Heartburn pain

PPIs (aka proton pump inhibitors) remain incredibly popular. These acid-suppressing drugs help heal ulcers. That’s a really good thing. For short term use, they’re terrific! The trouble is that they are overprescribed for a wide variety of vague gastrointestinal symptoms. And the FDA seems to think these drugs are so safe that the agency has allowed them to be sold over the counter (OTC).

More Bad News about PPIs:

These heartburn drugs may not be as innocuous as they might seem. PPIs are better known by their brand names-Nexium, Prevacid and Prilosec. They are also available generically as esomeprazole, lansoprazole and omeprazole.

Over the past several years, a number of serious adverse effects have come to light. They include an increased risk of infections such as pneumonia and Clostridium difficile, weakened bones, poor absorption of nutrients such as calcium, iron, magnesium, zinc and vitamin B12, heart attacks, kidney disease and dementia.

PPIs and Death:

Investigators used a large database of more than 3 million VA patients to determine that PPIs increase the likelihood of death over a six-year span (BMJ Open, July 4, 2017). The scientists used patient records to compare people who had received a new prescription for a PPI to those who did not take any acid-suppressing drugs as well as to those who took a different, less powerful acid-reducing medicine such as cimetidine or ranitidine. They found that people taking PPIs were about one-fourth more likely to die during the study.

The FDA’s Soft Spot for Drugs:

Once the FDA makes a decision that a class of drugs is safe enough to be sold without prescription it has a really hard time changing direction. Even death does not seem to be a problem for the FDA.

Imagine, though, that an herb such as black cohosh or echinacea were found to cause kidney damage or osteoporosis. What if an FDA staffer discovered that a probiotic formulation increased the risk of heart attacks or death? The hue and cry would be deafening. There would be instant press releases from the FDA about these grave dangers. We would see headlines and interviews on the evening news shows. Shortly thereafter, there would major efforts to limit access to such supplements. The FDA might even consider banning them outright.

As far as we can tell, the FDA does not seem alarmed by the recent reports about PPIs. There is certainly no mention of withdrawing such drugs from OTC status. That means you are on your own.

DO NOT stop PPIs Abruptly!

No one should ever stop a PPI suddenly, as that might trigger rebound hyperacidity and severe symptoms of indigestion. The authors of this paper in BMJ Open suggest that PPIs should be used for a limited amount of time and only when there is a clear medical indication and where benefits outweigh risks.

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  1. ANTHONY
    Alsip, IL
    Reply

    I was taking Protonix for 3 years. After reading about the effects I changed to chewable papaya enzyme. They work great.

  2. Jean
    CT
    Reply

    Have been “going off” omeprazole without difficulty and this is how: Month 1, change 1 day per week to 1/2 pill; Month 2, change two separated days (M, Th) per week to 1/2 pill; Month 3, change three separated days to 1/2 pill (Tues, Th, Sat) each week; Month 4, change 4 separated days per week to 1/2 pill (M, W, F, Sun), etc. until every day is 1/2 pill. After one month of 1/2 pills every day, every week, repeat the above decrease from 1/2 to none one day per week; Month 2, change two separated days each week to zero, etc etc. So far I am at 1/2 pills 5 days per week (2 days whole pill) without consequence. Lengthy yes, but worth it. Used this method in the past to successfully “withdraw” from Prozac. Get a 7-day pill tender and fill weekly to keep track. Good luck.

  3. David
    N.Y.
    Reply

    My cardiologist says to stop taking pantaprazole because a study says it can cause stroke. My gastroenterologist, who prescribed it, says that’s baloney. It has not been studied enough to come to that conclusion . Who’s direction do I take?

  4. Mary in SC
    Charleston SC
    Reply

    Ten years ago, after I had been on Nexium a few months, I had surgery for a knee replacement. The night before I was to be sent home from the hospital I woke up terribly nauseated with projectile vomiting. While cleaning me up the nurse took my blood pressure, and next thing I knew people were rushing in the room with medical equipment and the nurse was calling out my blood pressure that was going down and down.

