[india-drug] RE: Omeprazole (5)

["Nusrat Shafiq" <nusrat_shafiq@hotmail.com>]

Omeprazole (5)
******** 

Dear Pranav,

Apologies for not having replied earlier. I was very tied up.

What purpose would isomerization of PPI serve?  I will give you the example 
of Nexium which I had mentioned in my previous mail.

Well, Nexium is the left-handed version of omeprazole. S-omeprazole is one 
half of the mixture that comprises it?s predecessor. By specifically picking 
only the S conformation, the drug is made more potent. This sounds great, 
but its efficacy is only marginally better than Prilosec ? which has a 
generic version, and costs about a third less than Nexium.

I looked for interaction studies with antacids and PPIs, came across one, by 
Yesuda et al, 1999 Int J Clin Pharmacol Therap; 37 ----no significant 
interaction was noted bw antacid and PPI. Can we imagine a situation where 
the two would need to be given together? Hence, the clinical relevance of 
such a study is questionable.

Your suggestion regarding the use of PPI alternating with H2 blockers is 
sound logically but again why would you need to make it complex, when years 
of use of PPIs have shown it to be very safe? and effective. Y not ct giving 
PPI all days of the week?/

Warm Regards,
Nusrat

Dr Nusrat S.Khan
M.D(Pharmacology), D.M(Clinical Pharmacology)
PGIMER, Chandigarh
"Nusrat Shafiq" <nusrat_shafiq@hotmail.com>


P.S. At undergrad level I was not thinking of drugs as much as you are. Keep 
it up. I agree with most of the things you raised about teaching 
Pharmacology to undergrads.
P.S, P.S, P.S: Calling me Sir would amount to gender misappropriation!!!