Proton pump inhibitors (PPIs) are the most effective medicines for reducing stomach acid, which can relieve gastritis symptoms. But studies suggest those drugs have several serious downsides, linking them to increased risk for certain conditions.
Those findings come largely from observational studies, which don’t prove that the acid-reducing drugs cause the problems, only that there’s an association.
The U.S. Food and Drug Administration (FDA) requires drug makers to warn about some risks on PPI labels and inserts. In most cases, over-the-counter (OTC) PPIs are excluded because the FDA considers it unlikely that short-term use of low doses would pose serious risk. However, that assumes that people aren’t overusing the OTC products. There’s no convincing evidence than any one PPI is more effective or better tolerated or safer than any other.
Some PPIs come in both OTC and in prescription-strength form, including esomeprazole (Nexium), lansoprazole (Prevacid), and omeprazole (Prilosec, Zegerid). Prescription-strength PPIs include dexlansoprazole (Dexilant), pantoprazole (Protonix), and rabeprazole (AcipHex).
Below are potential risks, as suggested by recent research. Generally, the risks are greater in older adults and those with chronic conditions.
- Impaired kidney function, kidney disease, and kidney failure
- Bone loss and fractures of the hip and possibly the spine and wrist
- Nutrient malabsorption and deficiency, notably magnesium, calcium, iron, and vitamin B12
- Cardiovascular disease
- Gastrointestinal infections, notably Clostridium difficile
- Interactions with certain drugs, including the antifungal drug itraconazole; drugs metabolized by the CYP2C19 enzyme, such as diazepam (Valium) and phenytoin (Dilantin); and the antiplatelet drug clopidogrel (Plavix).
People over 65 should avoid taking PPIs for longer than eight weeks, except for certain conditions, because of the potential risks, and then do so only under a doctor’s supervision.
If you’re taking a prescription PPI, take the lowest effective dose and discontinue use with your doctor’s guidance as soon as possible.
If your doctor prescribes a PPI for long-term use, ask your doctor at least once a year whether you still need to take the drug at the same dose and frequency.
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Timothy Gower is an award-winning journalist who writes about health and medicine. His work has appeared in more than two dozen major magazines and newspapers, including Prevention, Reader’s Digest, and the Los Angeles Times.