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Riscos associados à terapêutica prolongada com inibidores da bomba de protões
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Advisor(s)
Abstract(s)
Os inibidores da bomba de protões (IBP) são um grupo farmacoterapêutico com uma elevada relevância no tratamento de patologias gástricas. As suas indicações clínicas incluem o tratamento de úlceras gástricas, duodenais e de stress, da esofagite erosiva, do refluxo não erosivo, da dispepsia, da doença de refluxo gastroesofágico e da síndrome de Zollinger-Ellison. O mecanismo de ação dos IBP baseia-se na inibição irreversível da bomba de protões H+/K+ ATPase. Assim, conseguem inibir a produção de ácido e aumentam o pH estomacal, combatendo a acidez provocada pelas patologias gástricas.
Trata-se de um dos grupos de fármacos mais vendidos a nível mundial, representando milhões de vendas em cada país. Estudos realizados comprovaram que o seu consumo tem vindo a aumentar, e a cada 2 anos as prescrições destes medicamentos poderão aumentar cerca de 3 vezes. No entanto, estima-se que cerca de 40% destas prescrições de IBP não têm uma indicação clara para a sua utilização. O baixo custo, o fácil acesso ao medicamento, a falta de controlo médico e a suposta segurança destes fármacos são os principais fatores que contribuem para um uso excessivo e desadequado.
Os IBP são fármacos com alguns riscos associados e a sua utilização indiscriminada e de forma prolongada pode originar importantes distúrbios. A hipocloridria, a alteração da microbiota e interações de metabolização são os principais desequilíbrios associados à utilização de IBP de forma prolongada. Como consequência, a exposição continuada a estes fármacos pode diminuir a absorção de minerais e nutrientes fulcrais para o organismo, aumentar o risco de demência, fraturas ósseas, infeções entéricas, desenvolvimento de pólipos estomacais, desenvolvimento de pneumonias, aumentar o risco cardiovascular e desencadear lesões renais.
Os riscos e benefícios do uso prolongado destes fármacos devem ser ponderados e a prescrição médica deve ser reavaliada e reajustada, para que haja uma otimização da sua utilização.
Proton pump inhibitors (PPIs) are a pharmacotherapeutic group with high relevance in the treatment of gastric disorders. Their clinical indications include treatment of gastric, duodenal and stress ulcers, erosive esophagitis, non-erosive reflux, dyspepsia, gastroesophageal reflux disease, Zollinger-Ellison syndrome and Helicobacter pylori eradication. The mechanism of action of PPIs is based on the irreversible inhibition of the proton pump H+/K+ ATPase. Thus, they can inhibit acid production and increase stomach pH, fighting the acidity caused by gastric pathologies. It is one of the world's best-selling drug groups, representing millions of sales in each country. Studies have shown that their consumption has been increasing, and every 2 years the prescriptions of these medicines may increase about 3 times. However, it is estimated that around 40% of these PPIs prescriptions do not have a clear indication for their use. The low cost, the easy access to the drug, the lack of medical control and the supposed safety of these drugs are the main factors that contribute to their excessive and inappropriate use. PPIs are drugs with some associated risks and their indiscriminate and prolonged use can lead to major disturbances. Hypochloridria, microbiota alteration and metabolization interactions are the main causes for risks to arise. Prolonged use of PPIs may decrease the absorption of minerals and key nutrients into the body, increase the risk of dementia, bone fractures, enteric infections, development of stomach polyps, development of pneumonia, increase cardiovascular risk and trigger renal damage. The risks and benefits of prolonged use of these drugs should be weighed and the prescription should be reevaluated and readjusted for optimal use.
Proton pump inhibitors (PPIs) are a pharmacotherapeutic group with high relevance in the treatment of gastric disorders. Their clinical indications include treatment of gastric, duodenal and stress ulcers, erosive esophagitis, non-erosive reflux, dyspepsia, gastroesophageal reflux disease, Zollinger-Ellison syndrome and Helicobacter pylori eradication. The mechanism of action of PPIs is based on the irreversible inhibition of the proton pump H+/K+ ATPase. Thus, they can inhibit acid production and increase stomach pH, fighting the acidity caused by gastric pathologies. It is one of the world's best-selling drug groups, representing millions of sales in each country. Studies have shown that their consumption has been increasing, and every 2 years the prescriptions of these medicines may increase about 3 times. However, it is estimated that around 40% of these PPIs prescriptions do not have a clear indication for their use. The low cost, the easy access to the drug, the lack of medical control and the supposed safety of these drugs are the main factors that contribute to their excessive and inappropriate use. PPIs are drugs with some associated risks and their indiscriminate and prolonged use can lead to major disturbances. Hypochloridria, microbiota alteration and metabolization interactions are the main causes for risks to arise. Prolonged use of PPIs may decrease the absorption of minerals and key nutrients into the body, increase the risk of dementia, bone fractures, enteric infections, development of stomach polyps, development of pneumonia, increase cardiovascular risk and trigger renal damage. The risks and benefits of prolonged use of these drugs should be weighed and the prescription should be reevaluated and readjusted for optimal use.
Description
Keywords
Inibidores da bomba de protões Riscos Uso abusivo Terapêutica prolongada Proton pump inhibitors Risks Abusive use Prolonged therapy