Acid-suppressive Drugs Research Articles

PP-62 - Is prescribing acid suppressive drugs for every patient is a good decision: a pH+ all case report

PP-62 - Is prescribing acid suppressive drugs for every patient is a good decision: a pH+ all case report

Review: Helicobacter pylori in pediatrics.

Despite a decrease in the prevalence of Helicobacter pylori infection, it still poses a significant health burden worldwide. This review summarizes important pediatric studies on Hpylori published from April 2018 to March 2019. Epidemiologic studies have reported different prevalences in different parts of the world and have mainly confirmed traditional risk factors. Several studies on pathophysiology attempted to identify risk markers in childhood for gastric cancer development later in life. One of the most interesting studies evaluated the relationship between eosinophilic esophagitis and Hpylori infection; however, an inverse relationship was not confirmed. The high resistance of Hpylori and, consequently, low eradication rates, is still a major concern and susceptibility testing before treatment has again been highlighted. Potassium-competitive acid blockers are promising new acid-suppressant drugs but their role in Hpylori eradication schemes is still to be determined.

Type IV Gastric Carcinoids in the Stomach Caused by ATP4A Gene Mutations

A 51-year-old Japanese woman who had a history of multiple gastric polyps for 10 years was referred to our hospital. Esophagogastroduodenoscopy showed multiple, small protruding lesions on the wall of the fundus and body of the stomach without any atrophic change (Figure A). She had never received acid suppression drugs or eradication therapy for Helicobacter pylori infection and anti–H pylori blood antibody test was negative. Although the serum antibodies for antiparietal cell and intrinsic factors were negative and her hemoglobin level was within the normal range, laboratory examination showed marked hypergastrinemia (4722 pg/mL).

Evaluación de la prescripción y uso de medicamentos supresores de ácido en hospitales centrales en la región de Abha, Arabia Saudita

Objetivo: El objetivo de este estudio fue estudiar y evaluar las indicaciones de los medicamentos supresores de ácidos y averiguar el porcentaje de recetas irracionales con medicamentos supresores de ácidos. Material / Métodos: es un estudio observacional prospectivo realizado en los Hospitales de las Fuerzas Armadas del Sur y en el Hospital de Maternidad Abha, ambos en Abha en la región de Assir (Arabia Saudita). El tamaño muestral del estudio fue de 185 pacientes. Se revisaron las hojas de casos de orden de prescripción de los pacientes para la prescripción de medicamentos supresores de ácido y se tomaron los datos pertinentes. Se identificó la edad de los pacientes mayores de 18 años. La duración del estudio fue de 8 semanas, entre mayo y junio de 2017. Resultados: nuestros resultados mostraron que la mayoría de las prescripciones de inhibidores de la bomba de protones (68,1%) eran injustificables y que este era el fármaco supresor de ácido más comúnmente prescrito para los pacientes (97,8%). La frecuencia de prescripción para los trastornos del espectro autistas en nuestro estudio, fue mayor en pacientes con un factor de riesgo existente y fue recomendada principalmente por los médicos como medicamentos concomitantes (67,6%). Los medicamentos concomitantes más comunes que se usaron con los inhibidores de la bomba de protones fueron los antiinflamatorios no esteroideos (29.2%) en los cuales la aspirina supuso el 13,5% de los antiinflamatorios no esteroideos prescritos, seguidos por los antimicrobianos (9.2%) Conclusión: los medicamentos supresores de ácido son los medicamentos más comúnmente recetados sin indicaciones adecuadas, por lo que son irracionales. Basado en los resultados de este estudio, crear conciencia sobre el uso razonable de los medicamentos supresores del ácido es una necesidad.

Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study

ObjectiveTo estimate all cause mortality and cause specific mortality among patients taking proton pump inhibitors (PPIs).DesignLongitudinal observational cohort study.SettingUS Department of Veterans Affairs.ParticipantsNew users of PPIs (n=157 625) or H2...

The Reduction in Gastric Atrophy after Helicobacter pylori Eradication Is Reduced by Treatment with Inhibitors of Gastric Acid Secretion.

