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Research Suggests Proton Pump Inhibitors Overused

New research suggests that Proton Pump Inhibitors (PPIs) such as Aciphex, Dexilant, Nexium, Prevacid, Prilosec, and Protonix are being overused. The information comes from series of studies reported at the American College of Gastroenterology’s recent, annual meeting. According to the studies, said WebMD, doctors are over-prescribing PPIs both in and out of hospital settings. “I’m uncomfortable when people who have heartburn start the drugs on their own, or when a health care professional guesses and puts them on the drugs,” says Mayo Clinic gastroenterologist Yvonne Romero, MD, reported WebMD. Romero was not involved in the research, but reviewed the findings for WebMD. One study found that most patients studied—60 percent—were prescribed a PPI while hospitalized and, typically, because they were prescribed a PPI prior to admission; 26 percent were inappropriately prescribed a PPI, said WebMD. Research found that 44 percent were sent home with a PPI prescription and 9 percent of these people had no obvious reason for staying on the PPI after discharge, said WebMD. A Canadian study revealed that 70 percent of patients studied were prescribed PPIs or H2RA drugs for ulcer prevention during intensive care stays but, in 97 percent of the cases, drug use was inappropriate, said WebMD; about 40 percent were released with an unnecessary prescription for the drugs with PPIs less likely to be discontinued versus H2RA drugs. “Prescription of a proton pump inhibitor in the ICU was associated with the inappropriate prescription of the proton pump inhibitor upon hospital discharge,” said study leader Jasjeet Rai, MD, of McGill University in Montreal, WebMD reported. Other studies revealed PPIs being taken without medical supervision and that drugs were taken for longer than needed or when not needed. PPIs are considered the strongest class of antacid medications and are the third-greatest selling class of drugs in the United States, said WebMD. Doctors wrote 113.6 million PPI prescriptions; however, some are available without a prescription, such as Prevacid 24HR, Prilosec OTC, and the combination medication Zegerid OTC that contains a PPI and sodium bicarbonate, WebMD explained. Popular because they effectively reduce stomach acids in ways that other, simpler OTC medications—Tums, Rolaids, Maalox—can not, they are also more powerful

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that H2 receptor antagonist (H2RA) drugs such as Axid, Pepcid, Tagamet, and Zantac, said WebMD, pointing out that popping a PPI is a lot easier than giving up favorite foods. Romero explained that “If you take them indiscriminately, you reduce the benefit-to-risk ratio.” Studies have linked PPIs to increased risks for Clostridium difficile (C. diff), a serious, sometimes deadly, diarrheal disorder, noted WebMD. NewsInferno just wrote about PPIs’ increased risks for fractures of the hip, spine, and wrist; increased risks for serious infections such as pneumonia and C. diff; and severe magnesium deficiency, which can cause life-threatening cardiac arrhythmias. Although these, and other serious side effects, are indicated on the drug’s labels, none have received the prominent and significant black box warning, which could be contributing to the fact that many physicians are unaware of the serious risks associated with PPI therapy. Most recently, consumer watchdog, Public Citizen, petitioned the U.S. Food & Drug Administration (FDA) to mandate manufacturers list serious adverse reactions associated with PPIs in a black box warning, said NewsInferno. Public Citizen wrote that evidence indicates that after using PPIs for a month or more, patients who stop will make even more stomach acid than before PPI treatment, so-called rebound acid hypersecretion, in which acid reflux symptoms return even worse than before therapy, explained NewsInferno. Patients begin taking PPIs again, leading to long-term dependency.

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