The People's Perspective on Medicine



Aciphex is used to treat erosive or ulcerative gastrointestinal acid reflux disease (GERD). It's also used to heal duodenal uclers, and in combination with amoxicillin and clarithromycin, it is prescribed to get rid of H. pylori.

People's Pharmacy Perspective

Suppressing acid is big business. Drug companies have made billions on a category of drugs called proton pump inhibitors (PPIs). These are medications such as Aciphex, Nexuium, Prevacid, Prilosec and Protonix. They are prescribed almost like candy because physicians perceive them as highly effective and totally safe.

Patients love such drugs because heartburn hurts. A wonderful meal can turn into a nightmare, especially if reflux wakes you in the middle of the night. And there is concern that repeated reflux (with its corrosive chemicals) can scar the esophagus and increase the risk of cancer. So what’s not to love about acid suppressing drugs?

Have you ever asked yourself why we make acid in the first place? A healthy stomach is incredibly efficient at churning out acid. And it’s not just humans. Most animals also make acid in their stomachs. That’s right, dogs, cats, cows, snakes, sheep and even snails make acid. Scientists suspect that vertebrates have been making acid in their stomachs for at least 300 million years.

Is this just a giant mistake? Did Mother Nature mess up? Well, according to the drug companies that make PPIs it must have all been a cosmic joke, because now that they can stop the acid, all should be well with the universe. But perhaps Mother Nature was on to something and shutting down acid production has some unintended consequences.

For one thing, acid serves as a powerful barrier to bacterial infection. Even with our obsession with cleanliness, there are a lot of nasty bugs out there. We swallow this stuff with our food and we stick our fingers in our mouths and they are loaded with germs. There is growing concern that PPIs are associated with an increased risk of pneumonia (Archives of Internal Medicine, May 14, 2007) and serious digestive tract infections (World Journal of Gastroenterology, Apr 7, 2009).

There are other concerns that have arisen with long-term acid suppression. Absorption of vitamin B12 is best accomplished in an acid stomach environment. Concerns have been raised that PPIs like Aciphex may make it harder for some people to absorb this crucial nutrient from the diet (Basic & Clinical Pharmacology & Toxicology, online, Jan. 2006). Another controversial issue that has the gastroenterology community up in arms is a report in the Journal of the American Medical Association (JAMA, Dec. 27, 2006) linking long-term PPI therapy at high doses to an increased risk of hip fracture. Whether this is due to poor calcium absorption remains unclear (American Journal of Gastroenterology, Mar., 2009.

Stopping PPIs can be quite a challenge. Since the stomach seems to “think” that acid is essential for good health, the cells there try extra hard to make acid even with a PPI on board. When such drugs are discontinued abruptly, the acid-making cells go into hyperdrive. For days, and sometimes weeks (or months), the stomach churns our extra acid. Think about your nose if your overuse a nasal spray. When you stop, there is something called rebound nasal congestion. The blood vessels overcompensate and leave you feeling totally stopped up. So to rebound acid production in the stomach can lead to horrific heartburn. There are very few “official” recommendations about how to get off PPIs without experiencing serious reflux discomfort.

Bottom line: Proton Pump Inhibitors like Aciphex and Nexium are very good at suppressing the production of stomach acid and reducing symptoms of GERD and healing stomach ulcers. Whether the unanticipated adverse effects described above will turn out to be of serious concern remains to be determined. In the meantime, millions pop their PPIs without knowing the long-term consequences. We hope this story turns out well because the stakes are high.

Common Side Effects

  • Headache
  • Nausea
  • Diarrhea
  • General abdominal discomform
  • Gas 
  • Dry mouth and/or sore throat

Serious Side Effects

  • Blood problems (thrombocytopenia, etc)
  • Liver issues
  • Serious allergic reactions
  • Severe skin reactions
  • Irritation of the pancreas (pancreatitis)
  • Muscle break down (rhambomyolysis)
  • Broken hips (rare and controversial and only linked to long-term use)

Full prescribing information is available at:

Check out Wikipedia for more user-friendly information: 

For Drug Interaction Information check out iGuard:

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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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Been taking this medication for over 20 yrs, no real problems until last few months with unexplained stomach problems, discomfort pain on left side and sharper on right. Recent CT showed nothing of significance according MD who read it. Due to Dr. shortage here have had a number of medical practitioners but not one asked how long I have been taking it or if there were problems or indicated there might be. Latest Dr. only gives a patient 10-15 min time and never indicated it might be the rabeprazole use, but she has only been practising for a year or so. I do have an appointment scheduled with a GI specialist in May and will ask more questions then.

I have been taking Rabeprzole for about 18 months. My nurse practitioner told me to stop taking it as has bad side effects. Including dementia and osteoporosis. I had been having problems keeping a thought in my head and it was worrying me. I stopped the drug cold turkey and I am having worse symptoms then when I first started it.

I have a lot of pain about 2 hours after I eat in my duodenum. The burping is really disturbing. I started taking Apple Cider Vinegar and it helps a little but not much. Does anyone know if these symptoms will clear up in time when my stomach settles down back to normal?

Made me sicker than I was before starting taking Acifex !!!!! Complained to Dr. about stomach pain ……. Worse stomach pain I’ve had from day one of starting this medication !!! Stopped taking it today only after using it for 2 weeks !!! Constant diarrhea , headache, awakening heartburn and all over crappy feeling !!! Will never take this again !!!! I’ll deal with the stomachache !!!

YES!!! Since I’ve been taking it, nothing else has changed in my life. I also have hypothyroidism, so have always had weight issues. Since I started taking Raberprazole, my weight has steadily increased. I asked my Dr about it, and she says it’s because I’m getting older (I’m 38). Then recently saw that it’s one of the side effects (even if rare).. I’d like to try to get off of it, but Not sure that I want to deal with the heart burn again..

Go to It’s one of the side effects; supposedly less common.

Has anyone had weight gain? I have been on Rabeprazole for 20 years for reflux, after being diagnosed with an under-active thyroid. Until then my weight was ok, after starting this medication my weight steadily increased. My doctor tells me I am doing something wrong like eating. He does not believe the medication is to blame.

My husband has been taking prilosec for years… and it has been very effective in treating his acid reflux. However, two to three years ago he developed a serious blood disorder – low platelets. The year before this he was diagnosed with low antibody levels – on routine physical. He has been to numerous doctors specializing in hematology and oncology, as sometimes the underlying problem can be cancer (lymphoma).
Most patients with these disorders are sick constantly with respiratory illness/pneumonia, etc… my husband hasn’t been sick a day with these disorders and none of the physicians can figure out why. Yesterday we visited a specialist at Cleveland Clinic. He reviewed all of his medications (just three including Prilosec, a mild hypertension drug and Lunesta for insomnia.) The specialist checked the “rare” side effects of Prilosec and up pops both low platelets and insomnia…) We are going to change out his medications to see if maybe the Prilosec is causing the low platelets and insomnia. Has anyone else on this site heard of anything like this????

Thanks! My mother took Protonix… (got serious blood problems, diarrhea, & her colon lining wore away!) So when it was later prescribed for me and I got diarrhea, I connected the dots & ceased taking it. Other PPIs have this effect also. PEPCID Complete gives relief w/o side effects but, over time, seems less effective. Are there other alternatives? My gallbladder always “dumps” 90% of its contents (high), but removal wasn’t recommended. I don’t want a cure that creates more problems than it solves, but would like some relief.

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