    Someone gave me a shot, and finally it started going back up. They told me I had a sudden case of pneumonia, and I was sent to intensive care, where I recovered with no further trouble. Wondering why I had contracted pneumonia so quickly, I did some internet research when I got home and ran across the side effects of Nexium. Two of them were “pneumonia” and “sudden death.”

    Needless to say, I never took it again. I later found out my stomach problems were being caused by gluten intolerance. They stopped after I drastically cut down on wheat products.

  5. David
    NW Oregon
    Reply

    For indefinite/unknown reasons (which seems to be common for many uses of PPI’s), I have been on (and needed!) Omeprazole for over 10 years.
    –My Primary Care doc has recently increased dosage to as many as 4 (20mg caps) per day!
    –I was astounded. He fumbled around when I confronted this.

    Frankly, after reading bad reports about PPI’s, I have secretly been trying to wean myself off them.

    SOME SUCCESS! I am comfortably down to 1 every-other day, though I had to use Pepto Bismol occasionally for a few months to get to this level.

  6. Karen
    WI
    Reply

    I have been taking a PPI (Prevacid) for close to 15 years. What are recommended natural alternatives?

  7. Les
    Reply

    Am 87 yrs old & have been on PPI’s off & on for over 45 yrs. Each time I attempted to wean from PPI meds, I immediately experienced recurrent indigestion discomfort. Currently taking Omeprazole 40mg daily to control indigestion discomfort.

  8. Marty
    Midwest
    Reply

    I was diagnosed with Barrett’s Esophagus 20 years ago and have been prescribed various (depending on what my insurance will cover)PPIs ever since. I do not have heartburn, regurgitation, or other symptoms and my last endoscopy showed no sign of Barrett’s, yet my gastro Doc still wants me on a prescription for LIFE! So frustrating, scared to take the esomeprazole, scared not to.

  9. Whitley
    NC
    Reply

    I’ll let this new research report From Medline Plus from NIH be my comment. It is near a simultaneous release above reports from Graedons. Medline/NIH report contradicts a great deal of what Graedons’ report say. I think the two groups need to have a sit down. Today I find them contradictory.

  10. Carol
    Sugar Land, TX
    Reply

    My GP nor my gastroenterologist ever talked to me about diet reasons for acid reflux. After research of acid causing foods, I was able to get off of these drugs. I was convinced that the last one I was on caused my heart to be fast (stated as a side effect), but even after getting off the med, I still (after almost a year) am still having the hard heart beat. I have changed BP meds several time. I’ve been given a clear go by 2 cardiologists after wearing a monitor for a month. It exhausts me! Any suggestions?

  11. Margaret
    North Carolina
    Reply

    I’m on esomeprazole magnesium and have been for years. My PA wanted me to get off this so she prescribed Ranitidine. I went straight from one to the other with no tapering. It was awful, but it got better. The Ranitidine did not eliminate the reflux pain. It was better, but I still had it after everything I ate or drank so I’ve gone back to taking the esomeprazole. I get blood tests and urine tests every 3 months. Am I supposed to be miserable the rest of my life. By the way I’ll soon be 70 years old.

  12. B
    Virginia
    Reply

    I have been on PPI’s for many years. Whenever I try to go off by taking things like Pepcid, Zantac, DCL licorice, cinnamon tea, etc. ….many suggested by the People’s Pharmacy, the heartburn is catastrophic! Nothing works better than Nexium.

    I had Barrett’s disease at one point. Cured by taking Nexium. My doctor says that we have to weigh the risks with the pill and the problem without it. I choose to stay on Nexium. I am very healthy for my age …77…so I guess I don’t worry so much about PPI’s killing me.

  13. Cindy
    Wisconsin
    Reply

    Following an endoscopy, I was diagnosed with Barrett’s esophagus (I am asymptomatic) and prescribed Omeprazole 20 mg to be taken once daily, an hour before breakfast. My GI specialist and my internist both say I must stay on this regimen for the rest of my life.

