Ингибиторы протонной помпы в онкологической практике: побочные эффекты при длительном применении и лекарственное взаимодействие

Ингибиторы протонной помпы (ИПП) являются бесспорными лидерами в терапии кислотозависимых заболеваний. В реальной клинической практике в последние десятилетия использование ИПП растет в геометрической прогрессии. Долгое время ИПП считались полностью безопасными лекарственными веществами как для краткосрочного, так и для длительного применения. Однако в современных клинических рекомендациях и обзорах и метаанализах текущего десятилетия, посвященных безопасности применения ИПП, отмечается, что при назначении ИПП в больших дозах на длительный срок следует учитывать возможность развития многочисленных побочных эффектов. Нами проведен поиск в информационных базах PubMed и Scopus публикаций, посвященных безопасности применения ИПП, включавший источники до 01.12.2023. В рамках обзора затронуты вопросы лекарственного взаимодействия ИПП с химиотерапевтическими препаратами, что, безусловно, следует учитывать в реальной клинической практике. Кроме этого, в последних обзорах и метаанализах рассматриваются такие побочные эффекты долгосрочного применения ИПП, как повышенный риск инфекции (инфекция Clostridium difficile, внебольничная пневмония), электролитные нарушения, поражения почек, повышенный риск переломов бедра, запястья и позвонков; повышенный кардиоваскулярный риск и ряд других, которые также могут оказать неблагоприятное влияние на прогноз у онкологических пациентов. Риск развития рака желудка при длительной терапии ИПП можно рассматривать в качестве вероятного побочного эффекта, поскольку наличие их связи с приемом ИПП не отрицается и не подвергается сомнению в последних обзорах и метаанализах. В отношении повышенного риска других онкологических заболеваний еще сохраняется неопределенность, поскольку есть публикации, не подтверждающие наличия их связи с применением ИПП. Однако представленный обзор, несмотря на ряд противоречий, позволяет сделать вывод, что повышенный онкологический риск при длительном применении ИПП реален и его необходимо учитывать при назначении ИПП на длительный срок.

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