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Special Alerts
Possible Increased Risk of Clostridium Difficile–Associated Diarrhea (CDAD) with Proton Pump Inhibitor Use: Update
February 2012
The U.S. Food and Drug Administration (FDA) and Health Canada have announced that proton pump inhibitors (PPIs) may be associated with an increased risk of Clostridium difficile–associated diarrhea (CDAD). The FDA reviewed reports of PPI-associated CDAD from the FDA Adverse Event Reporting System and from the medical literature. The association of PPI use and CDAD varied among studies, ranging from a risk of 1.4-2.75 higher in those exposed to a PPI compared to those without PPI exposure. Many of the cases reported involved patients who were elderly, had chronic and/or underlying conditions, or were taking broad-spectrum antibiotics - all of which could have increased the risk of CDAD. Health Canada has also been assessing study data on an ongoing basis. In spite of potential predisposition to CDAD, or other limitations to study design, association with PPI use could not be ruled out and patients with these risk factors may have more serious outcomes from CDAD associated with PPI use. The FDA is working with manufacturers to include information regarding the increased risk of CDAD with use of PPIs in their prescribing information and is also evaluating the risk of CDAD in users of histamine H2 receptor blockers. Health Canada also notes that the possible association between PPIs and CDAD is noted in their PPI product labeling.
The following advice is provided by the FDA and Health Canada to assist healthcare professionals in the management of patients receiving PPIs:
- Consider a diagnosis of CDAD in PPI users that have persistent diarrhea.
- Advise patients to get immediate care from a healthcare professional if they experience persistent watery stools, bloody diarrhea, abdominal pain or tenderness, nausea, loss of appetite, or fever while taking PPIs.
- Use the lowest dose and shortest duration of PPI therapy appropriate for the condition being treated.
For more information, refer to the following websites:
U.S.:
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm290838.htm
http://www.fda.gov/Drugs/DrugSafety/ucm290510.htm
Canada: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2012/2012_23-eng.php
Pronunciation
(ra BEP ra zole)
Generic Available (U.S.)
No
Index Terms
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Short-term (4-8 weeks) treatment and maintenance of erosive or ulcerative gastroesophageal reflux disease (GERD); symptomatic GERD; short-term (up to 4 weeks) treatment of duodenal ulcers; long-term treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome; H. pylori eradication (in combination therapy)
Canadian labeling: Additional uses (not in U.S. labeling): Treatment of nonerosive reflux disease (NERD); treatment of gastric ulcers
Use: Unlabeled
Maintenance of duodenal ulcer
Pregnancy Risk Factor
B
Pregnancy Considerations
Not shown to be teratogenic in animal studies, however, adequate and well-controlled studies have not been done in humans; use during pregnancy only if clearly needed
Lactation
Excretion in breast milk unknown/not recommended
Contraindications
Hypersensitivity to rabeprazole, substituted benzimidazoles (ie, esomeprazole, lansoprazole, omeprazole, pantoprazole), or any component of the formulation
Warnings/Precautions
Concerns related to adverse effects:
• Atrophic gastritis: Long-term omeprazole therapy has caused atrophic gastritis (by biopsy); this may also occur with rabeprazole.
• Carcinoma: No reports of enterochromaffin-like (ECL) cell carcinoids, dysplasia, or neoplasia has occurred.
• Fractures: Increased incidence of osteoporosis-related bone fractures of the hip, spine, or wrist may occur with proton pump inhibitor (PPI) therapy. Patients on high-dose (multiple daily doses) or long-term therapy (≥1 year) should be monitored. Use the lowest effective dose for the shortest duration of time, use vitamin D and calcium supplementation, and follow appropriate guidelines to reduce risk of fractures in patients at risk.
• Hypomagnesemia: Reported rarely, usually with prolonged PPI use of >3 months (most cases >1 year of therapy). May be symptomatic or asymptomatic; severe cases may cause tetany, seizures, and cardiac arrhythmias. Consider obtaining serum magnesium concentrations prior to beginning long-term therapy, especially if taking concomitant digoxin, diuretics, or other drugs known to cause hypomagnesemia; and periodically thereafter. Hypomagnesemia may be corrected by magnesium supplementation, although discontinuation of rabeprazole may be necessary; magnesium levels typically return to normal within 1 week of stopping.