Background: Helicobacter pylori (H. pylori) eradication therapy may improve gastric atrophy and intestinal metaplasia, but the results of previous studies have not always been consistent. The aim of this study was to compare the histological changes of intestinal metaplasia and gastric atrophy among the use of acid-suppressing drugs after H. pylori eradication. Methods: A cohort of 242 patients who underwent successful eradication therapy for H. pylori gastritis and surveillance endoscopy examination from 1996 to 2015 was analyzed. Changes in the histological scores of intestinal metaplasia and atrophy according to drug use (proton-pump inhibitors (PPIs), H2 receptor antagonists (H2RAs), and non-acid suppressant use) were evaluated in biopsies of the antrum and corpus using a generalized linear mixed model in all patients. Results: The mean follow-up period and number of biopsies were 5.48 ± 4.69 years and 2.62 ± 1.67 times, respectively. Improvement in the atrophy scores of both the antrum (p = 0.042) and corpus (p = 0.020) were significantly superior in patients with non-acid suppressant drug use compared with those of PPI and H2RA use. Metaplasia scores in both the antrum and corpus did not improve in all groups, and no significant differences were observed among groups in the antrum (p = 0.271) and corpus (p = 0.077). Conclusions: Prolonged acid suppression by PPIs or H2RAs may limit the recovery of gastric atrophy following H. pylori eradication.

Attitude and knowledge of Saudi community pharmacists towards use of proton pump inhibitors

IntroductionProton pump inhibitors (PPIs) effectively suppress acid secretion and play an important role in peptic ulcer disease and gastroesophageal reflux disease. There is a real concern about the overutilization of PPIs, which will lead to significant high cost and undesirable outcomes. Despite that most of PPIs are classified as prescribed medications, yet most of their users take them without prescription in Saudi Arabia. Therefore, it was important to understand community pharmacists practice in dealing with PPIs and to evaluate their despising pattern of these medications. MethodA cross-sectional survey-based study that was carried out between September and December 2017. The survey intended to evaluate the knowledge and attitude of CPs towards use of proton pump inhibitors and was built as an online survey. ResultsThe results of this study showed that almost all CPs prescribe anti-ulcer drugs for their patients. Most of the participants (68.4%) have prescribed PPI for acute gastritis (68.4%), prophylaxis for stress ulcers (17.7%) and stress ulcer (11.1%). 54.9 percent of the participants recommend using acid suppression drugs for 1 to 2 weeks when they prescribe them to their patients. Thirty-two percent of the respondents had reported adverse events with PPIs. The study showed a significant association between length of work experience in community pharmacy and reporting adverse events. ConclusionCommunity pharmacists in Saudi Arabia usually recommend and prescribe PPIs to their patients. Most of them have some knowledge on PPIs indications and side effects. Managing OTC PPI use in the community pharmacy setting is necessary to promote both patient and medication safety.

Pembrolizumab-Induced Hepatitis and Pancreatitis in a Patient With Stage IV Non-Small Cell Lung Cancer

Immune checkpoint inhibitors are a novel approach to treat cancers. Firstly used for treatment of malignant melanomas with promising results, they were later expanded to treat other cancers including non-small cell lung cancers (NSCLC) expressing PD-L1. We present a case of a 66-year-old male who was admitted to the hospital for generalized gastrointestinal complaints consisting of abdominal pain, nausea, vomiting, and loose stools occurring five times daily. Labs were significant for acute transaminitis with hyperbilirubinemia and elevated lipase. All workup for infectious and noninfectious causes was negative. The patient was started pembrolizumab 15 days before admission and his previous labs had all been normal before the initiation of treatment. He was treated with high dose of steroids with initial improvement and discharged on oral steroids taper. He subsequently presented again with worsening liver function tests (LFTs) results and was restarted on a higher dose but unable to tolerate it due to steroid-induced psychosis and left the hospital against medical advice. Presented the third time with persistent elevation of LFTs and worsening hyperbilirubinemia, this time he was started on different class of steroid with atypical antipsychotic but left again a few days later seeking care at a tertiary care institute. This case highlights one of the severe side effects of the immune checkpoint inhibitors which is acute hepatitis that can sometimes lead to acute liver failure. Prompt treatment with steroids is indicated for these patients; and those who are refractory or intolerant to steroids can be treated with a multimodal approach using topical steroids, N-acetylcysteine (NAC), ursodeoxycholic acid and immune suppressant drugs. J Med Cases. 2018;9(9):320-322 doi: https://doi.org/10.14740/jmc3131w

A Population-Based Pharmacokinetic Model Approach to Pantoprazole Dosing for Obese Children and Adolescents.

