Proton pump inhibitors (PPIs) such as Nexium® (esomeprazole), Prevacid® (lansoprazole), Prilosec® or Zegerid® (omeprazole), Protonix®(pantoprazole), AcipHex® (Rabeprazole), Dexilant® (dexlansoprazole) are used to treat a variety of conditions such as:
- Heartburn caused by gastroesophageal reflux disease (GERD), also known as acid reflux
- Ulcers in the stomach or intestines
- Barrett’s Esophagus
Ulcers are open sores inside the stomach or intestines. Ulcers can be caused by drugs known as nonsterioid antinflammatorys (NSAIDS). NSAID examples include Motrin® or Advil® (ibuprofen), Alieve® (Naproxen) or aspirin. A bacteria called Helicobacter pylori or H. pylori can cause a stomach infection, leading to stomach ulcers. H. pylori infections are usually caused by coming in contact with someone who is already infected and it usually causes no signs or symptoms until an ulcer has formed. Barrett’s esophagus usually occurs in people with long-term GERD. Repeated regurgitation of stomach acid into the lower esophagus can damage the lining. PPIs help prevent the acid from entering the esophagus so the skin inside can heal.
PPIs work by reducing the amount of acid that is produced in the stomach which reduces heartburn symptoms and helps stomach or intestinal ulcers heal properly. These medications are only meant to be used for a short time, around 2 months or less depending on what your doctor is treating. Often, patients may continue to take PPIs for years, unnecessarily. When used for less than one year, side effects with PPI treatment are usually mild and include rash, nausea, diarrhea, headache. However, there has been increasing evidence of serious side effects reported with long-term PPI use at high doses.
When used for years at a time, more serious side effects can occur such as low magnesium and/or vitamin B12 levels, bone fractures, and infections such as pneumonia or C. difficle, a severe case of contagious diarrhea. Your risk for these side effects increases over time, so the longer you use a PPI or the higher your dose, the more likely you are to develop these conditions. Your risk for these side effects is especially high if you are over 65 years of age.
It’s important to note that in some cases of severe GERD, ulcers or Barrett’s Esophagus long-term PPI use is needed and the benefit of use outweighs the risks associated with long-term PPI use.
PPIs are also available over-the-counter to purchase without a prescription or permission from your doctor. If you are using over-the-counter PPIs such as Nexium® (esomeprazole), Prevacid® (lansoprazole), and Prilosec® (omeprazole). You must follow the directions on the label. Taking more than what is recommended will put you at risk for the serious side effects mentioned above, as the risk increases with higher doses and longer treatment. If you have been taking a PPI for over a year, talk to you doctor to discuss the risks and benefits.
Other Options Besides PPIs
- Antacids: Tums® (calcium carbonate) or Rolaids® (calcium carbonate and magnesium hydroxide)
- Antacids are used when you are having symptoms
- H2-receptor antagonists: Zantac® (ranitidine) and Pepcid® (famotidine)
- Both are also available in higher doses with a prescription
- Zantac® and Pepcid® can be taken everyday to prevent symptoms before they occur or they can be taken when you are having symptoms
- Avoid triggers such as spicy food, alcohol, coffee, citrus fruit
- Avoid eating 2-3 hours before laying down or going to bed
- Weight loss
Ask your doctor or pharmacist if your PPI is still right for you.
For more information about PPIs, you can visit http://www.gastro.org/info_for_patients/gerd-107-long-term-use-of-proton-pump-inhibitors-ppisand visit Holmesburg Pharmacy on Wednesday April 25th from 9:00-5:00 to discuss your options with our student pharmacists and pharmacy staff.