Disease-related concerns:
• Gastric malignancy: Relief of symptoms does not preclude the presence of a gastric malignancy.
• Gastrointestinal infection (eg, Salmonella, Campylobacter): Use of proton pump inhibitors may increase risk of these infections.
• Hepatic impairment: Use caution in patients with severe hepatic impairment.
Concurrent drug therapy issues:
• Clopidogrel: Proton pump inhibitors (PPIs) may diminish the therapeutic effect of clopidogrel, thought to be due to reduced formation of the active metabolite of clopidogrel. The manufacturer of clopidogrel recommends either avoidance of omeprazole or use of a PPI with less potent CYP2C19 inhibition (eg, pantoprazole); given the potency of CYP2C19 inhibitory activity, avoidance of rabeprazole would appear prudent. Others have recommended the continued use of PPIs, regardless of the degree of inhibition, in patients with a history of GI bleeding or multiple risk factors for GI bleeding who are also receiving clopidogrel since no evidence has established clinically meaningful differences in outcome; however, a clinically-significant interaction cannot be excluded in those who are poor metabolizers of clopidogrel (Abraham, 2010; Levine, 2011).
Other warnings/precautions:
• Appropriate use: Helicobacter pylori eradication: Short-term combination therapy (≤7 days) has been associated with a higher incidence of treatment failure. The American College of Gastroenterology recommends 10-14 days of therapy (triple or quadruple) for eradication of H. pylori (Chey, 2007).
Adverse Reactions
1% to 10%:
Central nervous system: Pain (3%), headache (2% to 5%)
Gastrointestinal: Diarrhea (3%), flatulence (3%), constipation (2%), nausea (2%)
Respiratory: Pharyngitis (3%)
Miscellaneous: Infection (2%)
<1%, postmarketing, and/or case reports (limited to important or life-threatening): Abdomen enlarged, abdominal pain, abnormal stools, abnormal vision, agitation, agranulocytosis, albuminuria, allergic reaction, alopecia, amblyopia, anaphylaxis, anemia, angina pectoris, angioedema, anorexia, apnea, arrhythmia, arthralgia, arthritis, ascites, asthma, bloody diarrhea, bone pain, bradycardia, breast enlargement, bullous and other drug eruptions of skin, bundle branch block, bursitis, cataract, cellulitis, cerebral hemorrhage, chest pain substernal, cholangitis, cholecystitis, cholelithiasis, colitis, coma, contact dermatitis, convulsions, corneal opacity, CPK increased, cystitis, deafness, delirium, depression, diaphoresis, diabetes mellitus, diplopia, disorientation, dizziness, duodenitis, dysmenorrhea, dyspepsia, dysphagia, dyspnea, dysuria, edema, electrocardiogram abnormal, embolus, epistaxis, erythema multiforme, esophageal stenosis, esophagitis, extrapyramidal syndrome, eye hemorrhage, facial edema, fever, fracture, fungal dermatitis, gastritis, gastroenteritis, gastrointestinal hemorrhage, gingivitis, glaucoma, glossitis, gout, gynecomastia, hematuria, hemolytic anemia, hepatic encephalopathy, hepatic cirrhosis, hepatic enzymes increased, hepatitis, hepatoma, hernia, hyperammonemia, hypercholesteremia, hyperglycemia, hyperkinesia, hyperlipemia, hypertension, hyper-/hypothyroidism, hypertonia, hypokalemia, hypomagnesemia, hyponatremia, hypoxia, impotence, injection site hemorrhage/pain/reaction, insomnia, interstitial nephritis, interstitial pneumonia, jaundice, kidney calculus, leukocytosis, leukopenia, leukorrhea, liver fatty deposit, lymphadenopathy, malaise, melena, menorrhagia, metrorrhagia, MI, migraine, myalgia, neck rigidity, nervousness, neuralgia, neuropathy, neutropenia, orchitis, osteoporosis-related fracture, palpitation, pancreatitis, pancytopenia, paresthesia, peripheral edema, photosensitivity, polycystic kidney, polyuria, proctitis, pruritus, PSA increased, psoriasis, pulmonary embolus, QTc prolongation, rash, rectal hemorrhage, retinal degeneration, rhabdomyolysis, salivary gland enlargement, sinus bradycardia, skin discoloration, somnolence, Stevens-Johnson syndrome, stomatitis, strabismus, sudden death, supraventricular tachycardia, syncope, tachycardia, taste abnormal, thrombocytopenia, thrombophlebitis, thrombosis, thirst (rare) tinnitus, toxic epidermal necrolysis, tremor, TSH increased, ulcerative colitis, urinary incontinence, urticaria, vasodilation, ventricular arrhythmias, vertigo, vomiting, weakness, weight gain/loss, xerostomia
