Proton Pump Inhibitors, or PPI’s, are a class of prescription and over the counter medications that decrease the production of acid in the stomach. These medicines are used to treat multiple conditions including stomach ulcers, gastritis, reflux, and a condition called Barrett’s Esophagitis. Short term, these medications are very well tolerated and can provide relief for those suffering from acute gastrointestinal issues. Medications in this class include Prilosec (omeprazole), Protonix (pantoprazole), Prevacid (lansoprazole), Nexium (esomeprazole), and Dexilant (dexlansoprazole)
Long term use of these medicines and their associated side effects are not well documented. Within the last several years, research has shown that long term use (use greater than 8 weeks at a time) of PPI’s may come with long term consequence.
Stomach acid is essential in the breakdown of food and releasing nutrients from what we eat. Several vitamins, including iron, calcium, magnesium and B12. Decreasing the amount of stomach acid long term by using PPI’s can lead to deficits of these essential nutrients.
Stomach acid is also an important defensive mechanism for our GI tract and an association between long term PPI use and an increase in the intestinal infection Clostridium difficile has been shown. This infection can lead to diarrhea, nausea, vomiting, bloody stools and in some cases, death.
Most recently, a loose association between PPI use and the development of dementia has been shown and researchers are investigating the potential mechanisms involved.
In 2015, PPI’s were added to the Beer’s List by the American Geriatrics Society (AGS) as a medication that is potentially inappropriate for older adults. The Beer’s List is a guideline released by the American Geriatrics Society that makes recommendations to clinicians on medications that should not be routinely prescribed to older adults due to potential health risks. AGS states that long term use of PPI’s in older adults increase the risk of intestinal infections, loss of bone density, and fractures.
Safer Alternatives
If you suffer from occasional heart burn or acid reflux, H2 blocker medicines may be a better alternative. These medications include Zantac (ranitidine), Tagamet (cimetidine), and Pepcid (famotidine). These medications reduce acid in the stomach by reducing the production of histamines in the stomach. Long term use has not shown the side effects of PPI use and these medicines are safe in the elderly. They do not require daily routine dosing and can be taken when needed for symptoms.
Some of the H2 blockers DO come with medication-medication interactions, so always ask your pharmacist or primary care provider before starting a new medicine. And as always, NEVER stop or alter your medications without discussing this with your healthcare provider.
Florentin, M., & Elisaf, M. S. (n.d.). Proton pump inhibitor-induced hypomagnesemia: A new challenge. Retrieved March 12, 2016, fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782221/
Proton-Pump Inhibitors as Potentially Inappropriate Medications in Older Adults – Arkansas Geriatric Education Collaborative. (2016). Retrieved March 12, 2016, from http://www.agec.org/…/proton-pump-inhibitors-as-potentiall…/