Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.
Expert Rev Clin Pharmacol. 2013 Jul;6(4):443-51. doi: 10.1586/17512433.2013.811206.
This review summarizes the literature regarding long-term adverse effects of proton pump inhibitors (PPIs). A PubMed search (1966 to February 2013) for English language studies was conducted using key terms PPI: omeprazole, esomeprazole, pantoprazole, lansoprazole, dexlansoprazole, rabeprazole, pneumonia, Clostridium difficile, osteoporosis, risk of fractures, thrombocytopenia, rhabdomyolysis, anemia, iron deficiency, hypomagnesemia, vitamin B₁₂ and nephritis. The risk of pneumonia was increased 27-39% in short-term use of PPIs in three meta-analyses. C. difficile infections were also associated with the use of PPIs (odds ratio: 2.15; 95% CI: 1.81-2.55; p < 0.00001). This effect appears to be dose related. The US FDA has recently issued a warning regarding fractures and the impaired magnesium absorption associated with the use of PPI. Thrombocytopenia, iron deficiency, vitamin B12 deficiency, rhabdomyolysis and acute interstitial nephritis have also been reported with the use of PPIs. There is mounting evidence that PPIs are associated with serious adverse effects. Practitioners should be vigilant and counsel patients accordingly.
这篇综述总结了质子泵抑制剂（PPIs）长期不良反应的文献。使用关键词 PPI：奥美拉唑、埃索美拉唑、泮托拉唑、兰索拉唑、右旋兰索拉唑、雷贝拉唑、肺炎、艰难梭菌、骨质疏松症、骨折风险、血小板减少症、横纹肌溶解症、贫血、缺铁、低镁血症、维生素 B₁₂和肾炎，对 1966 年至 2013 年 2 月期间的英文文献进行了 Pubmed 搜索。在三项荟萃分析中，短期使用 PPIs 使肺炎风险增加 27-39%。艰难梭菌感染也与 PPI 的使用有关（比值比：2.15；95%置信区间：1.81-2.55；p < 0.00001）。这种影响似乎与剂量有关。美国 FDA 最近发布了一项关于骨折和与使用 PPI 相关的镁吸收受损的警告。血小板减少症、缺铁、维生素 B12 缺乏、横纹肌溶解症和急性间质性肾炎也与使用 PPIs 有关。越来越多的证据表明，PPIs 与严重不良反应有关。医生应该保持警惕，并相应地告知患者。
