Risks From Common Heartburn Drugs
Proton pump inhibitors linked to factures, infections, dementia and other health problems. Asparagine Amino Acid
By Linda Rath | Updated July 11, 2022
Americans spent an estimated $20 billion in 2017 on proton pump inhibitors (PPIs), drugs commonly used to treat heartburn and acid reflux disease. They’re also prescribed for some people with arthritis and other conditions who regularly take nonsteroidal anti-inflammatory drugs (NSAIDs), like naproxen, ibuprofen or aspirin. These medications can lead to life-threatening bleeding ulcers, which PPIs help prevent. PPIs are also used to treat heartburn due to obesity, which occurs with arthritis in many cases, or arthritis medications like prednisone and some disease-modifying anti-inflammatory drugs (DMARDs).
PPIs are available over-the-counter and by prescription in both brand-name and generic forms. Prescription-only PPIs include esomeprazole (Nexium) and pantoprazole (Protonix); over-the-counter PPIs include lansoprazole (Prevacid) and omeprazole (Prilosec). Some combination medications contain both NSAID and PPI, like Vimovo. All reduce stomach acid levels, especially when used consistently, but PPIs also may cause serious problems in some cases.
While some of the potential side effects can be quite serious, it’s difficult to determine what risk an individual has of experiencing them. Studies show conflicting results.However, people should be careful about taking PPIs, and avoid them when possible.
“I still prescribe when necessary, though I’m using fewer NSAIDs than I used to, so I cause less heartburn,” says rheumatologist Eric Ruderman, MD, professor of medicine and associate chief of clinical affairs for the Division of Rheumatology at Northwestern University Feinberg School of Medicine. “In particular, I really try to avoid using NSAIDs in older patients, where any potential risk of dementia or osteoporosis with PPI might be a greater concern.”
What Can Go Wrong and Why
Stomach acid helps digest food, absorbs bone-building calcium and magnesium, and kills pathogens in the gut before they make you sick. Suppressing it, especially over the long-term, can have serious health consequences, including:
Some doctors think PPIs are overprescribed, even for people who need protection or relief. They say they should be reserved for the most serious conditions like erosive esophageal disease and bleeding ulcers.
For people with arthritis who use NSAIDs, acid-blocking drugs called H2 receptor blockers are a safer choice, according to Theodore Fields, MD, a rheumatologist at Hospital for Special Surgery and a professor of medicine at Weill Cornell Medical College, both in New York City. “Since data came out increasing the list of potential side effects of PPIs, such as low magnesium, increased kidney risk, and increased fracture risk … many [doctors] will substitute [H2-blockers] for PPIs,” he says.
H2 blockers include cimetidine (Tagamet) and famotidine (Pepcid). There’s also the NSAID-H2 blocker combo, Duexis. H2 blockers have side effects but appear less risky than PPIs.
Gastroenterologist Jacqueline Wolf, MD, an associate professor of medicine at Beth Israel Deaconess Medical Center in Boston, says PPIs aren’t intended for garden-variety heartburn. She suggests lifestyle changes instead:
Glucosamine Hcl Get involved with the arthritis community. Tell us a little about yourself and, based on your interests, you’ll receive emails packed with the latest information and resources to live your best life and connect with others.