The People's Perspective on Medicine

Combining OTC Pain Relievers and Heartburn Pills Is Risky

Both OTC pain relievers and heartburn pills can increase the possibility of experiencing a heart attack; people using these drugs should know the risks.
Man grabs at his heart. He has a heart attack. angina chest pain MI infarction congestive heart failure

It’s hard for the FDA to admit it might have made a mistake. But when it comes to OTC pain relievers and heartburn pills, that seems to be the case. When the agency approved NSAID pain relievers like ibuprofen and naproxen for over the counter use, these drugs were perceived as very safe.

The problem is that the risks of medications may not always be obvious. Even before they became available without prescription, doctors worried about the drugs’ potential to cause bleeding ulcers.

Other consequences of NSAID use appeared more gradually. Evidence has accumulated that such medications increase the risk of heart attacks, high blood pressure, stroke, heart failure and atrial fibrillation (Expert Review of Cardiovascular Therapy, Oct., 2014).

Are Older People at Higher Risk Of NSAID Injury?

Unfortunately, these problems are more likely to be troublesome among older people, the very folks who are prone to aches and pains. Recently, researchers have found that NSAIDs also seem to increase the chance of falls among elderly individuals (Consultant Pharmacist, 2015).

If the FDA had known all of this up front, perhaps these drugs would not be available in supermarkets and gas stations all over America. But it may be too late to put the genie back in the bottle and restrict ibuprofen and naproxen to prescription use only.

PPI Problems

This pattern has been repeated in the case of the popular acid-suppressing drugs called proton pump inhibitors (PPIs). Drugs like omeprazole (Prilosec) or lansoprazole (Prevacid) were initially available by prescription only for serious gastrointestinal problems such healing ulcers, treating erosive esophagitis and easing a rare condition called Zollinger-Ellison syndrome.

Before long, though, doctors were using them to treat heartburn symptoms. PPIs have become among the most widely prescribed drugs in the world. In the U.S. it is estimated that over 20 million people receive prescriptions for powerful acid-suppressing drugs every year.


Once these powerful medicines went off patent, the manufacturers requested OTC status as Prilosec OTC, Prevacid24HR and Nexium 24HR. The FDA approved the switch on the grounds that these drugs were very safe.

Serious Side Effects of PPIs

Now, however, the dark sides of PPIs are coming to light. The most recent research shows that these medications boost the chance of a heart attack by about 20 percent (PLOS One, June 10, 2015).  This may not sound like much, but when you consider how many millions of folks take these medications, it adds up to a lot of additional heart attacks.

This is not the only problem that has been linked to PPI use. These drugs are also associated with an elevated possibility of broken bones, especially hip fractures (Annals of Epidemiology, Apr., 2014).

People taking acid-suppressing drugs are also more susceptible to pneumonia, with a 50 percent increase in risk (PLOS One, June 4, 2014). Nor are lung infections the only problem. People taking PPI medicines are more likely to contract Clostridium difficile, an intestinal infection that can cause life-threatening diarrhea (American Journal of Gastroenterology, July, 2012).

Many people take a PPI to protect their digestive tract from the damage that an NSAID pain reliever can do. As we have written, that may not achieve the desired effect. Although PPIs can help protect the stomach, they leave the small intestine vulnerable to injury (Mayo Clinic Proceedings, Dec., 2014). No one knows if the excess risk of heart attack from this combination might be greater than the danger from either drug alone.

Using Over the Counter Medicines Wisely

People like having access to powerful medications for symptom relief. But they need to inform themselves carefully about possible risks. OTC pain relievers and heartburn pills sometimes trigger serious or even life-threatening complications.

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    About the Author
    Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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    20 years ago I was told I needed to take anti reflux medication for the rest of my life to protect my osophacus from further damage. Interestingly I didnt suffer from heartburn until I started taking nexium. If I miss one day I really suffer from heartburn. I dont understand this and I really wonder if I needed this medication when prescribed

    Oh, Lord. The answer – and the answer for all OTC drugs – is moderation. Or at least monitoring. Yes, the side effects can be awful. But you’re taking a drug. Find me a drug that doesn’t have potential serious side effects.

    The point is for this instance, decide for yourself if the adverse effects are worth the benefits. Maybe the they are or maybe they aren’t. But don’t let a website with an easily identifiable bias make your decision for you.

    There is no arguing that PPI’s and H2 blockers shouldn’t be used for more than a couple of months at a time. However, I’m very curious about some of these so called increased risks, namely the risk of heart attack.

    If indeed these medications are being used to treat heartburn more and more commonly, wouldn’t that also assume that this medication is being prescribed to people as an alternative and easier remedy to diet? I’m on some now, but I know I have to adjust my diet to prevent my heartburn and upper respiratory acid erosion from being a common occurrence, and that this medication is not supposed to be a permanent solution.

    If people who eat a bad diet are at higher risk of heart attack and gastrointestinal issues, and despite being prescribed heartburn medication they continue their eating habits, wouldn’t that mean that whether or not they are taking heartburn medication be irrelevant or a mere coincidence?

