REVIEW article
Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1507812
Pharmacodynamics, pharmacokinetics, interactions with other drugs, toxicity and clinical effectiveness of proton pump inhibitors
Provisionally accepted
Łukasz Wołowiec*
Joanna Osiak
Albert JaśniakMichał JaniakLidia Wydeheft
Magdalena ŁukasiakMałgorzata PellowskaGrzegorz Grześk- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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The document comprehensively reviews proton pump inhibitors (PPIs), focusing on their pharmacodynamics, pharmacokinetics, drug interactions, toxicity, and clinical efficacy. PPIs irreversibly inhibit the H+/K+-ATPase enzyme in gastric parietal cells, effectively reducing gastric acid secretion. These drugs are widely prescribed for conditions like gastroesophageal reflux disease (GERD), peptic ulcer disease, eradication of Helicobacter pylori and as a prevention against bleeding from gastrointestinal tract. The review article highlights significant drug interactions associated with PPIs. Omeprazole, for instance, can interfere with the metabolism of clopidogrel, reducing its antiplatelet efficacy, which may have clinical implications. The article also discusses other drug interactions, including anticoagulants (e.g., warfarin), selective serotonin reuptake inhibitors (SSRIs), and immunosuppressive and chemotherapeutic drugs, as well as the side effects associated with taking PPIs. Long-term use of PPIs is linked to plenty of adverse effects, such as vitamin B12 and calcium deficiencies, which can lead to bone fractures. An increased risk of infections, including Clostridium difficile and small intestinal bacterial overgrowth (SIBO), is also noted. Cardiovascular risks, such as myocardial infarction and stroke, are observed in some patients on high-dose or prolonged PPI therapy. In rare cases, nephrotoxicity and hepatotoxicity are reported. Additionally, the document examines the potential role of PPIs in exacerbating certain cancers, such as gastric adenocarcinoma, and in influencing the severity of COVID-19 symptoms. PPIs are proven effective in treating GERD and preventing complications from nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in reducing the risk of NSAID-induced ulcers. The document stresses the importance of understanding drug interactions and the need for individualized treatment to minimize adverse effects. Ongoing research into PPIs' long-term safety and efficacy remains essential, particularly given their widespread use in clinical practice.
Keywords: PPIs, pharmacokinetics, interactions, Pharmacology, Pharmacodynamics
Received: 08 Oct 2024; Accepted: 27 Jun 2025.
Copyright: © 2025 Wołowiec, Osiak, Jaśniak, Janiak, Wydeheft, Łukasiak, Pellowska and Grześk. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Łukasz Wołowiec, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.