Author/Editor		Ivanuša, Marijan; Kocijančič, Borut
Title		Varno zdravljenje gastroezofagealne refluksne bolezni s cisapridom in omeprazolom
Translated title		Safe use of cisapride and omeprazole in the treatmnet of gastroesophageal reflux disease
Type		članek
Source		Farm Vestn
Vol. and No.		Letnik 51
Publication year		2000
Volume		str. 95-102
Language		slo
Abstract		Cisapride is a gastrointestinal prokinetic agent that promotes and co-ordinates peristaltic movements. Owing to a special mechanism of action it possesses a lower potential of producing side effects than older prokinetic agents. Metabolic interactions may occur if cisapride is administered concurrently with medications that are metabolised at the cytochrome P450 subunit 3A4 in the liver. There have been reports of individual cases of cardiac arrhythmia, including ventricular tachycardia, ventricular fibrillation, ventricular arrhythmia of the type torsades de pointes and QT interval prolongation. In-depth analyses have demonstrated that the majority of the patients experiencing the above adverse events had been concurrently taking various other medications or had a cardiac condition or were at an increased risk of cardiac arrhythmia. Cisapride may be administered concurrently with medications reducing gastric acid secretion (famotidine, ranitidine, omeprazole, etc). The use of cisapride is safe when due attention is paid to the known contraindications and the correct dosage regimen. Omeprazole is a proton pump inhibitor. It is an inactive prodrug that is accumulated and activated in the secretory canaliculi of the parietal cells where it is covalently bound to thiol groups of the proton pump. This stops the activity of the proton pump and, consequently, acid production. Omeprazole is the drug of first choice for the treatment of ulcer disease, gastroesophageal reflux disease and Zollinger-Ellison syndrome. The clinical experience we have gathered with omeprazole is wider than with any other proton pump inhibitor. While the safety of short-term omeprazole treatment has been confirmed several years ago, indisputable evidence has been brought in the past years, confirming that long-term administration of omeprazole provides a safe therapy as well.
Summary		Cisaprid je gastrointestinalni prokinetik, ki prek mienteričnega pleteža spodbuja in koordinira peristaltične valove. Zaradi posebnega mehanizma delovanja povzroča manj stranskih učinkov kot starejši prokinetiki. Možne so metabolične interakcije z zdravili, ki se presnavljajo na podenoti 3A4 citokroma P-450 v jetrih. Poročali so o posameznih primerih srčne aritmije, vključno z ventrikularno tahikardijo, ventrikulamo fibrilacijo, ventrikularno aritmijo tipa torsades de pointes in podaljšanjem intervala QT. Natančne analize so pokazale, da je večina teh bolnikov sočasno jemala tudi številna druga zdravila ali pa so imeli srčno obolenje ali povečano tveganje za srčne aritmije. Cisaprid lahko jemljemo sočasno z zdravili, ki zmanjšajo izločanje želodčne kisline (famotidin, ranitidin, omeprazol itd.). Ob upoštevanju znanih kontraindikacij in ob pravilnem odmerjanju je uporaba cisaprida varna. Omeprazol je zaviralec protonske črpalke. Je neaktivno predzdravilo, ki se kopiči in aktivira v sekrecijskih kanalčkih parietalnih celic. Tam se kovalentno veže na tiolne skupine protonske črpalke in ustavi njeno delovanje, s tem pa tudi nastajanje kisline. Omeprazol je zdravilo prve izbire za zdravljenje ulkusne bolezni, gastroezofagealne refluksne bolezni in Zollinger-Ellisonovega sindroma. Z njim imamo več kliničnih izkušenj kot s katerimkoli drugim zaviralcem protonske črpalke. Varnost kratkotrajne uporabe je bila potrjena že pred več leti, v zadnjih letih pa so potrdili tudi varnost dolgotrajne uporabe omeprazola.
Descriptors		GASTROESOPHAGEAL REFLUX OMEPRAZOLE PIPERIDINES DRUG INTERACTIONS ARRHYTHMIA