Page 67 - Retail Pharmacy Assistants - November 2020

common fracture location was the upper extremity, but the PPI cohort was more likely to suffer from lower-extremity, rib, and spinal fractures. This appeared to be a class effect and wasn’t tied to a specific PPI agent. “This study suggests an increased risk of fracture among otherwise healthy paediatric patients exposed to PPIs,” Nathan Robert Fleishman, lead researcher at Children’s Mercy Kansas City hospital in the US, said in a statement. Ms Rigby says the study supports the requirement to limit the use of PPIs to children who are benefiting from them, and for the least period required, as well as ensuring these children remain under medical supervision Another recent cohort study shows the extent to which use of PPIs is on the rise in children, as well as potential side effects. Published in Pediatrics, the study, ‘CYP2C19 phenotype and risk of proton pump inhibitor-associated infections’, examined DNA from patients aged between zero and three at the time of PPI exposure. Sara Van Driest, Assistant Professor of Pediatrics at Monroe Carell Jr Children’s Hospital in Vanderbilt, Tennessee, in the US, notes the increase in the number of adverse infection events associated with the use of PPIs in children. She says that because these medications are available OTC for LITTLE LEGENDS 65 adults, they’re thought to be a safe option for children, but her team’s research has shown that PPIs do carry some risk. According to Professor Van Driest, a specific enzyme in the body, CYP2C19, helps break down these medications. The enzyme works differently in each person – slow, normal, fast and sometimes not at all – impacting the ability of the medication to be safely metabolised. In that CYP2C19 inactivates PPIs, genetic variants that decrease the enzyme’s function may increase the medicine levels in the body, leading to more infection events. The body gets protection from unwanted organisms from stomach acid, so care has to be taken when reducing stomach acid, because it can increase risk of infections, Ms Rigby says. The study included PPI-exposed infants, both healthy and those with chronic health conditions, with varying levels of enzyme function. A total of 670 individuals took part in the study, with the findings adding to the growing evidence that CYP2C19’s impact on PPIs warrants extra consideration when prescribing. “We’re hoping that pediatricians will pause before starting PPIs, knowing that there’s an increased risk of infections while their patients are on this drug,” Professor Van Driest said. “If there’s a need to start the drug, they can consider genetic testing to find out their patient’s CYP2C19 status.” “It’s so important that pharmacies make sure that patients who use PPIs aren’t using them unnecessarily and for too long, with many unwanted side effects.” RETAIL PHARMACY ASSISTANTS • NOV 2020