Proton Pump Inhibitors

Nexium, Prilosec, PrevAcid and other proton pump inhibitors are highly effective medications used to treat GERD and other problems associated with the excess production of gastric acid. While they have been considered extremely safe, recent research has found that extended use of these drugs may increase a patient’s risk for kidney complications, including chronic kidney disease and renal failure. Other studies have found possible links to heart attacks, dementia and blood vessel damage.

How Do Proton Pump Inhibitors Work?

Prilosec (omeprazole), the first proton pump inhibitor approved by the U.S. Food & Drug Administration, was brought to market in 1989. Since then, a number of other proton pump inhibitors have been approved for either prescription or over-the-counter sales, including:

Proton pump inhibitors work by inhibiting the ability of certain cells in the stomach to produce gastric acid. Over-production of  acid can lead to or aggravate a number of conditions, including ulcers. As such, the use of proton pump inhibitors can help alleviate:

  • Acid reflux
  • Heartburn
  • Peptic ulcers
  • Gastritis
  • Barrett’s esophagus
  • Erosive esophagitis
  • Gastrinomas or other stomach tumors
  • Zollinger-Ellison syndrome

Side effects commonly associated with the use of proton pump inhibitors include headache, diarrhea, constipation, nausea, or itching. Long-term use of the drugs has also been linked to infections, bone fractures, and certain vitamin and mineral deficiencies. Proton pump inhibitors might also interact with other medications, including some anti-seizure drugs and blood thinners like warfarin or Plavix.

Are Proton Pump Inhibitors Overused?

Approximately 20 million people in the U.S. take proton pump inhibitors, and they are the most commonly used drugs in the world. Their popularity has led to concerns that the medications are being overused. In fact, one recent study suggested that as many as 75% of the prescriptions written for proton pump inhibitors are inappropriate. And while the drugs should only be taken for a short period of time (ranging from 3 to 8 weeks); the same research found that 31% of patients had been taking proton pump inhibitors for two years or more. At least 25% had been using the drugs for about a year.

There are many options for treating acid-related problems. For infrequent heartburn, consider  life-style changes and over-the-counter antacids like TUMS. Another class of heartburn drugs called H2 blockers, which includes Zantac and Tagamet, can be used as a long-term solution for the  management of acid-related problems. However, H2 blockers are not an ideal treatment for esophagitis.

Women Might Benefit from Lower Dosage

A study published in May 2016 suggested that women who used proton pump inhibitors could obtain the same benefits from lower doses of the drugs. Published in the  Journal of Clinical Gastroenterology, the study involved around 100 proton pump inhibitor users, half male and half female, who were  undergoing treatment  for erosive esophagitis. During the experiment, half took a lower dose for  8 weeks. The women involved in the study were three times more likely to tolerate the lower dosage compared to men. Read More

Consumer Reports Cautions Against Overuse of Proton Pump Inhibitors

In July 2016, Consumer Reports warned that proton pump inhibitors are actually a poor choice for most heartburn sufferers, as the majority could find relief with other treatments. Among other things, the article cited the many side effects associated with the drugs, as well as recent studies suggesting that long-term use of proton pump inhibitors might be associated with an increased risk of chronic kidney disease and kidney failure. Read More

Consequences of Long-Term Use

Some recent studies have suggested that the long-term use of proton pump inhibitors has the potential to adversely affect a person’s health:

  • June 2015: Research published in PLOS One found that people who take proton pump inhibitors were 16-to-21% more likely to have a heart attack.
  • January 2016: According to a report in JAMA: Internal Medicine, patients who use a proton pump inhibitors twice per day may be 46% more likely to develop chronic kidney disease. Patients who used the drugs just once per day may face a 15% higher risk. Read More
  • April 2016: Research published in JAMA Neurology suggested that seniors who use proton pump inhibitors were 44% more likely to suffer from dementia compared with those not receiving the medications.  Read More
  • April 2016: A study published in the Journal of the American Society of Nephrology suggested that patients who use proton pump inhibitors were 96% more likely to develop kidney failure and 28% more likely to suffer chronic kidney disease compared to those who took another class of heartburn medications.  The findings also indicated that the overall risk increases with higher doses and longer duration of use. Read More
  • May 2016: A study published in Circulation Research revealed that long-term exposure to Nexium might accelerate blood vessel aging, which could open the door to a host of side effects including heart attacks and strokes. Read More
  • November 2016: A study conducted by Danish researchers suggests proton pump inhibitors to an overall 21% increased risk of ischemic stroke. The increased risk ranged from 30% for the highest dose of lansoprazole (Prevacid) to 94% for the highest dose of pantoprazole (Protonix). Read More
  • February 2017: A study published in Kidney International suggests that proton pump inhibitor users who go on to develop chronic kidney disease may not experience any acute kidney problems early on, leaving many unaware of the decline in renal function. Read More
  1. HealthLine (N.D.) “Find the Best Proton Pump Inhibitors (PPIs) for Gastroesophageal Reflux Disease (GERD)”
  2. Journal of the Royal Society of Medicine (2013) “Inappropriate use of proton pump inhibitors among medical inpatients: a questionnaire-based observational study”
  3. JAMA: Internal Medicine (2016) “Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease”
  4. PLOS One (2015) “Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population”
Last Modified: March 5, 2017

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