Metabolism/Transport Effects
Substrate of CYP2C19 (major), CYP3A4 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits CYP2C19 (moderate), CYP2C8 (moderate), CYP2D6 (weak), CYP3A4 (weak)
Drug Interactions
Amphetamines: Proton Pump Inhibitors may increase the serum concentration of Amphetamines. Specifically, data indicate that Proton Pump Inhibitors may increase the rate at which Amphetamines are absorbed. Total exposure to Amphetamines is not significantly changed. Risk C: Monitor therapy
ARIPiprazole: CYP3A4 Inhibitors (Weak) may increase the serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole systemic exposure/affects with concomitant use of a weak CYP3A4 inhibitor. Decrease aripiprazole dose to 25% of the usual dose in patients receiving both a CYP3A4 and a CYP2D6 inhibitor (regardless of potencies). Risk C: Monitor therapy
ARIPiprazole: CYP2D6 Inhibitors (Weak) may increase the serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy and/or indication. Consult product labeling for specific recommendations. Risk C: Monitor therapy
Atazanavir: Proton Pump Inhibitors may decrease the serum concentration of Atazanavir. Management: Avoid concurrent PPI in HIV treatment-experienced patients. For treatment-naive patients, atazanavir/ritonavir dose should be given approximately 12 hours after the PPI, and the PPI should not exceed the equivalent of 20 mg omeprazole. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Proton Pump Inhibitors may diminish the therapeutic effect of Bisphosphonate Derivatives. Risk C: Monitor therapy
Cefditoren: Proton Pump Inhibitors may decrease the serum concentration of Cefditoren. Management: If possible, avoid use of cefditoren with proton pump inhibitors (PPIs). Consider alternative methods to minimize/control acid reflux (eg, diet modification) or alternative antimicrobial therapy if use of PPIs can not be avoided. Risk D: Consider therapy modification
Citalopram: CYP2C19 Inhibitors (Moderate) may increase the serum concentration of Citalopram. Management: Limit citalopram dose to a maximum of 20 mg/day if used with a moderate CYP2C19 inhibitor. Patients using this combination should be monitored closely for evidence of citalopram toxicity (e.g., serotonin syndrome, QT prolongation, etc.). Risk D: Consider therapy modification
Clopidogrel: RABEprazole may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Management: Due to the possible risk for impaired clopidogrel effectiveness, clinicians should carefully consider the need for proton pump inhibitor therapy in patients receiving clopidogrel. Other acid-lowering therapies do not appear to share this interaction. Risk D: Consider therapy modification
Conivaptan: May increase the serum concentration of CYP3A4 Substrates (Low risk). Risk C: Monitor therapy
CYP2C19 Inducers (Strong): May increase the metabolism of CYP2C19 Substrates. Risk C: Monitor therapy
CYP2C19 Substrates: CYP2C19 Inhibitors (Moderate) may decrease the metabolism of CYP2C19 Substrates. Risk C: Monitor therapy
CYP2C8 Substrates: CYP2C8 Inhibitors (Moderate) may decrease the metabolism of CYP2C8 Substrates. Risk C: Monitor therapy
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Dabigatran Etexilate: Proton Pump Inhibitors may decrease serum concentrations of the active metabolite(s) of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Proton Pump Inhibitors may decrease the serum concentration of Dasatinib. Management: Avoid concurrent use of proton pump inhibitors with dasatinib. Antacids (taken 2 hours before or after dasatinib administration) should be used in place of these agents if some acid-reducing therapy is needed. Risk D: Consider therapy modification
Deferasirox: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Delavirdine: Proton Pump Inhibitors may decrease the serum concentration of Delavirdine. Management: Chronic therapy with proton pump inhibitors (PPIs) should be avoided in patients treated with delavirdine. The clinical significance of short-term PPI therapy with delavirdine is uncertain, but such therapy should be undertaken with caution. Risk X: Avoid combination
Dexmethylphenidate: Proton Pump Inhibitors may increase the absorption of Dexmethylphenidate. Specifically, proton pump inhibitors may interfere with the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption (early) and decreased delayed absorption. Risk C: Monitor therapy
