Review article: the clinical pharmacology of proton pump inhibitors

• Published in: Alimentary pharmacology & therapeutics 2006-06, Vol.23 (s2), p.2-8
• Main Authors: SACHS, G., SHIN, J. M., HOWDEN, C.W.
• Format: Article
• Language: English
• Subjects: Antacids - pharmacokinetics; Antacids - pharmacology; Antacids - therapeutic use; Anti-Ulcer Agents - pharmacokinetics; Anti-Ulcer Agents - pharmacology; Anti-Ulcer Agents - therapeutic use; Gastric Acid - secretion; Humans; Parietal Cells, Gastric - drug effects; Parietal Cells, Gastric - metabolism; Peptic Ulcer - blood; Peptic Ulcer - drug therapy; Proton Pump Inhibitors
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2006.02943.x

Summary Proton pump inhibitors inhibit the gastric H+/K+‐ATPase via covalent binding to cysteine residues of the proton pump. All proton pump inhibitors must undergo acid accumulation in the parietal cell through protonation, followed by activation mediated by a second protonation at the active secretory canaliculus of the parietal cell. The relative ease with which these steps occur with different proton pump inhibitors underlies differences in their rates of activation, which in turn influence the location of covalent binding and the stability of inhibition. Slow activation is associated with binding to a cysteine residue involved in proton transport that is located deep in the membrane. However, this is inaccessible to the endogenous reducing agents responsible for restoring H+/K+‐ATPase activity, favouring a longer duration of gastric acid inhibition. Pantoprazole and tenatoprazole, a novel proton pump inhibitor which has an imidazopyridine ring in place of the benzimidazole moiety found in other proton pump inhibitors, are activated more slowly than other proton pump inhibitors but their inhibition is resistant to reversal. In addition, tenatoprazole has a greatly extended plasma half‐life in comparison with all other proton pump inhibitors. The chemical and pharmacological characteristics of tenatoprazole give it theoretical advantages over benzimidazole‐based proton pump inhibitors that should translate into improved acid control, particularly during the night.