Omeprazole Prilosec and lansoprazole Prevacid have been available the longest and consequently are the most familiar to physicians and patients. Omeprazole and lansoprazole are now available over-the-counter.
While the newer medications, rabeprazole Aciphex and pantoprazole Protonix have data to suggest better suppression of stomach acid compared to omeprazole, there is no proof that the differences are clinically important. Rabeprazole and pantoprazole are smaller and may be better for patients who have problems swallowing capsules.
Pantoprazole is marketed as being cheaper, and may be better for patients paying for their own medications. Zegerid is a combination of omeprazole and sodium bicarbonate.
Information on side effects from studies where a PPI is compared to a placebo shows that the most common side effects are headache, abdominal pain, bloating, diarrhea and nausea. Interestingly, the incidence of these side effects is the same as when patients take the placebo. It is hard to compare side effect profiles between the medications, but there is no reason to believe that there are significant differences. There is no scientific data to guide physicians on how to deal with the relatively few patients that have side effects from one of the PPIs.
However, nearly all physicians have had the experience of switching from one PPI to another successfully. If you are having side effects from a PPI, you will not necessarily develop the same side effects if you switch to another PPI. Discuss this option with your physician. The only exception may be in the extremely rare instance of severe allergic reactions.
Source: U. A study published in JAMA ; was conducted to determine whether there is an association between long-term proton pump inhibitor PPI therapy and the risk of hip fracture. The study concluded that long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture.
Question What does this study mean for people who benefit from taking a PPI? The currently available PPIs include:. This is the latest in a series of articles that have questioned the safety of these powerful, widely used medications. Worldwide, PPIs have been available for over 20 years. In the s there were concerns that, by profoundly decreasing stomach acid production, they might lead to other health problems such as serious infections, poor absorption of vitamins and minerals, even gastrointestinal cancers.
However, by the mids, based largely on anecdotal experience, it was becoming clear that PPIs were remarkably safe. Formal studies looking at the use of PPIs in hundreds of patients showed virtually no long term side effects.
As a result, new PPIs were developed, PPIs became generic and ultimately available over the counter without a prescription. This was a great advance in our ability to treat the millions of patients worldwide that have acid-peptic diseases. In the last few years, researchers have been able to evaluate the side effects and complications of medications by using large databases of millions of patients. They were able to identify over 13, people with a hip fracture and compare them to over , people who did not have a hip fracture.
They also found that the risk increased further if the patients were taking the PPI a longer period of time, or at higher doses. This is probably due to impaired calcium absorption when there is less acid in the stomach. Now, it must be mentioned that the patients with hip fractures in this study were much more likely to be a cigarette smoker, be thin, be a diabetic, be alcoholic, have had a stroke, had dementia or had previous bone fractures.
Studies like this talk about the risk per patient-year of follow up. For example, if one follows patients for 10 years, that is 1, patient-years of follow-up. This study suggests that the risk of a hip fracture that is specifically related to PPI use is about 2 per 1, patient-years.
There have been other reports over the past couple of years about the possible risk of pneumonia and infections of the colon with a bacterium called clostridium difficile in patients taking PPIs. Again, these articles looked at the medical records of hundreds of thousands of patients and found a small increased risk in patients using PPIs.
Additionally, like the hip fracture study, other medical illnesses such as diabetes, heart and lung disease were also important risk factors. The Canadian Task Force for Preventative Health Care recently published recommendations for the prevention of osteoporosis in women. Parietal cells have receptors for three stimulators of acid secretion, acetylcholine, gastrin, and histamine While the effect of the PPI is irreversible on each individual parietal cell, permanently stopping it from pumping acid into the stomach, when these cells reach the end of their short natural life days , the body generates new parietal cells, which are able to produce acid.
This is why ongoing dosing is essential. The PPI class of medication directly affects the proton pump, rather than using an indirect approach, such as that of the histamine-2 receptor antagonists, which were the most widely accepted acid-reducing products prior to PPI discovery.
They work by neutralizing acid in the stomach sodium bicarbonate derivatives and absorbing acid calcium and magnesium salts.
While all PPIs are in the same class, each has a unique chemical profile. As with Pantoloc, Tecta is indicated for the treatment of conditions where a reduction of gastric acid secretion is required, such as duodenal ulcer, gastric ulcer, reflux esophagitis, the symptoms of reflux heartburn and acid regurgitation , and duodenal ulcers associated with infection by H. They work by turning off pumps that produce acid in the stomach. Previous studies suggest long-term use is associated with problems including kidney damage , C.
Recognizing those risks, Dr. Louis, and his colleagues checked to see if the drugs are also associated with higher risk of death. Al-Aly called the risk small but significant since such a large number of people in the U. To conduct the study, researchers combed through medical records of about , new users of PPI drugs and nearly 75, people who started another class of drugs, called H2 blockers, to reduce stomach acid.
The administrative data came from the U. Department of Veterans Affairs and researchers followed half the participants for at least five years. In Tuesday's issue of BMJ Open , Al-Aly and his co-authors evaluated the relationship between how long people took PPI drugs and risk of death, and found a higher risk of death with longer use.
The researchers cautioned that the results should not deter prescribing and use of PPI when there's a clear medical reason for them. That naturally has to be done by their physician. The study's authors also suggested that regularly reviewing use of prescription and over-the-counter medications could be worthwhile.
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