Table of Contents
Proton pump inhibitors (PPIs) suppress the production of stomach acid and work by inhibiting the molecule in the stomach glands that is responsible for acid secretion (the gastric acid pump). Recent guidelines indicate that PPIs should be the first drug treatment, because they are more effective than H2 blockers. Once symptoms are controlled, patients should receive the lowest effective dose of PPIs.
The standard PPI has been omeprazole (Prilosec), which is now available over the counter without a prescription. Newer prescription oral PPIs include esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (AcipHex), and pantoprazole (Protonix). In February 2009, the FDA approved the long-acting PPI dexlansoprazole (Kapidex), which is taken once a day.
Studies report significant heartburn relief in most patients taking PPIs. PPIs are effective for healing erosive esophagitis.
In addition to relieving most common symptoms, including heartburn, proton pump inhibitors also have the following advantages:
- They are effective in relieving chest pain and laryngitis caused by GERD.
- They may also reduce the acid reflux that typically occurs during strenuous exercise.
Patients with impaired esophageal muscle action are still likely to have acid breakthrough and reflux, especially at night. PPIs also may have little or no effect on regurgitation or asthma symptoms.
Currently, these drugs are recommended for patients with:
- Moderate symptoms that do not respond to H2 blockers
- Severe symptoms
- Respiratory complications
- Persistent nausea
- Esophageal injury
These medications have no effect on non-acid reflux, such as bile backup.
Adverse Effects. Proton-pump inhibitors may pose the following risks:
- Side effects are uncommon but may include headache, diarrhea, constipation, nausea, and itching.
- Long-term use of these drugs has been linked to an increased risk of hip, wrist, and spine fractures, possibly because stomach acid may be needed to absorb calcium from the diet. Patients who are on long-term PPI therapy may need to take a calcium supplement or the osteoporosis drugs, bisphosphonates to reduce their fracture risks.
- There is some evidence that PPIs increase the risk for community-acquired pneumonia, especially within the first 2 weeks of starting the medication. Researchers do not know the reason for this possible association. Newer research indicates that PPIs may also increase the risk for hospital-acquired pneumonia.
- Pregnant women and nursing mothers should discuss the use of proton pump inhibitors with their health care provider, although recent studies suggest that PPIs do not pose an increased risk of birth defects.
- PPIs may interact with certain drugs, including anti-seizure medications (such as phenytoin), anti-anxiety drugs (such as diazepam), and blood thinners (such as warfarin). Studies have found that taking PPIs with the blood thinner clopidogrel (Plavix) reduces the effectiveness of this blood thinner by nearly 50%.
- Long-term use of high-dose PPIs may produce vitamin B12 deficiencies, but more studies are needed to confirm whether this risk is significant.
Previous Section
Review Date: 07/11/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor
of Medicine, Harvard Medical School; Physician, Massachusetts
General Hospital. Also reviewed by David Zieve, MD, MHA, Medical
Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
