Heartburn pain

When powerful acid-suppressing drugs called proton pump inhibitors (PPIs) were first introduced in 1989 they were promoted as highly effective and extremely safe. Doctors embraced drugs like Prilosec, Prevacid and Nexium enthusiastically and quickly turned these medications into billion dollar success stories for the pharmaceutical industry.

When these prescription drugs lost their patent protection the FDA agreed that the medications were so safe they could be sold over the counter without medical supervision. Now you can buy Nexium 24HR, Prevacid24HR and Prilosec OTC in any drugstore without a prescription.

Many doctors remain convinced that these PPIs are among the safest drugs in the pharmacy. It also seems hard for the FDA to embrace the idea that there are serious heartburn drug dangers and that perhaps its approval for OTC status of PPIs may require reconsideration.

Proton Pump Inhibitors and Kidney Disease:

Over the last 25 years, however, side effects from long-term use of PPIs have gradually come to light. The most recent potential complication is chronic kidney disease (CKD). This is a very serious condition that puts people at risk for heart disease and premature death.

The study published in JAMA Internal Medicine (online, Jan. 11, 2016) found that people taking proton pump inhibitors for a long time were more likely to develop chronic kidney disease.

This is an association, and there is no definitive evidence yet that PPIs trigger CKD. But the connection is worrisome. One reader shared his doctor’s perspective on PPIs:

Doctor Denies Heartburn Drug Dangers:

“My doctor prescribed omeprazole for acid reflux and I have been taking it for about a year. At first I took it religiously every day, then occasionally I would skip a day.

“When I read the paperwork included with this medication I was alarmed. It appears that omeprazole is not intended for long-term use. Side effects like bone fractures, diarrhea, cramps and magnesium or calcium depletion seem to become more likely the longer it is used.

“I brought this to my doctor’s attention, but he did not appear nearly as concerned as I am. He said I should take magnesium and calcium supplements and added that over the many years this PPI has been prescribed, he has not seen or read about any problems with long-term use.

“I am not comfortable with what I read, so I do not take the drug daily as prescribed. Instead I take it every other day and sometimes the intervals are longer.

“I keep bringing up these issues and my doctor always reassures me there is nothing to worry about. I will still look for a way to eventually phase off this medication.”

What Happens When PPIs are Stopped Suddenly?

Stopping proton pump inhibitors is not always easy. After a few months the body adapts to a low-acid environment. Discontinuing the drug abruptly may result in severe heartburn symptoms for several weeks.

Nancy shared her accidental withdrawal from a PPI before it went OTC:

“I have been taking omeprazole for some time but forgot to take it with me to California while I was traveling. One day my whole chest was on fire. I saw a local pharmacist and he said it was because I stopped the omeprazole too suddnely and nothing suppressed the acid reflux. He told me to never take omeprazole again that it was a very bad drug and said not to take any type of those medications.”

CAH had a different experience with a pharmacist:

“I have been trying to get off the Prilosec for a couple of years. But if I stop I am so miserable after a few days that I weaken and start it again. Whether it is GERD or acid rebound is impossible to know. I just came from talking to my local pharmacist-who, interestingly, had never heard of a rebound effect from PPIs! He has no helpful advice about how to stop it.”

Long-Term Heartburn Drug Dangers:

Other complications of PPIs include an increased risk of pneumonia, especially among older people. Another infection, Clostridium difficile (C. diff), is linked to PPI use and can cause prolonged and debilitating diarrhea that is hard to treat.

Nutritional deficiencies such as magnesium, iron and vitamin B12 may develop over time. There are data suggesting that chronic PPI users may be at increased risk of cardiovascular complications (PLOS One, June 10, 2015). Such reactions may be rare, but so many patients take PPIs that side effects could have a large impact.

Allison’s experience with proton pump inhibitors:

“I believe that PPIs (proton pump inhibitors) create more problems than they solve. It took me three tries, over several years, to extricate myself from these drugs, after their being prescribed to me for GERD for 15 to 20 years.

“During that period, I developed Vitamin B12 deficiency and osteoporosis as well as sporadic, diarrhea-predominant IBS. I also had a bout of C. difficile colitis. I suspect that PPIs either caused or contributed to all of these conditions and events.”

Beba had a somewhat similar experience:

“I had been on Nexium for 7-8 years for mild GERD. Last year I started having severe side effects, which I didn’t realize were related to the Nexium. I was having severe heart palpitations and muscle cramps/weakness. Since heart disease runs in the family I was sent to cardio dr. who diagnosed me with low magnesium, low iron, b-12 deficiency, no vitamin D levels that registered and calcium levels that were low.

