The launch of the first proton pump inhibitor (PPI) to be licensed for “on-demand”
use — Astra Zeneca’s esomeprazole (Nexium) — has been followed
by warnings from the manufacturer of another PPI that these drugs might not
be safe when used intermittently.
In a press release issued on September 13 on behalf of Janssen-Cilag, manufacturer
of rabeprazole (Pariet), Dr Owen Epstein (consultant gastroenterologist, Royal
Free hospital, London) warns “Most patients should take [PPIs] daily to
prevent symptoms. PPIs are not a rescue therapy and patients should not wait
for symptoms and damage to occur before taking them.” Dr Epstein adds:
“Any patient experiencing gastro-oesophageal reflux disease symptoms is
a patient whose oesophagus is being damaged and who is at increased risk of
developing oesophageal ulcers, strictures, Barrett’s oesophagus and cancer.”
Commenting on this warning, Professor Duncan Colin-Jones (consultant gastroenterologist,
Queen Alexandra hospital, Portsmouth) told The Journal on September 19 that
it was important to separate out the patient groups for whom intermittent use
of PPIs was and was not appropriate. He said he saw no reason why PPIs could
not be taken intermittently for reflux that was not severe. Professor Colin-Jones
added that the principle laid down by the National Institute for Clinical Excellence
was to use the lowest effective dose of PPI and that this could be achieved
through “on-demand” use.