Proton Pump Inhibitors

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Proton Pump Inhibitors - Interactions and Warnings

Reduced serum vitamin B12 (cobalamin) levels have been documented occasionally during long-term treatment with a proton pump inhibitor (PPI) in selected groups of patients. This has largely been confined to patients being treated for Zollinger-Ellison syndrome who have sustained drug-induced achlorhydria, which does not ordinarily occur during treatment with a PPI. An appreciation of normal cobalamin metabolism and the pharmacological action of the PPIs adequately explain the mechanism for this reduction. PPIs do not promote the development of pernicious anemia.
- J Clin Gastroenterol 2000 Jan;30(1):29-33 -- Vitamin B12 levels during prolonged treatment with proton pump inhibitors. -- Howden CW.

Possible effect on the absorption of zinc and iron. Gastric acid secretion has been demonstrated to facilitate iron absorption. Gastric acid secretion plays a role in the regulation of zinc absorption in man.
- J Am Coll Nutr 1991 Aug;10(4):372-5 -- Inhibition of gastric acid secretion reduces zinc absorption in man. -- Sturniolo GC, Montino MC, Rossetto L, Martin A, D'Inca R, D'Odorico A, Naccarato R.

The antacid was found to precipitate folic acid at a pH of greater than 4.0, thus removing it from the aqueous phase. This appears to be the explanation for the lowered folate absorption in the presence of antacid. Although the effects of these drugs on reducing folic acid absorption were relatively small, such reductions could become clinically significant in chronic antacid or H2 receptor antagonist use or intensive antacid or H2 receptor antagonist use by individuals eating diets that are marginal in folate content.
- J Lab Clin Med 1988 Oct;112(4):458-63 -- Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. -- Russell RM, Golner BB, Krasinski SD, Sadowski JA, Suter PM, Braun CL.

Drug Specific Information


last update: November 2008

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