הומפרדקס זי

אני סובל מצרבות חריפות והתמכרתי ממש להומפרדקס החדש שהוא כדור יעיל יעיל... האם יתכן שהוא פוגע קצת בעניין המין אם יש משהו בכיוון ..מה הפיתרון ?

שלום מנחם, התרופה שאתה נוטל לטיפול בצרבות (אומפרדקס Z), היא ממשפחת התרופות המעכבות הפרשת חומצה בקיבה. לא נמצאה במאגרי המידע איזשהי תופעת לואי של פגיעה בתפקוד המיני. לא ציינת אם אתה נוטל תרופות נוספות אשר עלולות לגרום גם הן לתופעות לואי. בברכה, מוחמד

מנחם שלום, למרות שלא קיים מידע לגבי תופעת לוואי זו במאגרי המידע שבידינו קרי המיקרומידקס (מאגר מידע מצוין) בעלון לצרכן של היצרן מופיעה תופעת לוואי שהזכרת ולצערי אין אפשרות לבדוק הסיבה לכך (יש אפשרות לפנות ליצרן חב' דקסון ישראל). כשמופיעה תופעה כזו יש לשלול סיבות אחרות לכך ולצערי אין לי אפשרות לבדוק את זה ללא מידע על התרופות הנוספות שאתה מקבל. האפשרות השניה היא להשתמש בתכשיר גסטרו 20 מ"ג פעמיים ביום לכמה ימים ולראות אם תופעה זו חולפת . בברכה, כמאל

