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Considering the high prevalence and chronic nature of the acid peptic disease, PPIs have been extensively used and their safety has attracted much attention. Esomeprazole has well-established efficacy and safety in treatment of all clinical manifestations of the acid peptic disease. As a group, PPIs inherently bear a potential for drug-drug interactions reflecting either on disposition of PPIs (e.g., their dependence on CYP-mediated metabolism, pantoprazole excepted) or on disposition of concomitant drugs (e.g., reduced gastrointestinal acidity may affect absorption of certain drugs; apart from pantoprazole, PPIs may inhibit CYP2C19). Clinically relevant drug-drug interactions with esomeprazole (or PPIs) have been only sporadic, likely also due to the awareness about this possibility. It is important to note that warnings have been issued regarding the potential of PPIs (including esomeprazole, but likely excluding pantoprazole) to reduce the efficacy of clopidogrel (inhibition of clopidogrel activation by CYP2C19), but this is not the subject of our presentation (our patient did not take clopidogrel). Also, the association between long-term use of PPIs and an increased risk of fractures has been recognized. Esomeprazole, as well as all marketed PPIs, has an overall excellent safety profile reflected by the fact that most of them have a world-wide over-the-counter status. In particular, cardiovascular safety of esomeprazole and omeprazole appears good and they seem not to increase the risk of adverse cardiac events. We present a patient with a condition that appears to be a case of esomeprazole-induced chest pain with changes that we recorded with the standard 12-lead electrocardiogram (ECG) which should be related to coronary ischemia but not typical for it.

Esomeprazole-Induced Chest Pain: A Case of an Unexpected Serious Adverse Reaction to a Proton Pump Inhibitor