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Implicações farmacocinéticas do uso de inibidores da bomba de protões na população idosa polimedicada
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Abstract(s)
Os inibidores da bomba de protões (IBP) são amplamente utilizados no tratamento de doenças relacionadas com a hipersecreção gástrica, como a doença do refluxo gastroesofágico, úlceras pépticas, gastrite, esofagite de refluxo e para a erradicação do Helicobacter pylori. Em Portugal, estão disponíveis várias moléculas desta classe terapêutica, incluindo omeprazol, pantoprazol, esomeprazol, lansoprazol e rabeprazol.
Estes fármacos atuam por inibição irreversível da H⁺/K⁺ ATPase das células parietais gástricas, promovendo uma supressão prolongada da secreção ácida.
Apesar da sua eficácia e aparente segurança, o uso prolongado de IBP na população idosa polimedicada levanta preocupações significativas. O envelhecimento está associado a alterações farmacocinéticas relevantes, nomeadamente ao nível da absorção, distribuição, metabolismo e excreção (ADME), que podem comprometer a eficácia e segurança destes medicamentos. Nos idosos polimedicados, o risco de interações medicamentosas é elevado, sobretudo com fármacos metabolizados pelas mesmas vias hepáticas.
Adicionalmente, os IBP podem interferir na absorção ou metabolismo de outros medicamentos, aumentando o risco de reações adversas.
Apesar de classificados como medicamentos potencialmente inapropriados (MPI) em indivíduos com mais de 65 anos, os IBP continuam a ser prescritos por períodos prolongados e, por vezes, sem indicação clínica clara. Tal prática tem sido associada a efeitos adversos relevantes, como défices de micronutrientes, alterações da microbiota, fraturas osteoporóticas, complicações renais, hipergastrinémia e possível declínio
cognitivo.
Neste contexto, o papel do farmacêutico é central na promoção do uso racional dos IBP, através da revisão terapêutica periódica, identificação de interações, monitorização de efeitos adversos e apoio à desprescrição sempre que clinicamente indicada, contribuindo para uma terapêutica mais segura, eficaz e individualizada.
Proton pump inhibitors (PPIs) are widely used in the treatment of diseases related to gastric hypersecretion, such as gastroesophageal reflux disease, peptic ulcers, gastritis, reflux esophagitis, and for the eradication of Helicobacter pylori. In Portugal, several molecules in this therapeutic class are available, including omeprazole, pantoprazole, esomeprazole, lansoprazole, and rabeprazole. These drugs act by irreversibly inhibiting H⁺/K⁺ ATPase in gastric parietal cells, promoting prolonged suppression of acid secretion. Despite their efficacy and apparent safety, prolonged use of PPIs in the polymedicated elderly population raises significant concerns. Aging is associated with relevant pharmacokinetic changes, particularly in terms of absorption, distribution, metabolism, and excretion (ADME), which can compromise the efficacy and safety of these drugs. In polymedicated elderly patients, the risk of drug interactions is high, especially with drugs metabolized by the same hepatic pathways. In addition, PPIs may interfere with the absorption or metabolism of other drugs, increasing the risk of adverse reactions. Although classified as potentially inappropriate medications (PIMs) in individuals over 65 years of age, PPIs continue to be prescribed for prolonged periods and sometimes without clear clinical indication. This practice has been associated with significant adverse effects, such as micronutrient deficiencies, changes in the microbiota, osteoporotic fractures, renal complications, hypergastrinemia, and possible cognitive decline. In this context, the role of the pharmacist is central in promoting the rational use of PPIs through periodic therapeutic review, identification of interactions, monitoring of adverse effects, and support for deprescribing whenever clinically indicated, contributing to safer, more effective, and individualized therapy.
Proton pump inhibitors (PPIs) are widely used in the treatment of diseases related to gastric hypersecretion, such as gastroesophageal reflux disease, peptic ulcers, gastritis, reflux esophagitis, and for the eradication of Helicobacter pylori. In Portugal, several molecules in this therapeutic class are available, including omeprazole, pantoprazole, esomeprazole, lansoprazole, and rabeprazole. These drugs act by irreversibly inhibiting H⁺/K⁺ ATPase in gastric parietal cells, promoting prolonged suppression of acid secretion. Despite their efficacy and apparent safety, prolonged use of PPIs in the polymedicated elderly population raises significant concerns. Aging is associated with relevant pharmacokinetic changes, particularly in terms of absorption, distribution, metabolism, and excretion (ADME), which can compromise the efficacy and safety of these drugs. In polymedicated elderly patients, the risk of drug interactions is high, especially with drugs metabolized by the same hepatic pathways. In addition, PPIs may interfere with the absorption or metabolism of other drugs, increasing the risk of adverse reactions. Although classified as potentially inappropriate medications (PIMs) in individuals over 65 years of age, PPIs continue to be prescribed for prolonged periods and sometimes without clear clinical indication. This practice has been associated with significant adverse effects, such as micronutrient deficiencies, changes in the microbiota, osteoporotic fractures, renal complications, hypergastrinemia, and possible cognitive decline. In this context, the role of the pharmacist is central in promoting the rational use of PPIs through periodic therapeutic review, identification of interactions, monitoring of adverse effects, and support for deprescribing whenever clinically indicated, contributing to safer, more effective, and individualized therapy.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Inibidores da Bomba de Protões (IBP) Idosos Polifarmácia Farmacocinética