Pharmacokinetic data for proton pump inhibitors (PPIs), acid-suppression drugs commonly prescribed to children, are lacking for obese children who are at greatest risk for acid-related disease. In a recent multi-center investigation, we demonstrated decreased, total body weight adjusted, apparent clearance (CL/F) of the PPI pantoprazole for obese children compared with their non-obese peers. Subsequently, we developed a population-based pharmacokinetic (PopPK) model to characterize pantoprazole disposition and evaluated appropriate pantoprazole dosing strategies for obese pediatric patients, using simulation. Pharmacokinetic data from the only prospective study of PPIs in obese children (aged 6-17years; n = 40) included 273 pantoprazole and 256 pantoprazole-sulfone plasma concentrations, after single oral-dose administration, and were used for pantoprazole model development and covariate analysis (NONMEM®). Model evaluation was performed via bootstrapping and predictive checks, and the final model was applied to simulate systemic pantoprazole exposures for common dosing scenarios. A two-compartment PopPK model, which included CYP2C19 genotype and total body weight, provided the best fit. Resultant, typical, weight-normalized pantoprazole parameter estimates were different than previously reported for children or adults, with significantly reduced pantoprazole CL/F for obese children. Of the dosing scenarios evaluated, the weight-tiered approach, approved by the US Food and Drug Administration, achieved pantoprazole exposures [area under the curve (AUC0-∞)] within ranges previously reported as therapeutic, without over- or under-prediction for obese children. Our data argue against empiric dose escalation of PPIs for obese children and support current FDA-approved pediatric weight-tiered dosing for pantoprazole; however, 3- to 5-fold inter-individual variability in pantoprazole AUC0-∞ remained using this dosing approach.

Decrease in the Inappropriate Use of Acid Suppression Therapy in the Geriatric Age Group by Educational Intervention

Inappropriate use of acid suppression therapy may lead to unnecessary harms, especially in the geriatric population. Despite this, acid suppression therapy remains one of the most commonly prescribed medications in the hospital. Therefore, we aimed to assess the prevalence of acid suppression therapy in a geriatric inpatient population and to create an educational intervention to improve the appropriateness of inpatient acid suppression therapy in this population. Using a time-series design, we established a historical control by performing a retrospective chart review on inpatient geriatric patients who were started on acid suppression therapy while in a teaching-based hospital. Accepted indications for acid suppression therapy were based on those endorsed by the US Food and Drug Administration and literature review. Inclusion criteria were: (1) age 65 years or older; (2) acid suppression therapy-initiated in the hospital; and (3) patients admitted to the medicine teaching services. Patients who were already on acid suppression drugs before their hospitalization were excluded. We then created an educational intervention, which consisted of lectures and distribution of information pocket cards to residents. Data were collected for 2 months after the intervention. We used a 2-tailed Fisher’s exact test and Student t test to analyze our results. Before our educational intervention, 65% of geriatric patients were inappropriately placed on acid suppression therapy, for which 13% were discharged without further indications. After the educational intervention, the inappropriate use of acid suppression therapy decreased to 45% (P < .001). In addition, there was a significant increase from 35% to 55% (P < .001) in the appropriate use of acid suppression therapy after the educational intervention. There is a significant overuse of acid suppression therapy in hospitalized geriatric patients. These agents are often continued at the time of the discharge, leading to potential harms and increased health care cost. Educational interventions are one potential method that may help improve the appropriateness of acid suppression therapy for elderly inpatients.

Bacteria, Bones, and Stones: Managing Complications of Short Bowel Syndrome.

Short bowel syndrome (SBS) occurs in patients who have had extensive resection. The primary physiologic consequence is malabsorption, resulting in fluid and electrolyte abnormalities and malnutrition. Nutrient digestion, absorption, and assimilation may also be diminished by disturbances in the production of bile acids and digestive enzymes. Small bowel dilation, dysmotility, loss of ileocecal valve, and anatomical changes combined with acid suppression and antimotility drugs increase the risk of small intestinal bacterial overgrowth, further contributing to malabsorption. Metabolic changes that occur in SBS due to loss of colonic regulation of gastric and small bowel function can also lead to depletion of calcium, magnesium, and vitamin D, resulting in demineralization of bone and the eventual development of bone disease. Persistent inflammation, steroid use, parenteral nutrition, chronic metabolic acidosis, and renal insufficiency may exacerbate the problem and contribute to the development of osteoporosis. Multiple factors increase the risk of nephrolithiasis in SBS. In the setting of fat malabsorption, increased free fatty acids are available to bind to calcium, resulting in an increased concentration of unbound oxalate, which is readily absorbed across the colonic mucosa where it travels to the kidney. In addition, there is an increase in colonic permeability to oxalate stemming from the effects of unabsorbed bile salts. The risk of nephrolithiasis is compounded by volume depletion, metabolic acidosis, and hypomagnesemia, resulting in a decrease in renal perfusion, urine output, pH, and citrate excretion. This review examines the causes and treatments of small intestinal bacterial overgrowth, bone demineralization, and nephrolithiasis in SBS.