    I have osteoporosis and mild anemia, and have been a Type 1 diabetic for 45 years so I am concerned about the malabsorption of calcium and other nutrients as well as the danger posed to my kidney function and heart.
    Can anyone offer suggestions?

  14. Shirley
    TN
    Reply

    I need help to find a more effective way to taper off these drugs or a safer alternative drug that works as well as PPIs. I have tried several methods suggested by your digestive heartburn guide and am still not able to do so as of now. The Nissan surgical treatment is a last resort for me.

  15. Frank
    Port St Lucie, FL
    Reply

    I’m a perfect example of this situation. My gastroenterologist prescribed lansoprazole after an endoscopy. I asked him how long should I stay on this drug. His response was “indefinitely!”

    Needless to say, especially after absorbing all the data on The People’s Pharmacy, I tapered myself off the drug. Subsequently, I continue to hear and read about all of the problems, side effects, and contraindications of lansoprazole and related PPI’s. Thank you!

  16. Grace
    Nashville NC
    Reply

    I took PPIs for years DR’s orders.
    After reading how harmful they were I decided to make a change. I would take a ginger cap one day and meds the next for a several weeks then switched to the ginger every day. It took me about a month to wean off the PPIs . I tried stopping the PPIs several times but had such terrible stomach pain I would go back taking the PPIs .
    I have taken a ginger cap everyday for 2 or 3 years with no problem

  17. Janet
    SC
    Reply

    I am on Prilosec for almost a year. I’ve struggled with taking them, suffered for not taking. I’ve tried everything natural with no relief. I have GERD and as a result ( I think ) ; the results have caused my esophagus to go into contractions, which mimics a heart attack. It’s very painful and for me very frightening. When I read and hear all the bad things about PPI’s I am afraid, but on the other end it’s a must for me.

  18. David
    Texas
    Reply

    PPI’s use increased exponentially After the patents for H-2s expired. No promotion against them and the lack of awareness of serious side effects led to widespread usage. This is another example of unintended consequences of knowledge assimilation or rather lack of.

    The value of a “drug” salesman is that the problems with competitive drugs are called to ones attention. I think the term is counter detailing. I always welcomed their input and never refused information. The more information I had the better my decision making process.

  19. Grace
    Missouri
    Reply

    I am including the text from a more complete article. This gives a less harrowing perspective. P

    People who used proton-pump inhibitors experienced a 25% heightened risk of death from all causes compared with people taking H2 blockers, the researchers estimated.

    If about 500 patients took proton-pump inhibitors for a year, there would be one death that may be related to the drug use, explained Al-Aly. The longer patients used PPIs, the higher their risk of early death, he added.

    When comparing users of proton-pump inhibitors with non-users of PPIs or H2 blockers, the same 25% higher risk level was seen, the analysis indicates.

    “In our studies, however we looked at the data, there was always a consistent relationship between (proton-pump inhibitor) use and the risk of death,” Al-Aly said.

    Al-Aly and his co-authors say the biological reason for a link between PPIs and increased risk of early death is not clear. Evidence suggests that these drugs change how genes express themselves, increasing some DNA activities while decreasing others. It is these genetic differences that may contribute to earlier deaths.

  20. Capra
    Reply

    As a healthcare provider- I have often asked the same question. Why are these drugs OTC? I have even seen physicians prescribe these meds and the person stays on it FOREVER. For many, their stomach distress is caused by too little stomach acid. But you rarely see a physician discuss this or even investigate which ailment a person has: too much or too little stomach acid.

    • Susan
      27526
      Reply

      Why in the name of all that is good are these horrendous PPIs prescribed to every baby with gas!!!! If you google it you will see and it is truly outrageous! It took me months to get off after using them for decades and getting off was horrendous! Now I take ranitidine as needed. How is a baby supposed to get off if they are still taking a PPI at 2 years or more!

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