1- ...בכל זאת קיים מידע בספרות לגבי התרופה הנ"ל ופגיעה בתפקוד המיני . ראה מאמר בסוף 2- גם לקבוצה השניה שהוצעה מוכרות גיניקומסטיה וירידת ליבידו . 3- רצוי להמליץ על הגבלת משך שימוש וכך גם בעלון של תרופת OTC זו. ערב טוב , עמי . Nederlands Bijwerkingen Centrum Lareb Mei 2007 Omeprazole AND erectile dysfunction Introduction Omeprazole is a proton-pump inhibitor for acid-related diseases. It is registered for use in benign peptic AND duodenal ulcers, reflux esophagitis, severe reflux esophagitis in children above the age of 1 year, treatment of reflux symptoms, acid-related dyspepsia AND Zollinger-Ellison syndrome. Beside this, it may be used as prophylaxis in patients, who have to be treated with NSAIDs, but have a medical history of peptic ulcer, erosions OR symptoms of dyspepsia. Omeprazole is available as capsules (10, 20, AND 40 mg), AND also as MUPS (Multiple Unit Pellet System) tablets (10, 20, AND 40 mg). Omeprazole capsules reached the Dutch market early 1988. The most common adverse reactions are nausea, vomiting, diarrhoea, constipation, abdominal pain AND flatulence, somnolence, sleeping problems, dizziness, headache AND paraesthesia [1,2]. Reports From 1992 until 1 September 2006, the Netherlands Pharmacovigilance Centre Lareb received 10 reports of erectile dysfunction OR impotence in association with omeprazole. The time to onset varied from 1 day to 10 weeks. One patient (patient A) also suffered from decreased libido. In four patients improvement was seen after withdrawal of omeprazole (patient C,D, G, H). In patient F symptoms diminished after a dose reduction to 20 mg daily AND treatment with sildenafil. Patient H also suffered from a depression; his medical history included a vasectomy AND a hernia nuclei pulposi. In one patient (patient D) a positive rechallenge was observed. Patient C only experienced impotence on a dosage of 20 mg, but not on a lower dosage of 10 mg. He also experienced erectile dysfunction after start of lansoprazole. One patient (patient B) did not recover after discontinuation of omeprazole. Patient E used celiprolol, also known for impotence reaction,as concomitant medication; withdrawal of this drug however did not result in improvement of symptoms. Nederlands Bijwerkingen Centrum Lareb Mei 2007 Table 1. reports of erectile dysfunction/impotence associated with the use of omeprazole Patient, Sex, age Report date Drug Indication for use Concomitant medication ADR Time to onset, outcome A M, 65 1992 omeprazole 20 mg od not specified not reported impotence libido decreased 14 days not reported B M, 55 1997 omeprazole 20 mg bid gastric ulcer Tetracycline* Metronidazole* Bismuthcitrate* Cimetidine impotence 3 days not recovered C M, 57 1998 omeprazole 20 mg bid diaphragmatic hernia not reported impotence unknown recovered D M, 46 1999 omeprazole 20 mg bid reflux esophagitis budesonide betamethasone miconazole impotence days recovered E M, 49 2000 omeprazole 40 mg od not specified Celiprolol* amlodipine impotence 10 weeks not reported F M, 56 2001 omeprazole 40 mg od diaphragmatic hernia not reported impotence 1 month recovering G M, 45 2003 omeprazole 40 mg od dyspepsia not reported impotence 2 weeks recovered H M, 42 2005 omeprazole 20 mg od dyspepsia not reported impotence 1 day recovered I M, 45 2006 omeprazole 10 mg od gastroesophageal reflux not reported impotence 3 weeks unknown J M, 65 2006 omeprazole 20 mg od not specified colchicines acenocoumarol diclofenac erectile dysfunction unknown unknown * also indicated as suspect drug Other sources of information SPC Erectile dysfunction has not been described in the SPCs of omeprazole capsules and omeprazole MUPS [1,2]. Literature Carvajal et al. describes three patients who developed impotence, unilateral gynaecomastia OR anorgasmia in relation to omeprazol treatment [3]. Another fifteen reports of impotence AND fifteen reports of gynaecomastia in association with use of omeprazole were described by Lindquist [4]. Seven of the patients with impotence AND five of those with gynaecomastia either had recovered OR were improving at the time of notification suggesting a causative role for omeprazole. Nederlands Bijwerkingen Centrum Lareb Mei 2007 Databases On 1 September 2006 the Lareb database contained 10 reports of erectile dysfunction OR impotence in association with omeprazole, which is not statistically disproportional (ROR 1.87, 95 % CI 0.99-3.51) On 1 September 2006, the WHO Collaborating Centre had received a disproportional number of 170 reports of impotence in association with omeprazole (ROR 2.13, 95 % CI 1.83-2.48). Discussion The mechanism is not clear. However, in a few publications the influence of proton pump inhibitors on serum free testosterone level was suggested as underlying mechanism for sexual dysfunction. Rosenheim AND Flockhart suggest a role for serum free testosterone level in the development of libido loss in a 42-year old woman during treatment with esomeprazole, the S-enantiomer of omeprazole. While taking esomeprazole, the patient's loss of libido improved with oral testosterone supplementation AND deteriorated after testosterone withdrawal. There was steady improvement in both sexual function AND serum free testosterone concentration after discontinuation of esomeprazole. Due to the temporal relationship between esomeprazole intake AND sexual dysfunction, the authors postulate that esomeprazole causes induction of testosterone metabolism. A role of CYP 3A4 had been postulated, converting testosterone to beta-hydroxytestosterone [5]. In the publication of Coulson the influence of lansoprazole treatment on testosterone metabolism AND clearance was tested in male rats. Lansoprazole treatment induced hepatic CYP-dependent testosterone metabolism in vitro AND enhanced plasma clearance of radio labelled testosterone in vivo. The authors conclude that these effects may have contributed to depletion of circulating testosterone levels [6]. In other publications however no influence of the proton pump inhibitors omeprazole, rabeprazole, pantoprazole OR lansoprazole on testosterone plasma levels OR other hormones like prolactin was found [7-11]. Conclusion Lareb received ten reports of erectile dysfunction in association with omeprazole. In some, a positive dechallenge was observed. Disproportionality in the WHO database supports this association as well as some publications in the literature. References 1. Dutch SPC Losec®. (version date 4-5-2005) http://www.cbg-meb.nl/IB-teksten/12438-14905-16745.pdf. 2. Dutch SPC Losec ® MUPS. (version date 4-11-2005) http://www.cbg-meb.nl/IB-teksten/21683-21684- 21685.pdf. 3. Carvajal A, Martin Arias LH. Gynecomastia AND sexual disorders after the administration of omeprazole. Am J Gastroenterol. 1995;90(6):1028-9. 4. Lindquist M, Edwards IR. Endocrine adverse effects of omeprazole. BMJ 1992;305(6851):451-2. 5. Rosenshein B, Flockhart DA, Ho H. Induction of testosterone metabolism by esomeprazole in a CYP2C19*2 heterozygote. Am J Med Sci 2004;327(5):289-93. 6. Coulson M, Gibson GG, Plant N, Hammond T, Graham M. Lansoprazole increases testosterone metabolism and clearance in male Sprague-Dawley rats: implications for Leydig cell carcinogenesis. Toxicol.Appl.Pharmacol 2003;192(2):154-63. 7. Dammann HG, Burkhardt F, Wolf N. The effects of oral rabeprazole on endocrine AND gastric secretory function in healthy volunteers. Aliment.Pharmacol Ther 1999;13(9):1195-203. 8. Gaetani M, De Giorgio R, Buratti P, Pasquali R, Capelli M, Stanghellini V, Corinaldesi R. Chronic oral administration of lansoprazole does not affect the hypothalamic pituitary gonadal axis in healthy young men. Eur J Gastroenterol.Hepatol. 1995;7(3):211-3. 9. Dammann HG, Bethke T, Burkhardt F, Wolf N, Khalil H, Luehmann R. Effects of pantoprazole on endocrine function in healthy male volunteers. Aliment.Pharmacol Ther 1994;8(5):549-54. Nederlands Bijwerkingen Centrum Lareb Mei 2007 10. MacGilchrist AJ, Howden CW, Kenyon CJ, Beastall GH, Reid JL. The effects of omeprazole on endocrine function in man. Eur.J.Clin.Pharmacol. 1987;32(4):423-5. 11. Muller P, Seitz HK, Simon B, Dammann HG, Feurle G, Huefner M, Lichtwald K, Schmidt-Gayk H. [4 weeks' administration of omeprazole: effect on acid behavior AND basal hormone levels]. Z.Gastroenterol. 1984;22(5):236-40.

עברתי לגסטרו 20 לפי המלצתך ובאמת יש שיפור אני חושב , אבל אני יגיד יותר מדויק אחרי שבת תודה לך וגם למוחמד אבו פול ובדרך אגב אני לא לוקח שום תרופה קבוע