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.
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.