When Are Proton Pump Inhibitors Appropriate?

Published on June 27, 2016 by Sandy Liebhard

Are you using Nexium or another proton pump inhibitor to get relief from heartburn? According to a  new Consumer Reports investigation, these drugs are actually a poor choice for most heartburn sufferers, as the majority could find relief with other treatments.

Proton Pump Inhibitors: What’s the Problem?

Some people might be surprised to learn that drugs like Nexium, Prilosec and PrevAcid don’t actually provide immediate relief of heartburn symptoms. Unlike TUMS, Zantac or other alternatives, proton pump inhibitors are intended to be taken daily, and can take several days to work.

There’s also the issue of side effects. Recent studies suggest that long-term use of proton pump inhibitors might be associated with an increased risk of chronic kidney disease and kidney failure. The medications have also been linked to low magnesium, bone fractures, B12 deficiency and other complications.

The American Gastroenterological Association recommends that people who need a proton pump inhibitor take the drug for the shortest time necessary to address symptoms. But according to Consumer Reports, that’s often easier said than done, thanks to a rebound effect that can cause the stomach to produce even more acid. As a result, many people experience a significant uptick in heartburn symptoms once they stop taking the medications.

“People can wind up on PPIs indefinitely—even if they don’t need them—because they start to suffer rebound symptoms every time they try to stop,” Michael Wolfe, M.D., chair of the department of medicine at Case Western Reserve University in Cleveland, Ohio, said in an interview with Consumer Reports.

When a Proton Pump Inhibitor is the Right Choice

Proton pump inhibitors are appropriate for patients who have been diagnosed with GERD, which can damage the lining of the esophagus and lead to other complications, including cancer. Patients who experience heartburn symptoms more than twice a week might be suffering from GERD or another disorder that would make a proton pump inhibitor appropriate, and should discuss their symptoms with their doctor.

For quick relief of occasional heartburn, drugs like TUMS or Mylanta might be a good choice.  Another option is an H2 blocker such as Pepcid AC or Zantac 75, which provide fast and long-lasting relief from symptoms.

If your doctor does recommend a proton pump inhibitor, Consumer Reports suggests that you discuss starting with an over-the-counter brand, as these appear to work just as well as their prescription counterparts. Once your symptoms have resolved, talk to your doctor about a plan for weaning yourself off the drug, so that you can avoid the rebound effect.