Myopathy including polymyositis: a likely class adverse effect of proton pump inhibitors?

  title={Myopathy including polymyositis: a likely class adverse effect of proton pump inhibitors?},
  author={David W. J. Clark and Johanna Strandell},
  journal={European Journal of Clinical Pharmacology},
ObjectivePolymyositis occurring in patients treated with omeprazole has been signalled as a possible adverse drug reaction (ADR) by the New Zealand Intensive Medicines Monitoring Programme (IMMP) and the WHO Collaborating Centre for International Drug Monitoring: the Uppsala Monitoring Centre (UMC). Polymyositis and other myopathies have also been reported in post-marketing data and in the medical literature in association with proton pump inhibitor (PPI) use. We wished to follow-up these… 


This report concluded that lansoprazole could triggered myopathy adverse drug reaction in some sensitive patient and urged health professionals to pay more attention at possible myopathic adverse drug reactions in the use of lansobrazole and other proton pump inhibitors, so that more serious adverseDrug reactions could be prevented.

Proton Pump Inhibitors

A limited body of published data suggests that PPI use has been associated with myopathy-like symptoms without long-term effects following discontinuation, and overall, the available published data do not show a high risk of myopathy with PPI Use but should be considered if a patient presents with myopathic symptoms and concurrent PPIUse.

Statin-Associated Polymyositis Following Omeprazole Treatment

A man, age 59 years, who had been treated with a combination of atorvastatin and gemfibrozil for approximately 5 years and developed polymyositis after treatment with omeprazole for 7 months is described.

Muscular Adverse Drug Reactions Associated with Proton Pump Inhibitors: A Disproportionality Analysis Using the Italian National Network of Pharmacovigilance Database

It is suggested that the class of PPIs could be involved in reports of muscular ADRs, rather than any other ADR, more frequently than any non-statin drug.

Proton Pump Inhibitors and Risk of Rhabdomyolysis

The level of evidence is insufficient to establish a causal relationship and is largely based on sporadic case reports, so in general, patients with suspected PPI-associated rhabdomyolysis have not been re-challenged with a PPI after recovery.

Proton pump inhibitors are not associated with inflammatory myopathies: A case control study

The findings do not support an association of PPI exposure with IM and could be further investigated with larger cohorts.

Polymyositis Presenting as Rhabdomyolysis After the Initiation of Omeprazole

Clinicians should consider autoimmune myopathy in the differential for cases with persistently elevated creatine kinase in patients with rhabdomyolysis who do not respond to first-line therapy.

Diclofenac- and Pantoprazole-Induced Rhabdomyolysis: A Potential Drug Interaction

The close relationship between diclofenac and pantoprazole, and the cytochrome P450 and P-glycoprotein systems offers a strong indication that a drug interaction may be occurring.

Rhabdomyolysis in an elderly multitreated patient: Multiple drug interactions after statin withdrawal

Perils and pitfalls of long-term effects of proton pump inhibitors

There is mounting evidence that PPIs are associated with serious adverse effects, and practitioners should be vigilant and counsel patients accordingly.



Rhabdomyolysis Causing AV Blockade Due to Possible Atorvastatin, Esomeprazole, and Clarithromycin Interaction

The pharmacokinetic profiles of these agents suggest that a possible contribution to this reaction was P-glycoprotein (PGP) inhibition by esomeprazole altering atorvastatin's normally significant first-pass clearance.

Possible Lansoprazole-Induced Eosinophilic Syndrome

The time course strongly suggests that lansoprazole was the causative agent and it is important to consider medications when diagnosing patients with hypereosinophilia and/or myalgia when diagnostican pacientes con hipereos inofilia y/o mialgia.

Rhabdomyolysis associated with omeprazole

A 56-year-old Japanese man visited Tokyo Metropolitan Police Hospital with an episode of nausea and dizziness that had begun the previous evening, and a follow-up examination showed that he was doing well 6 months later, although his physical findings were negative for rhabdomyolysis.

Effects of clarithromycin on lansoprazole pharmacokinetics between CYP2C19 genotypes.

It is indicated that there are significant drug interactions between lansoprazole and clarithromycin in all CYP2C19 genotype groups probably through CYP3A inhibition, and the bioavailability of lansiprazole might, to some extent, be increased through inhibition of P-glycoprotein during clarityromycin treatment.

Comparison of inhibitory effects of the proton pump-inhibiting drugs omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole on human cytochrome P450 activities.

In vitro studies suggest that lansoprazoles and pantoprazole are the most potent in vitro inhibitors of CYP2C19 and CYP3A4, respectively.

Quality criteria for early signals of possible adverse drug reactions

Signal Generation in the New Zealand Intensive Medicines Monitoring Programme

Rates of reporting should be quoted with the results of cohort studies to facilitate assessment of their power to detect new signals, and more resources need to be invested in the training and support of clinical evaluators.

A Bayesian neural network method for adverse drug reaction signal generation

The BCPNN will be an extremely useful adjunct to the expert assessment of very large numbers of spontaneously reported ADRs, and can be used in the detection of significant signals from the data set of the WHO Programme on International Drug Monitoring.

Introducing triage logic as a new strategy for the detection of signals in the WHO Drug Monitoring Database

The signal detection strategy at the Uppsala Monitoring Centre (UMC) gave too many drug–adverse drug reaction (ADR) combinations for individual review, so additional selection strategies were needed to improve the likely signal‐to‐noise ratio.