Q. I saw part of a news story on TV that said people who take Nexium (and similar drugs) for a year or more are at greater risk of bone density loss and have more bone fractures.
I have been taking Nexium for almost a year and a half. I have had a knee replacement and a total hip replacement. I did not get the details of who did the study and how. I want to ask my gastroenterologist if I can stop taking Nexium, but I would like to be able to give him some details. Can you supply them?
A. The research was published in the Journal of the American Medical Association (Dec. 27, 2006). The scientists compared more than 13,000 cases of hip fracture to some 135,000 matched control patients in the United Kingdom.
They found that long-term use of drugs such as Aciphex (rabeprazole), Nexium (esomeprazole) or Prilosec (omeprazole) for more than a year increased the likelihood of hip fracture by more than 40 percent. Patients on high-dose heartburn medication were more than twice as likely to break a hip as those not taking such drugs. The investigators hypothesize that reducing stomach acid decreases calcium absorption and increases bone loss.
We understand that having had your surgical joint replacements increases your concern about the strength of your bones. There is no association that we know of between the PPI medicines such as Prilosec and the need for a replacement.
Q. I am a 40-year-old male taking Toprol XL for high blood pressure and Crestor for high cholesterol. Prior to starting on Toprol, I suffered from frequent debilitating and nauseating migraines for 10 years. I noticed that after starting Toprol the frequency of my migraines decreased dramatically. Could the Toprol be responsible for this life saving benefit?
A. Indeed it could. Toprol (metoprolol) is a beta-blocker. This type of medicine is often used to treat heart problems or high blood pressure. It is also prescribed to prevent migraine headaches.
Q. My father is on Coumadin and Plavix to keep blood clots from causing a heart attack. His family doctor prescribed Relafen for arthritis pain but it led to intestinal bleeding. Then she switched him to another pain reliever called Mobic.
Now he is in the hospital with severe rectal bleeding. What can he take for his joint pain that will not put him at risk of a bleeding ulcer?
A. The official prescribing information for Plavix warns that combining this drug with the anticoagulant warfarin (Coumadin) requires caution due to an increased risk of hemorrhage. Doctors are also warned that combining NSAID pain relievers (such as ibuprofen, naproxen, Mobic, Relafen, etc) with Plavix or warfarin can lead to a bleeding ulcer.
Patients with arthritis are caught in a dilemma. The very drugs they need to ease their aching joints may trigger life-threatening reactions like the one your father experienced. We discuss these issues and offer safer options in our Guide to Alternatives for Arthritis. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. AA-2, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.
A topical pain reliever might be an option. NSAID gels or lotions such as Pennsaid (diclofenac), Feldene (piroxicam) and Nurofen (ibuprofen) can relieve symptoms without intestinal irritation. Such products are not available in the U.S. but with a prescription from his doctor, your father could import one from another country.

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  1. B.L.R.
    Reply

    I take Synthroid first thing in the morning on an empty stomach. I take Toprol XL with dinner. I’m trying to figure out the best time to take Calcium Citrate without it interfering with the other meds. (I also take Vit. D). What do you suggest? Thank you so much.
    PEOPLE’S PHARMACY RESPONSE: YOU CAN TAKE THE CALCIUM CITRATE AT DINNER WITHOUT WORRY. IT WON’T INTERFERE WITH TOPROL XL.

  2. Melba G.
    Reply

    For severe Acid Reflux, I have been on Prilosec, or Nexium for more years than I can document. I’m 86 now, but News articles suggest that I’ve been lucky, and should not continue this mediation!
    My question is – I want to know what I can take in it’s place – as I will be unable to eat anything beyond, rice, grits, or unseasoned potatoes in three days.
    MBG
    PEOPLE’S PHARMACY RESPONSE: DON’T TRY TO STOP SUDDENLY! ASK YOUR DOCTOR TO HELP YOU FIND A WAY TO CUT BACK GRADUALLY.
    YOU MIGHT FIND THAT LEAVING THE RICE, GRITS AND POTATOES OFF YOUR PLATE CAN HELP. SOME PEOPLE REPORT SUCCESS WITH A LOW-CARB DIET.

  3. DP
    Reply

    I have been taking Aciphex, 20 mg, for 8 1/2 years. I am also aware of the greater risk of hip fractures/Journal of the American Medical Association article. My question is should I try calcium citrate over calcium carbonate products for better calcium absorption?
    PEOPLE’S PHARMACY RESPONSE: CALCIUM CITRATE IS SOMEWHAT LESS LIKELY TO CAUSE CONSTIPATION. IT MIGHT BE WORTH A TRY.

  4. Carole Merritt
    Reply

    I have been taking Nexium 40MG daily for several years. Due to having thyroid removed in 1999, I take Levoxyl ll2 HCT 32- 12.5 tab daily. Since they both require no food, I have been taking them together first thing in morning, one hour before meals. After talking with new drug plan pharmacist, he informed me that Nexium reduces the effects of levoxyl and it should be taken four hours before or after any other drug.
    I have been weak, tired, and have stiff legs and a general malaise for more than a year. It disgusts me to think there is no indication on the Nexium printout or the levoxyl printout. I also take two calcium, atacand, atenolol, premarin, daily aspirin, fish oil, multivitamin, vesicare, and biotin daily. I thought I had my schedule down to a science, until today. Thank God for pharmacists!

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