“He sent me to get a Dexa scan where I was diagnosed with osteopenia (pre osteoporosis.) I weaned myself off Nexium, with Zantac every other day and Mothers apple cider vinegar with honey (all organic). I also took DGL licorice and Alka Seltzer antacids.

“It took me two months to get completely off of Nexium, but I did it. I no longer have heart palpitation; my calcium, B-12 and magnesium levels are all normal. However, my Dexa scan is still bad, so I am doubling up on the calcium rich foods and working out. This stuff is bad, I only hope that I haven’t done any damage to my heart. I am scheduled to go back to cardio dr. in May. Wish me luck.”

Other Options:

Some patients may require a PPI for long periods of time, but others may find alternative approaches helpful for controlling heartburn symptoms. For those who would like to learn more about such alternatives and ways to get off PPIs, we offer our Guide to Digestive Disorders. In it you will get more details on DGL licorice and Persimmon-Ginger tea for gradual weaning off powerful acid suppressing drugs. There are also many non-drug options for dealing with heartburn at this link.

Share your own experience with PPIs below as well as strategies for coping with heartburn below in the comment section.

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  1. Barbara W
    Florida
    Reply

    My doctor prescribed omeprazole 10 mg for my heartburn in June of 2013. As I wasn’t getting much relief, he upped my dosage to 40 mg in Sept of that year. Six weeks later I was diagnosed with triple negative, highly differential, breast cancer and when I started the chemo treatments, was told to stay on the omeprazole as it would help protect my digestive system during treatment. With so much on my plate I never even considered a heartburn medicine as anything to even think about.

    Nearing the end of a 5 month regimen of chemo, I developed severe neuropathy in my feet and a mild case in my hands, which my neurologist ordered B12 shots to help combat, as I had low B12 readings. I also began experiencing balance issues, dizziness and lightheadedness.

    All of these conditions were considered by-products of the chemo and/or by the radiation treatments, that I had to stop because of damage to my lungs and kidneys. By spring of 2015, I was experiencing extremely painful cramps in my legs and was diagnosed with a magnesium deficiency. As the chemo had brought on the neuropathy, I just assumed it had also caused the B12 and magnesium deficiencies.

    When I read the results of the studies released in Feb this year about the dangers of PPIs, I looked at my omeprazole for the first time and decided it might have been a contributing factor. Last week, I decided to not renew my prescription and though I was warned not to go cold turkey, I did. In just three days I was experiencing severe pain and as I’m training for a tri (my first since cancer diagnosis), the stomach pain was interfering with my training and several times I thought I would pass out.

    My doctor was not happy with my stopping and reluctantly told me to try Zantac and if that doesn’t work go back on Omeprazole. My father went on dialysis when he was 71 (after being treated for ulcers and heartburn for decades) and stayed on dialysis until his death at 93. Knowledge that this drug probably has kept my body from absorbing vital minerals when I most needed them and that this drug could cause kidney failure is a risk I’m not willing to take.

    I will not go back on any ppi, but am wondering if Zantac and other H2 blockers will impact my B12, magnesium and potassium absorption issues as well. And will I have similar withdrawal problems when I try to go off them in about six weeks? It is very difficult to run, bike and swim with no feeling in one’s feet and both thighs cramping, but I can’t do those activities with extreme stomach pain either. Since I have had the neuropathy now for almost two years, no one is optimistic it will go away and I’m not sure this is something I can tolerate for many more years.

    In the meantime I hope that I am not jumping from the pot into the fire by switching to the H2 blockers, but I feel like I have no choice. I’m angry that I ever took a ppi. I should have been more vigilant, but was dealing with more pressing health issues. This is a good example of the “cure” being worse than the disease.

  2. Marianne
    Calgary
    Reply

    I’ve had terrible heartburn for years and my Doctor tried to give me PPI’s. I took them for 2 days but after reading the dangers I stopped. I insisted on tests to find the cause of the heartburn and found I have hiatal hernia.

    I have been for two Chiropractor treatments and my heartburn is almost completely gone. I tried this after reading loads of other people’s success with this. I thought I’d give it a whirl before going the surgery route and glad I did! I’m going for a pain free brunch now and going to chat with the waiter there who has had his hiatal hernia cured this way. It’s a mechanical issue.

    Mine likely developed because I sit hunched over my coffee table on my lap top for years putting upward pressure on my stomach. I will take care to sit upright and learning to breath correctly. It’s a shame Doctors just want to hook is on dangerous drugs instead of helping to actually fix the problem. Guess that’s too much work or maybe they don’t know how to do anything else but prescribe drugs these days. Thank God for the Internet!

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