September 3, 2013
Even though their names sound a bit like invaders from outer space, drugs such as Nexium and Protonix have become extremely popular.
These proton-pump inhibitors (PPIs) include dexlansoprazole (Dexilant), lansoprazole (Prevacid), omeprazole (Prilosec) and rabeprazole (AcipHex). Such drugs are the most powerful acid suppressors in the pharmacy, originally reserved for severe heartburn and reflux. Now, however, they frequently are used to treat a wide range of gastrointestinal symptoms.
They are thought to be safe. In fact, the Food and Drug Administration approved lansoprazole and omeprazole for sale over the counter. Millions pop Prilosec, Prevacid or their house-brand equivalents to ease indigestion. But evidence has been accumulating that brings the long-term safety of such medications into question.
The first serious problem to be detected was an increased risk of pneumonia (Journal of the American Medical Association, Oct. 27, 2004). There also is a higher chance of contracting a disruptive intestinal infection, C. difficile (Journal of the American Medical Association, Dec. 21, 2005).
People taking PPIs long term are more likely to become deficient in magnesium and more vulnerable to bone fractures (Expert Review of Clinical Pharmacology, July 2013). Even more worrisome is a recent connection between acid-suppressing PPI drugs and cardiovascular complications, especially in patients at high risk for heart problems.
New research demonstrates that PPIs reduce the flexibility of blood vessels (Circulation online, July 3, 2013). These drugs interfere with the production of nitric oxide, a natural compound made by the body that helps blood vessels relax. This might help explain why a study found that older people on high-dose PPIs were more likely to die during the year after hospital discharge (JAMA Internal Medicine, April 8, 2013).
These meds can sometimes be difficult to discontinue. When such medications are stopped suddenly, the body can respond by churning out excess stomach acid for weeks or months (Gastroenterology, July 2009; Scandinavian Journal of Gastroenterology, May 2013). For tips on getting off PPIs and other ways to treat heartburn, consult our Guide to Digestive Disorders. To order, send $3 in check or money order with a long (No. 10), stamped (66 cents), self-addressed envelope to: Graedons' People's Pharmacy, No. G-3, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 at peoplespharmacy.com.
Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a