Proton pomp inhibitors: focus on a multimorbid patient

A.N. Kazyulin¹, T.S. Shindina², I.M. Shcherbenkov³, C.C. Arkhipova⁴

¹A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

²Polyclinics No. 5, Moscow

³Multidisciplinary Clinics "Center of Endosurgery and Lithotripsy", Moscow

⁴LLC "Universal", Moscow

This paper discusses the selection of a proton pump inhibitor (PPI) in multimorbid patients. In these patients, polypharmacy associated with high risks of cumulative adverse effects of drug interactions comes to the fore. The authors describe a woman with gastroesophageal reflux disease (GERD) and comorbid cardiovascular disease, metabolic syndrome, and diabetes. The diagnostic algorithm in the lack of therapeutic effect of PPIs is addressed. Polymorphism of genes encoding CYP2C19 and CYP3A4 isoenzymes is considered the cause of refractory GERD. Most likely, this woman belongs to so-called rapid metabolizers. Ineffective treatment is accounted for because metabolites of a prescribed PPI have shown no pharmacological activity. The authors uncover the mechanism of action of rabeprazole given cytochrome P450 gene polymorphisms, thereby preventing hydrochloric acid secretion effectively and making drug effects predictable. Clinical studies on drug interactions in multimorbid patients rec eiving rabeprazole are addressed. Rabeprazole is an effective and safe treatment modality in patients with GERD and comorbidities.

Keywords: rabeprazol, drug interactions, gastroesophageal reflux disease, polypharmacy, multimorbid patient, proton pomp inhibitors.

For citation: Kazyulin A.N., Shindina T.S., Shcherbenkov I.M., Arkhipova C.C. Proton pomp inhibitors: focus on a multimorbid patient. RMJ. 2021;10:27–30.