the hypothetical interaction between PPI (especially omeprazole) and clopidogrel, which reduces the latter's antiplatelet effect. Although this recommendation should be followed, this interaction should be specifically evaluated to determine its clinical effect and the possible alternatives in patients at risk of gastrointestinal bleeding.

Lastly, the present article reviews PPI administration in special, currently debated situations, such as in pregnant or breastfeeding women.

Keywords:
Acid secretion
proton pump inhibitors
pharmacology
safety
interactions
clopidogrel
toxicity
adverse reactions
use in special situations
pregnancy
breastfeeding
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Copyright © 2010. Elsevier España S.L.. Todos los derechos reservados
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