PROTON PUMP INHIBITORS

The proton pump inhibitors (PPI) are sometimes called “stomach protectors.” Since they became available in the late 1980s, the number of gastric operations has fallen significantly. These tablets or capsules are used to treat duodenal and stomach ulcers as well as acid reflux. An estimated 15 million Americans take these medicines regularly.

CHEMICAL NAME

The active ingredients are omeprazole, esomeprazole, pantoprazole, lansoprazole, and dexlansoprazole, respectively.

MEDICINES

These medications are sold under a number of different brand names in the U.S., including Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole), Prevacid (lansoprazole), and Dexilant (dexlansoprazole). They are used to treat ulcers of the stomach and intestine as well as acid reflux, which occurs when stomach acid flows backward into the esophagus.

HOW IT WORKS

The active ingredients in proton pump inhibitors block the gastric proton pump, which is the terminal stage in the secretion of gastric acid. Decreasing levels of stomach acid aids in the healing of ulcers and diminishes the pain of indigestion and heartburn.

SIDE EFFECTS

Because so many Americans are accustomed to taking PPIS to treat acid reflux and ulcers, experts warn about the growing tendency to use them for treating less-significant medical conditions such as flatulence, nausea, and stomach pain. The potential side effects may include gastrointestinal problems such as diarrhea, nausea, and vomiting, as well as insomnia, skin rashes, general indisposition, and lethargy. In recent years the FDA has issued warnings about potential long-term effects, including increased risk of fractures, diarrhea associated with Clostridium difficile bacteria, vitamin B12 deficiency, and acute interstitial nephritis, which can lead to kidney failure. Studies have suggested that patients taking PPIS in high doses or over a long period are at increased risk for hip, spine, and wrist fractures. PPIS have been found to reduce the absorption of calcium from dietary sources by as much as 40% after just two weeks of treatment. There have also been reports of pneumonia: Acid suppression causes the ph of gastric juices to rise, which can promote an overgrowth of bacteria. This can potentially lead to microaspiration, the unintended aspiration of small amounts of reflux material into the lungs, which can lead to pneumonia.

INTERACTIONS

Omeprazole (but not pantoprazole) lessens the antiplatelet effect of clopidogrel, a blood thinner. The result: higher risk of stroke. There are also severe warnings about combining omeprazole with atazanavir or nelfinavir (antiretroviral medications used to treat HIV/AIDS). PPIS are also known to interact with certain foods, preventing, for example, the absorption of calcium from dairy products. Patients taking a PPI long-term should consider vitamin D and calcium supplements.

PROPER USE

PPIS have been associated with increased deficiencies of vitamin C, vitamin B12, calcium, iron, and magnesium—which require vitamin and mineral supplements (in consultation with a physician). Originally prescription-only, PPIS are now available in 20 mg OTC tablets and capsules. Nevertheless, PPIS should not be taken for more than 14 days without consulting a physician—and the daily dose should not exceed 20 mg. They should be taken on an empty stomach (at least an hour before a meal).