Erlotinib: Proton Pump Inhibitors may decrease the serum concentration of Erlotinib. Risk X: Avoid combination
Fluconazole: May increase the serum concentration of Proton Pump Inhibitors. Risk C: Monitor therapy
Gefitinib: Proton Pump Inhibitors may decrease the serum concentration of Gefitinib. Risk C: Monitor therapy
Herbs (CYP3A4 Inducers): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Indinavir: Proton Pump Inhibitors may decrease the serum concentration of Indinavir. Risk C: Monitor therapy
Iron Salts: Proton Pump Inhibitors may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk C: Monitor therapy
Itraconazole: Proton Pump Inhibitors may decrease the serum concentration of Itraconazole. Risk D: Consider therapy modification
Ketoconazole: May increase the serum concentration of Proton Pump Inhibitors. Proton Pump Inhibitors may decrease the serum concentration of Ketoconazole. Risk D: Consider therapy modification
Ketoconazole (Systemic): May increase the serum concentration of Proton Pump Inhibitors. Proton Pump Inhibitors may decrease the serum concentration of Ketoconazole (Systemic). Risk D: Consider therapy modification
Mesalamine: Proton Pump Inhibitors may diminish the therapeutic effect of Mesalamine. Proton pump inhibitor-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Consider avoiding concurrent administration of high-dose proton pump inhibitors (PPIs) with sustained-release mesalamine products. Risk D: Consider therapy modification
Methotrexate: Proton Pump Inhibitors may increase the serum concentration of Methotrexate. Risk C: Monitor therapy
Methylphenidate: Proton Pump Inhibitors may increase the absorption of Methylphenidate. Specifically, proton pump inhibitors may interfere with the normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early) and decreased delayed absorption. Risk C: Monitor therapy
Mycophenolate: Proton Pump Inhibitors may decrease the serum concentration of Mycophenolate. Specifically, concentrations of the active mycophenolic acid may be reduced. Risk C: Monitor therapy
Nelfinavir: Proton Pump Inhibitors may decrease serum concentrations of the active metabolite(s) of Nelfinavir. Proton Pump Inhibitors may decrease the serum concentration of Nelfinavir. Risk X: Avoid combination
Pimozide: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Pimozide. Risk X: Avoid combination
Posaconazole: Proton Pump Inhibitors may decrease the serum concentration of Posaconazole. Risk X: Avoid combination
Raltegravir: Proton Pump Inhibitors may increase the serum concentration of Raltegravir. Risk C: Monitor therapy
Rilpivirine: Proton Pump Inhibitors may decrease the serum concentration of Rilpivirine. Risk X: Avoid combination
Saquinavir: Proton Pump Inhibitors may increase the serum concentration of Saquinavir. Risk C: Monitor therapy
Tacrolimus: Proton Pump Inhibitors may increase the serum concentration of Tacrolimus. Management: Tacrolimus dose adjustment may be required. Rabeprazole, pantoprazole, or selected H2-receptor antagonists (i.e., ranitidine or famotidine) may be less likely to interact. Genetic testing may predict patients at highest risk. Risk D: Consider therapy modification
Tacrolimus (Systemic): Proton Pump Inhibitors may increase the serum concentration of Tacrolimus (Systemic). Management: Tacrolimus dose adjustment may be required. Rabeprazole, pantoprazole, or selected H2-receptor antagonists (i.e., ranitidine or famotidine) may be less likely to interact. Genetic testing may predict patients at highest risk. Risk D: Consider therapy modification
Tipranavir: May decrease the serum concentration of Proton Pump Inhibitors. These data are derived from studies with Ritonavir-boosted Tipranavir. Risk C: Monitor therapy
Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Vismodegib: Proton Pump Inhibitors may decrease the serum concentration of Vismodegib. Management: Carefully consider the need for any medication that increases the pH of the upper GI tract (PPIs, H2RAs, antacids), as these could significantly reduce vismodegib systemic exposure. Vismodegib dose increases are unlikely to compensate for this effect. Risk D: Consider therapy modification
Voriconazole: Proton Pump Inhibitors may increase the serum concentration of Voriconazole. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may cause gastric mucosal irritation).