Stress-related upper gastrointestinal bleeding in adult neurocritical care patients: a Chinese multicenter, retrospective study

Objective: China has limited data on stress-related gastrointestinal ulcers in patients admitted for neurosurgical care. This study evaluated the incidence of upper gastrointestinal bleeding (UGIB) and use of stress ulcer prophylaxis (SUP) in Chinese neurocritical care patients (Glasgow Coma Scale [GCS] score ≤10).Methods: This multicenter, retrospective study was performed from January 2015 to July 2015. Medical records of 1468 patients hospitalized during 2014 were reviewed. An estimated UGIB incidence rate of 4.4% was considered for precision of 1.3% for estimation of UGIB. The primary endpoint was evaluation of overall incidence of any overt UGIB in ≤14 days after cerebral lesion. Secondary endpoints included incidence of UGIB with or and without clinically significant complications, time to UGIB, associated risk factors and SUP used.Results: We analyzed 1416 patients (mean age: 53.7 ± 14.00 years; males: 62.4%) with cerebral lesions. Overall incidence rate of UGIB ≤14 days was 12.9% (95% CI: 11.2%–14.7%), 0.76% with and 12.1% without significant clinical complications. Average time and duration of bleeding were 2.9 ± 3.37 days and 4.2 ± 8.4 days, respectively. The most significant risk factors for UGIB were mechanical ventilation for >48 hours (p < .0001), UGIB history (p = .0026) and use of anticoagulants (p < .0001). Acid-suppression drugs were administered for SUP in 79.0% of the patients, whereas 40.5% received hemostatic drugs.Conclusions: The rate of UGIB incidence was higher than the estimated rate in neurocritical care patients in China, suggesting the need for better management and treatment for stress-related mucosal disease in China. History of UGIB, mechanical ventilation and/or anticoagulants significantly affected UGIB.ClinicalTrials registry number: NCT02316990.

Acid-suppressive drugs and risk of kidney disease: A systematic review and meta-analysis.

More concerns had been raised about the risk of kidney disease (KD) associated with acid-suppressive drugs. But whether they could directly increase such risk remained unclear. Meta-analysis was conducted to comprehensively investigate this relationship. PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and three Chinese databases were searched until April 2017 for observational studies investigating the associations between acid-suppressive drugs and KD. Pooled log (odds ratios [ORs]) or log (hazard ratios [HRs]) with standard errors for KD risk were calculated using the generic inverse variance method and random-effect model. Ten studies involving 128020 KD patients were included. Proton pump inhibitor (PPI) therapy was associated with higher risks of acute interstitial nephritis (OR, 2.78; 95% confidence interval [CI], 1.25-6.17), acute kidney injury (AKI) (HR, 1.85; 95% CI, 1.33-2.59), chronic kidney disease (CKD) (HR, 1.47; 95% CI, 1.03-2.09), and end-stage renal disease (ESRD) (HR, 1.61; 95% CI, 1.26-2.04) than non-PPI therapy. Additionally, PPI significantly increased the risks of AKI (HR, 1.32; 95% CI, 1.16-1.51), CKD (HR, 1.28; 95% CI, 1.24-1.33), and ESRD (HR, 1.96; 95% CI, 1.21-3.17) compared with histamine 2 receptor antagonist (H2 RA). Relationship between H2 RA therapy and AKI (OR, 0.98; 95% CI, 0.90-1.07) or CKD (OR, 1.00; 95% CI, 0.89-1.11) was not found. Proton pump inhibitor therapy significantly increased the risks of acute interstitial nephritis, AKI, CKD, and ESRD. Similar risks were not identified for H2 RA therapy. More clinical trials are needed to confirm our findings.

Acid-Suppressive Drug Use During Pregnancy and the Risk of Childhood Asthma: A Meta-analysis.

