Why some proton pump inhibitors are more equal than others

After the omeprazole patent expired in 2002, numerous generic products were introduced on the market. In a relatively short time many patients received substituted treatment. Clinicians noted a substantial number of patients with more reflux symptoms. We describe a male surgeon of 61 and a woman of...

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Bibliographic Details
Published inNederlands tijdschrift voor geneeskunde Vol. 153; p. B414
Main Authors Otten, Marten H, Lekkerkerker, J F F Frits, Mulder, Chris J J
Format Journal Article
LanguageDutch
Published Netherlands 2009
Subjects
2-Pyridinylmethylsulfinylbenzimidazoles
Deglutition Disorders - etiology
Drugs, Generic - adverse effects
Drugs, Generic - pharmacokinetics
Drugs, Generic - therapeutic use
Female
Gastroesophageal Reflux - drug therapy
Humans
Intestinal Absorption
Male
Middle Aged
Omeprazole - pharmacokinetics
Omeprazole - therapeutic use
Proton Pump Inhibitors - pharmacokinetics
Proton Pump Inhibitors - therapeutic use
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Summary:After the omeprazole patent expired in 2002, numerous generic products were introduced on the market. In a relatively short time many patients received substituted treatment. Clinicians noted a substantial number of patients with more reflux symptoms. We describe a male surgeon of 61 and a woman of 59 both with the red flag symptom of dysphagia after generic substitution. The first patient received a generic substitute of omeprazole, the second a therapeutic substitute of pantoprozole, i.e. omeprazole. The literature suggests three possibilities to explain the inadequacy of the substitution: (a) biphasic metabolism where the raised pH in the stomach may prematurely inactivate the PPI, with an unpredictable effect, (b) differences in acid-resistant coating of the generic products, and (c) influence of multiple dosing of PPIs after several days' use. We conclude that all three factors may contribute to a difference in absorption and therefore clinical effectiveness.
ISSN:0028-2162
1876-8784