Food: High-fat meals may delay absorption, but Cmax and AUC are not altered.
Herb/Nutraceutical: St John's wort may increase the metabolism and thus decrease the levels/effects of rabeprazole.
Storage
Store at 25°C (77°F). Protect from moisture.
Mechanism of Action
Potent proton pump inhibitor; suppresses gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump
Pharmacodynamics/Kinetics
Onset of action: Within 1 hour
Duration: 24 hours
Absorption: Oral: Well absorbed within 1 hour
Protein binding, serum: ~96%
Metabolism: Hepatic via CYP3A and 2C19 to inactive metabolites
Bioavailability: Oral: ~52%
Half-life elimination (dose dependent): 1-2 hours
Time to peak, plasma: 2-5 hours
Excretion: Urine (90% primarily as thioether carboxylic acid metabolites); remainder in feces
Dosage
Oral:
Children ≥12 years: U.S. labeling: Short-term treatment of GERD: 20 mg once daily for ≤8 weeks
Adults >18 years and Elderly:
Erosive/ulcerative GERD: Treatment: 20 mg once daily for 4-8 weeks; if inadequate response, may repeat up to an additional 8 weeks; maintenance: 20 mg once daily
Canadian labeling: 20 mg once daily for 4 weeks; if inadequate response, may repeat for an additional 4 weeks (lack of symptom control after 4 weeks warrants further evaluation); maintenance: 10 mg once daily (maximum: 20 mg once daily)
Symptomatic GERD: Treatment: 20 mg once daily for 4 weeks; if inadequate response, may repeat for an additional 4 weeks
Canadian labeling: 10 mg once daily (maximum: 20 mg once daily) for 4 weeks; lack of symptom control after 4 weeks warrants further evaluation
Duodenal ulcer: 20 mg/day before breakfast for 4 weeks; additional therapy may be required for some patients
Gastric ulcers (Canadian labeling): 20 mg once daily up to 6 weeks; additional therapy may be required for some patients
Helicobacter pylori eradication:
Manufacturer labeling: 20 mg twice daily administered with amoxicillin 1000 mg and clarithromycin 500 mg twice daily for 7 days
American College of Gastroenterology guidelines (Chey, 2007):
Nonpenicillin allergy: 20 mg twice daily administered with amoxicillin 1000 mg and clarithromycin 500 mg twice daily for 10-14 days
Penicillin allergy: 20 mg twice daily administered with clarithromycin 500 mg and metronidazole 500 mg twice daily for 10-14 days or 20 mg once or twice daily administered with bismuth subsalicylate 525 mg and metronidazole 250 mg plus tetracycline 500 mg 4 times/day for 10-14 days
Hypersecretory conditions: 60 mg once daily; dose may need to be adjusted as necessary. Doses as high as 100 mg once daily and 60 mg twice daily have been used, and continued as long as necessary (up to 1 year in some patients).