The association between acid-suppressive drug exposure during pregnancy and childhood asthma has not been well established. To conduct a systematic review and meta-analysis on this association to provide further justification for the current studies. We searched PubMed, Medline, Embase, the Cochrane Database of Systematic Reviews, EBSCO Information Services, Web of Science, and Google Scholar from inception until June 2017. Observational studies in which researchers assessed acid-suppressive drug use during pregnancy and the risk of childhood asthma were included. Of 556 screened articles, 8 population-based studies were included in the final analyses. When all the studies were pooled, acid-suppressive drug use in pregnancy was associated with an increased risk of asthma in childhood (relative risk [RR] = 1.45; 95% confidence interval [CI] 1.35-1.56; I2 = 0%; P < .00001). The overall risk of asthma in childhood increased among proton pump inhibitor users (RR = 1.34; 95% CI 1.18-1.52; I2 = 46%; P < .00001) and histamine-2 receptor antagonist users (RR = 1.57; 95% CI 1.46-1.69; I2 = 0%; P < .00001). None of the researchers in the studies in this meta-analysis adjusted for the full panel of known confounders in these associations. The evidence suggests that prenatal, maternal, acid-suppressive drug use is associated with an increased risk of childhood asthma. This information may help clinicians and parents to use caution when deciding whether to take acid-suppressing drugs during pregnancy because of the risk of asthma in offspring.

Use acid-suppressing drugs appropriately with an individualized approach to minimize the risk of infection

Acid-suppressing drugs (ASDs) have been associated with an increased risk of various infections, although causality has not been determined owing to data limitations and conflictions. As such, ASDs should be used cautiously and be limited to appropriate evidence-based settings. ASD regimens should also be individualized (taking into account patient risk factors, likelihood of adverse events and drug interactions) and the overall risks and benefits of the therapy balanced. It may also be prudent to consider adjunctive preventative measures, such as prebiotics, probiotics, increased fibre intake and correction of vitamin D status.

Functional dyspepsia.

Functional dyspepsia is one of the most prevalent functional gastrointestinal disorders. Functional dyspepsia comprises three subtypes with presumed different pathophysiology and aetiology: postprandial distress syndrome (PDS), epigastric pain syndrome (EPS) and a subtype with overlapping PDS and EPS features. Functional dyspepsia symptoms can be caused by disturbed gastric motility (for example, inadequate fundic accommodation or delayed gastric emptying), gastric sensation (for example, sensations associated with hypersensitivity to gas and bloating) or gastric and duodenal inflammation. A genetic predisposition is probable but less evident than in other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Psychiatric comorbidity and psychopathological state and trait characteristics could also play a part, although they are not specific to functional dyspepsia and are less pronounced than in IBS. Possible differential diagnoses include Helicobacter pylori infection and peptic ulceration. Pharmacological therapy is mostly based on the subtype of functional dyspepsia, such as prokinetic and fundus-relaxing drugs for PDS and acid-suppressive drugs for EPS, whereas centrally active neuromodulators and herbal drugs play a minor part. Psychotherapy is effective only in a small subset of patients, whereas quality of life can be severely affected in nearly all patients. Future therapies might include novel compounds that attempt to treat the underlying gastric and duodenal inflammation.

Designed inhibitors with hetero linkers for gastric proton pump H+,K+-ATPase: Steered molecular dynamics and metadynamics studies

Acid suppressant SCH28080 and its derivatives reversibly reduce acid secretion activity of the H+,K+-ATPase in a K+ competitive manner. The results on homologation of the SCH28080 by varying the linker chain length suggested the improvement in efficacy. However, the pharmacokinetic studies reveal that the hydrophobic nature of the CH2 linker units may not help it to function as a better acid suppressant. We have exploited the role of linker unit to enhance the efficacy of such reversible acid suppressant drug molecules using hetero linker, i.e., disulfide and peroxy linkers. The logarithm of partition coefficient defined for a drug molecule relates to the partition coefficient, which allows the optimum solubility characteristics to reach the active site. The logarithm of partition coefficient calculated for the designed inhibitors suggests that inhibitors would possibly reach the active site in sufficient concentration like in the case of SCH28080. The steered molecular dynamics studies have revealed that the Inhibitor-1 with disulfide linker unit is more stable at the active site due to greater noncovalent interactions compared to the SCH28080. Centre of mass distance analysis suggests that the Cysteine-813 amino acid residue selectively plays an important role in the inhibition of H+,K+-ATPase for Inhibitor-1. Furthermore, the quantum chemical calculations with M11L/6-31+G(d,p) level of theory have been performed to account the noncovalent interactions responsible for the stabilization of inhibitor molecules in the active site gorge of the gastric proton pump at different time scale. The hydrogen bonding and hydrophobic interaction studies corroborate the center of mass distance analysis as well. Well-tempered metadynamics free energy surface and center of mass separation analysis for the Inhibitor-1 is in good agreement with the steered molecular dynamics results. The torsional angle of the linker units seems to be crucial for better efficacy of drug molecules. The torsional angle of linker units of SCH28080 (COCH2C) and of Inhibitor 1 (CSSC) prefers to lie within ∼60°–90° for a longer time during the simulations, whereas, the peroxy linker (COOC) of Inhibitor 2 prefers to adopt ∼120–160°. Therefore, it appears that the smaller torsion angle of linker units can achieve better interactions with the active site residues of H+,K+-ATPase to inhibit the acid secretion activity. The reversible drug molecules with disulfide linker unit would be a promising candidate as proton pump antagonist to H+,K+-ATPase.

