How Safe is Omeprazole?

Hello, Summarians,

Just because a drug is readily available doesn’t mean that we don’t have to consider all of its effects. OTC does not always mean safe for all body processes and time durations. This summary can help us understand some of the new information that is constantly being revealed.

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Acid Suppressant Drugs in Veterinary Medicine

The use of acid-suppressant drugs (ASDs) like proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) in veterinary medicine is well-established, but their effects outside of altering gastric pH are less understood. Research in humans and rodents has shown that ASDs have various pH-independent effects, which can be beneficial or adverse. These effects include impacts on inflammation, tumorigenesis, oxidative stress, and fibrosis. 

In terms of inflammation and immunomodulation, ASDs can exert anti-inflammatory effects by inhibiting pathways such as nuclear factor-κβ (NF-κβ) and affecting leukocyte behavior. This can be useful in conditions like eosinophilic esophagitis, sepsis, and neoplastic diseases. However, there is limited veterinary research on these effects, with some studies suggesting that ASDs could influence circulating leukocyte numbers or functions in dogs. 

Regarding tumorigenesis, ASDs like PPIs may influence cancer progression and treatment. They can induce apoptosis in neoplastic cells and improve chemotherapeutic efficacy, potentially due to mechanisms such as vacuolar-ATPase (V-ATPase) inhibition or modulation of the aryl hydrocarbon receptor (AhR). Evidence from veterinary studies is sparse but suggests some potential for ASDs in enhancing cancer treatment outcomes. 

ASDs also exhibit antioxidant properties, which could help in treating oxidative stress-related conditions. Some studies show that ASDs can scavenge free radicals and reduce oxidative damage, though specific research in veterinary patients is lacking. 

Lastly, while short-term adverse effects of ASDs include potential cytopenias and drug interactions, long-term use is associated with a range of complications, including kidney damage, cardiovascular issues, and alterations in gastrointestinal permeability. The long-term impact of these drugs on cats and dogs remains largely unexplored. 

Overall, while ASDs have established benefits in managing gastric conditions, their broader effects on inflammation, cancer, oxidative stress, and fibrosis warrant further investigation to optimize their use and monitor potential adverse outcomes in veterinary medicine. 

Gould, E. N., Grady, K., & Tolbert, M. K. (2024). pH-independent effects of acid suppressants in dogs and cats: a One Health perspective and case for further investigation. American Journal of Veterinary Research https://doi.org/10.2460/ajvr.24.07.0194 

Bottom line — We need to be aware of there other effects as well.

Diet Choices of US Dogs

The study examines dietary choices among dogs in the US using data from the Dog Aging Project, which includes over 45,000 dogs. It finds that most dogs are fed kibble, but choices vary based on demographic factors. Older dog owners are more likely to choose non-kibble diets, and smaller dogs are also more commonly fed alternatives to kibble, possibly due to health issues or cost considerations. Raw diets are more likely to be given to purebred, intact, or highly active dogs, with urban dogs receiving commercial raw diets and rural dogs getting home-prepared ones. Therapy and service dogs are more frequently fed raw diets, raising concerns about zoonotic risks. 

The study also shows that dogs in poorer health are more likely to be fed non-kibble diets, which may be due to efforts to improve palatability or meet specific health needs. The influence of dog size, owner age, and other demographic factors on diet choice highlights the importance of accounting for these variables in diet-related health studies to avoid confounding biases. 

However, the study acknowledges limitations, including potential selection biases and gaps in understanding owner motivations and emerging diet options. The data collection during the COVID-19 pandemic might also affect the results. Future research should consider these factors and further explore the impact of various diets on dog health. Understanding these demographic influences is crucial for designing effective studies and guiding veterinary advice on pet nutrition. 

O’Brien, J. S., Tolbert, M. K., Dog Aging Project Consortium, & Ruple, A. (2024). Dog and owner demographics impact dietary choices in Dog Aging Project cohort. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.24.05.0358 

Bottom line — A broad view of actual US feeding patterns

Zonisamide to Treat Seizures in Dogs

Zonisamide (ZNS), a newer-generation antiseizure medication (ASM), has been used to treat epilepsy in dogs and cats. Synthesized in 1979, it was first approved for human use in Japan in 1989 and later in the U.S. and Europe. ZNS works by inhibiting repetitive neuronal firing through blockade of voltage-gated sodium and calcium channels and enhancing GABA receptor function, among other mechanisms. 

In veterinary medicine, ZNS has favorable pharmacokinetic properties and has shown efficacy in reducing seizure frequency in dogs with idiopathic epilepsy (IE). A recent study evaluated ZNS as a monotherapy for dogs with newly diagnosed IE, finding that 76% of the dogs experienced a ≥50% reduction in seizure frequency, and 55% achieved seizure freedom. The study suggested a starting dose of 2.5-5 mg/kg every 12 hours, with a therapeutic plasma concentration range of 10-40 μg/mL. 

Common adverse effects of ZNS in dogs were mild and transient, including reduced activity, decreased appetite, and vomiting. Rare adverse events like hepatopathy and keratoconjunctivitis sicca were noted but are reversible upon discontinuation of the drug. The study concluded that ZNS is a potentially effective and well-tolerated first-line ASM for canine IE. However, larger randomized controlled trials are needed to further assess its long-term efficacy and safety. 

Saito M, Nomura A, Hasegawa D, et al. Clinical efficacy and tolerability of zonisamide monotherapy in dogs with newly diagnosed idiopathic epilepsy: Prospective open-label uncontrolled multicenter trial. J Vet Intern Med. 2024; 38(4): 2228-2236. doi:10.1111/jvim.17108 

Bottom Line — Zonisamide is an effective and well-tolerated first-line drug for seizures in dogs

Just putting things in perspective …