News

RUMOR: Proton pump inhibitors (PPIs) don't need to be taken before meals after the first few doses.
TRUTH:      Some providers are telling patients that it's not necessary to take PPIs (omeprazole, etc) before meals...after the first few doses. They believe that the drug reaches steady state after a few days...and therefore timing of dosing doesn't matter.
     But this isn't true.
     The half-life of PPIs is only about 1 or 2 hours...so steady state can never be obtained with daily dosing. The drug will have washed out of the body before the next dose is given.
     The reason they can be dosed just once daily is because they IRREVERSIBLY inhibit the H/K ATPase enzyme. New enzymes have to be synthesized to overcome the inhibition. Once a proton pump is inactivated, acid inhibition lasts up to 24 hours.
     But PPIs only inhibit ACTIVE proton pumps, so they work best when acid secretion is being triggered by a meal.
     Tell patients to take their PPI on an EMPTY stomach...30 to 60 minutes BEFORE meals. Explain that it's best if the drug is on board before the acid pumps are activated. This ensures that the peak serum concentration of the PPI coincides with maximal acid secretion.
     Explain to patients that it can take up to 3 or 4 days of daily medication before they'll have full benefit. This is because not all proton pumps are inactivated with the first dose.