Watch out: How safe are PPIs?

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PPIs, a category of anti-acid reflux drugs than includes such household names as Nexium, Losec, Prilosec, Dexilant, and several others, are among the most common prescription drugs in the world.

In addition, several PPI formulations are available OTC without prescription.

Hence, millions and millions of people use them.

In theory, for the vast majority of patients, PPIs should be prescribed (or self-used) only when lifestyle adjustments and other older, safer drugs have been tried first, and PPIs should only be used for a limited time in the lowest dose possible.

As well, every repeat prescription for a PPI should come with the standard reminder that these drugs should just be used for short-term relief so “Hey, do you really need this new script?”

But as Homer Simpson sagely reminds us, “In theory, communism works” so IRL, PPIs are taken by most users for many, many years, some for life.

And this despite the many studies that have linked PPIs to a higher risk of a slew of some pretty awful complications including among others pneumona, osteoporosis, dementia, C. difficile infections, and chronic kidney disease.

So if you’ve noted the many studies that have warned about PPIs, you will not be surprised, I’m sure, to learn that a new study¬†just published online in the BMJ concluded that compared to people who use older anti-acid drugs and those who don’t use drugs for acid reflux at all, PPI users have a higher risk of dying prematurely.

And the longer they (I should actually write “we” because I’ve been on Nexium for over 2 decades) use a PPI, the greater that comparative risk of death.

Yikes!

This news comes with a couple of key cautions, however.

First, this study is what’s called an observational study, hence the researchers cannot account for why PPI users have a higher risk of death: it may be that despite the researchers’ diligent efforts to rule out important differences between PPI users and users of other reflux drugs, there is still a pretty good chance that PPI users are either sicker (PPIs are often not first-line drrugs but are prescribed only when others have failed) or perhaps PPI users are less likely to adhere to other anti-reflux lifestyle adjustments which would have the added benefit of lowering death from other conditions.

Perhaps, but more likely, PPIs are problematic drugs with potential risks, especially for long-term use.

However, as someone who has tried many many times to get off his PPI, I can attest that the rebound acid reflux I get whenever I do cut out my PPI makes my life so uncomfortable that I rush back on it pretty quickly, although I have managed to change a dose of 40 mg Nexium every day into 20 mg 2 out of 3 days.

As I always remind myself (and you): life is a balance of risk/benefit.

And life has to be enjoyed.

 

4 thoughts on “Watch out: How safe are PPIs?

  1. Hi Dr. Art
    I read your blog on PPI and I am going to see how I am taking every 2 – 3 days @ 20 MG.
    Do you just cut your 40mg in half.
    Great blog
    Teresa

    1. Hi
      In theory, the manufacturer of Nexium claims that you are not supposed to break these hard-shelled pills because that can interfere with the mechanism required for slow absorption of the pill’s contents.
      I have absolutely no idea if this is true or, if it is true, whether that ever really matters to anyone in the real world, but being a true neurotic, I just bought a bunch of 20 mg pills for myself.
      I still keep a stash of 40 mg pills, though, for the now more rare occasions when my reflux symptoms flare significantly.
      BTW, here’s another thing to ponder: are generic esomeprazole pills as effective as the brand name Nexium ones?
      I tried to get Health Canada to tell me where the generic esomeprazole pills come from – I have significant concerns about the oversight of pharmaceutical companies in certain overseas countries – but Health Canada refused to tell me; told me to get in touch with the generic company, which, of course, never got back to me with the information.
      The reason I asked for this information is that it seemed to me at the time that my reflux had flared despite my careful use of generic esomeprazole, so I wondered about the pills.
      So I switched back to brand name Nexium and my symptoms eased pretty quickly although I’d hastily add that that may have just been a placebo effect or pure chance.
      It would still be nice to know, however, where my pills come from.
      Or how often – and with what kind of personnel (our people or some locally-hired freelancer?) – Health Canada checks the manufacturers’ operations to ensure they meet whatever standard they are supposed to meet.

      1. Hi Dr. Art.
        Thank you for being a voice of reason in all of this. I too am on a PPI and have been for 5 years. The memory of the gastric pain when I tried to go off them prevents me from attempting another go at it. I have read countless articles on natural remedies to help with reflux rebound when weaning off PPI’s. Did you try any of these alternate methods during your attempts at stopping the medication?
        Thank you.

        1. I’ve tried every single “home” and “natural” remedy I’ve been sent over the years including especially apple cider vinegar (several attempts) and probiotics (ditto).
          Nothing has ever helped even a bit.
          That is not to say that those will also not work for you.
          Merely that there is no universal formulaic answer mostly because we all differ (often substantially) as to why we get what we get and how we react to our problems.
          But if a remedy, natural or otherwise, is safe and not too arduous to follow, always worth a try.

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