    This is scary. I have pericarditis and my doctor prescribed ibuprofen’s, which I told him I was sensitive to. HE told me would you rather have a life threatening complication from pericarditis or stomach irritation? He then gave me protonix while I’m taking the ibuprofens to protect my stomach. SHOULD I be worried?

    I would also like to know if this information includes TUMS and like drugs that are also OTC. Thank you anyone.

    No. Tums and other simple antacids are not a problem for this.

    What is best advice for getting off Omeprazole? Tried very slowly to alternate pepcid with it and immediately got extremely nauseous. Has anyone had good luck trying to get off?

    Seeking relief from arthritis I was prescribed Ibuprofen and Omeprazole. On reading the possible side effects I spoke to a G.P. about my concerns , and her answer was don’t take them then. I am now determined to learn more about eating foods that will not have an adverse effect on my health, avoiding caffeine has helped too.

    I think the simple answer is to avoid sugar keep bread to a minimum and try to eat within a 4 to 6 hour time span. Read Dr Michael Mosley’s book adapt to yourself. Hard but easy to get your health back. Watch the stones fall away I went from a size 16 ladies to a size 8 in 6 months. Understand how evil sugar is even in fruit and fasting the body goes into repair mode when not eating and also slows ageing down – gives your liver time to process what you have eaten.

    I cannot believe how people just resort to drugs…….It’s your diet folks…..Sugar addicts you don’t realise it but you are. I can’t stand sweet stuff anymore …I used to love chocolate…I love having a lovely size 8 Figure better and the compliments…I am 57 often people think I am in My mid 4Os.

    It is really no surprize to me and others about the problems caused by taking Omeprazole I started some time ago doing a little research into this terrible drug and new one day something would come of it.
    My now retired doctor placed me and others on this 30 years ago when reps visited the surgery promoting it.
    Last year I became most unwell on holiday and a local doctor saw me and suggested that I see my on doc when I returned home which was in a few days. By this time I was really very unwell and doc decided to send me for emergency endoscopy which showed benign stomach polyps with acid reflux[the very thing this drug was supposed to help] I was told to continue with Omeprazole and I was also given for spinal compression Naproxen. During this time several months had gone by and I was supposed to have been going abroad didn’t get as Naproxen +OMEPRAZOLE caused severe palpatations unfit to fly.
    This is now one year exactly since tests have been done and sorry to say Ive been diagnosed with Atrial Fibrillation caused by ? Omeprazole. Seen by a specialist who did research into it and I was taken off it and put on Zantac the damage has been done possibly not by one but both drugs.
    A review should be done every 6 months on drugs like this and not wait till 30 years down the line to be told there is a problem so concerned are the medical staff it was decided that I should be put on an anticoagulant twice a day in case I develop a stroke!
    I would urge people to keep any evidence of being on both drugs as I don’t think we have heard the last of this problem and I think it would be a good idea to do a survey into it and involve the media of the severity .

    I have been taking PPIs for 15 years and for most of them, Protonix and now Pantoprazole. I am just now starting to have serious side effects from them. I have stomach cramps, nausea and I do, also, have polyps all over my stomach. My doctor is trying to wean me off this medication. I have heard it is hard to do. I hope I am successful. I do have a hiatal hernia and erosion in my esophagus.

    I am on Protonix and have injuries requiring pain medication.

    My question is what does one do in this case?

    I will discuss this issue with my Primary Care Doctor.
    I would also like your input.

    Thank you,

    I’m having trouble trying to order ONLY 1 Digestive Disorders and it shows 3 in cart. If you can please help me

    The FDA makes the decisions to allow OTC sales of drugs for many reasons – safety, and patient welfare do not appear to be the main reasons for these FDA decisions however. Insurance companies push to have popular, expensive drugs sold OTC so they don’t need to pay for the prescription. Big Pharma looks at OTC/DTC sales as a way to boost their profits without messing with those pesky doctors.
    The worst drug sold OTC is Tagamet/cimetidine. This drug interacts with hundreds of drugs in bad ways through slowing the cytochrome p450 enzymes for drug metabolism. The interaction with alcohol is particularly deadly as 400 to 600 of cimetidine blocks alcohol metabolism for almost a day and is leaving people dead and in prison after drinking their regular 6 pack. A patient taking Tagamet, Zocor,fluoxetine/Prozac, a little grapefruit juice and allopurinol stands a good chance of death if the ER doc adds any of several classes of antibiotics. Medicine these days is not as dangerous as seeking medical care in the 1800’s – but we are getting closer with each class of drugs patients are “forced” to take along with OTC’s not being monitored by anybody with training. OTC needs to be reconsidered and regulation of OTC sales needs to be removed from the Federal Trade Commission which has always been worse than even the FDA.

    Does this concern about NSAIDs extend to creams such as Voltaren? I use it every day.

    What about TUMS? Same thing? I try not to take the two at the same time or closer than two hours apart on those rare occasions when I the arthritis acts up and I have indigestion.

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