NERD (Canadian labeling): Treatment: 10 mg (maximum: 20 mg once daily) for 4 weeks; lack of symptom control after 4 weeks warrants further evaluation
Dosage adjustment in renal impairment: No dosage adjustment required
Dosage adjustment in hepatic impairment:
Mild-to-moderate: Elimination decreased; no dosage adjustment required
Severe: Use caution
Administration: Oral
May be administered without regard to meals; best if taken before breakfast. Do not crush, split, or chew tablet. May be administered with an antacid.
Dietary Considerations
May be taken without regard to meals; best if taken before breakfast.
Patient Education
Swallow whole; do not crush, split, or chew. Follow recommended diet and activity instructions. Avoid alcohol. You may experience headache, diarrhea, or gas. Report persistent abdominal pain or headaches.
Geriatric Considerations
No difference in efficacy or safety was noted in elderly subjects as compared to younger subjects. No dosage adjustment is necessary in the elderly.
An increased risk of fractures of the hip, spine, or wrist has been observed in epidemiologic studies with proton pump inhibitor (PPI) use, primarily in older adults ≥50 years of age. The greatest risk was seen in patients receiving high doses or on long-term therapy (≥1 year). Calcium and vitamin D supplementation and close monitoring are recommended to reduce the risk of fracture in high-risk patients.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause insomnia, anxiety, dizziness, depression, nervousness, somnolence, vertigo, convulsions, abnormal dreams; may rarely cause agitation, amnesia, confusion, extrapyramidal syndrome
Mental Health: Effects on Psychiatric Treatment
None reported
Nursing: Physical Assessment/Monitoring
Assess those medications requiring acid environment for absorption. Monitor reduction in symptoms.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, delayed release, enteric coated, oral, as sodium:
AcipHex®: 20 mg
Pricing: U.S. (www.drugstore.com)
Tablet, EC (Aciphex)
20 mg (30): $249.99
References
Abraham NS, Hlatky MA, Antman EM, et al, “ACCF/ACG/AHA 2010 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 on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents,” Circulation, 2010, 122(24):2619-33.
Bell AD, Roussin A, Cartier R, et al, “The Use of Antiplatelet Therapy in the Outpatient Setting: Canadian Cardiovascular Society Guidelines,” Can J Cardiol, 2011, 27(Suppl A):1-59.
Chey WD, Wong BC, et al, “American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection,” Am J Gastroent, 2007, 102(8):1808-25.
Cockayne SE, Glet RJ, Gawkrodger DJ, et al, “Severe Erythrodermic Reactions to the Proton Pump Inhibitors Omeprazole and Lansoprazole,” Br J Dermatol,1999, 141(1):173-5.
Kahrilas PJ, Shaheen NJ, Vaezi MF, et al, “American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease,” Gastroenterology, 2008, 135(4):1383-91.
Levine GN, Bates ER, Blankenship JC, et al, “2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions,” Circulation, 2011, 124(23):e574-651.
Natsch S, Vinks MH, Voogt AK, et al, “Anaphylactic Reactions to Proton-Pump Inhibitors,” Ann Pharmacother, 2000, 34(4):474-6.
Paoluzi P, Iacopini F, Crispino P, et al, “2-Week Triple Therapy for Helicobacter pylori Infection is Better Than 1-Week in Clinical Practice: a Large Prospective Single-Center Randomized Study,” Helicobacter, 2006, 11(6):562-8.
Talley NJ and Vakil N, “Practice Parameters Committee of the American College of Gastroenterology. Guidelines for the Management of Dyspepsia,” Am J Gastroenterol, 2005, 100(10):2324-37.
Wolfe MM and Sachs G, “Acid Suppression: Optimizing Therapy for Gastroduodenal Ulcer Healing, Gastroesophageal Reflux Disease, and Stress-Related Erosive Syndrome,” Gastroenterology, 2000,118(2 Suppl 1):9-31.
International Brand Names
Lexi-Comp.com
Last full review/revision February 2012
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