Author: Patel AS, Pohl JF, Easley DJ.
Source: Pediatrics in Review. 2003; January,24 (1), 12-15.
Proton pump inhibitors (PPI) are a group of medications used to decrease acid production in the stomach. They are used to treat gastroesophageal reflux and other types of stomach and intestinal problems. In this review article, the authors explain how these medicines work to stop acid production by blocking proton production. They feel that these medications provide better acid blockade than the more traditionally used class of medications called histamine receptor antagonists such as Zantac? and Pepsid?.
The PPI?s require an acidic environment and should be given on an empty stomach 30 minutes before a meal. This allows the medication to get through the stomach and into the intestine before it begins to release.
Currently 5 PPI?s are available in the US: omeprezole (Prilosec?), lansoprazole (Prevacid?), rabeprazole (Aciphex?), pantoprazole (Protonix?), and esomeprazole (Nexium?). Research reports minimal risk for patients with long term use.
Each brand of PPI is discussed in the article and technical differences are explained. Pediatric research has been done on omeprezole and lansoprazole. Omeprezole comes in 10, 20, and 40 mg capsules. Four preparations are recommended; mixing granules with water, acidic fruit juices, or foods such as yogurt or applesauce to prevent removal of the protective coating. Also a sodium bicarbonate suspension which allows the granules to dissolve is ideal for use in tube fed patients or when administering directly into the intestine (an alkaline environment). Lansoprazole comes in 15 and 30 mg doses as well as a liquid suspension and should be administered similar to omeprezole. Pantoprazole is unique in that it had been approved for oral and intravenous administration. There is much potential for PPI use in pediatrics because of the effectiveness of this drug class in reducing acid secretion.
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