Stress Ulcer Prophylaxis in Neurocritical Care.

Stress ulcer prophylaxis (SUP) with acid-suppressive drug therapy is widely utilized in critically ill patients following neurologic injury for the prevention of clinically important stress-related gastrointestinal bleeding (CIB). Data supporting SUP, however, largely originates from studies conducted during an era where practices were vastly different than what is considered routine by today's standard. This is particularly true in neurocritical care patients. In fact, the routine provision of SUP has been challenged due to an increasing prevalence of adverse drug events with acid-suppressive therapy and the perception that CIB rates are sparse. This narrative review will discuss current controversies with SUP as they apply to neurocritical care patients. Specifically, the pathophysiology, prevalence, and risk factors for CIB along with the comparative efficacy, safety, and cost-effectiveness of acid-suppressive therapy will be described.

Тест сравнительной кинетики растворения лекарственных препаратов, содержащих омепразол, воспроизводящий секреторные и моторно-эвакуаторные нарушения в желудке больных с кислотозависимыми заболеваниями

С помощью теста сравнительной кинетики растворения изучено высвобождение (кинетика растворения) оригинального и 10 воспроизведенных препаратов омепразола разных производителей в среде, имитирующей умеренно кислую среду желудка, характерную для состояния медикаментозной кислотосупрессии, и в модели патологического дуоденогастрального рефлюкса. Методом ВЭЖХ определяли концентрацию омепразола в аликвотах, отбираемых через 4, 10, 15, 20, 30, 45, 60 мин в растворе с рН (7,0 ± 0,05) после 2 ч экспозиции при pH (1,2 ± 0,05) или (4,0 ± 0,05). 4 мин — время воздействия патологического дуоденогастрального рефлюкса на лекарственную форму омепразола. Показано, что не все изученные препараты могут быть в полной мере признаны эквивалентными оригинальному препарату в изучаемых условиях in vitro.

Do acid suppressive drugs (pantoprazole and ranitidine) attenuate the protective effect of alendronate in estrogen-deficient osteoporotic rats?

BackgroundAlendronate is a drug of choice in the treatment of postmenopausal osteoporosis. Acid suppressive drugs are recently used in combination with alendronate to protect against stomach ulceration and oesophagitis occurring as serious problems in patients under this treatment. Aim of the workTo study the effect of pantoprazole and ranitidine on the anti-resorptive effect of alendronate in a rat model of osteoporosis. Material and methods64 female Wister albino rats were included (8 rats/group). Treated groups were Ovariectomized bilaterally to induce osteoporosis. Rats were treated orally with alendronate (3mg/kg/day), ranitidine (20mg/kg/day), pantoprazole (3mg/kg/day), combined alendronate and ranitidine or alendronate and pantoprazole for 4weeks. Bone mineral density (BMD) was determined using dual-energy X-ray absorptiometry scan. Serum bone-specific alkaline phosphatase (BSALP), serum calcium, cortical thickness and histopathological examination were assessed. ResultsInduction of osteoporosis significantly elevated serum BSALP, decreased serum calcium, bone mineral density and cortical thickness and significantly increased the histopathological score. Ranitidine treatment resulted in insignificant changes in tested parameters. Pantoprazole given alone, significantly decreased serum calcium and increased serum BSALP. At the end of the experiment, alendronate significantly improved BSALP level, serum calcium, BMD, cortical thickness and histopathological score. This improvement was not affected by combining ranitidine with alendronate. Meanwhile, pantoprazole with alendronate caused a significant deterioration of tested parameters. ConclusionRanitidine proved safer than pantoprazole for patients with high risk of osteoporosis and in alendronate-treated patients. Clinicians should carefully judge the indication of use of acid suppressing medications in osteoporotic patients.