Heartburn Drugs: Why Less May Be More

Proton pump inhibitors tied to rare, serious health risks

/ Author:  / Reviewed by: Jennifer Gershman, PharmD, CPh

(RxWiki News) When it comes to acid reflux, better care sometimes means less medication.

In a new review, a team of experts from Canada advised that proton pump inhibitors (PPIs) — a class of drugs often used to treat heartburn and other gastrointestinal issues — only be prescribed at the lowest dose possible and for the shortest period of time to avoid some rare, but potentially serious, side effects.

This recommendation echos another made by the Canadian Association of Gastroenterology, which called for a periodic reassessment of all patients on PPIs.

"[PPIs] are associated with a number of rare but potentially serious adverse effects," wrote Todd C. Lee, MD, MPH, an internal medicine specialist at McGill University Health Center in Montreal, and colleagues. "These uncommon effects become highly relevant when considering the tens of millions of patients who take PPIs worldwide."

PPIs include omeprazole (brand name Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium), among others.

According to Dr. Lee and colleagues, some PPIs have been tied to an increased risk of heart attack in patients taking the blood thinner clopidogrel (Plavix).

Other PPIs have been tied to rebound heartburn and a malabsorption of the vitamins B-12, iron and magnesium, according to these experts. Others have been tied to an increased risk of Clostridium difficile (C. difficile) infection. C. difficile is a bacterium that can cause diarrhea and serious intestinal conditions. An increased risk of fractures has also been linked to long-term PPI therapy.

To minimize these risks, patients should limit their alcohol and caffeine intake — which can cause gastric distress — and doctors should focus on safe prescribing, Dr. Lee and colleagues wrote.

These recommendations align with those of Choosing Wisely Canada, a campaign launched in 2012 to encourage doctors and patients to engage in conversations about unnecessary tests, treatments and procedures. This campaign was modeled after a similar one in the US.

This review was published Nov. 23 in the Canadian Medical Association Journal.

No funding sources or conflicts of interest were disclosed.

Review Date: 
November 19, 2015
Last Updated:
November 23, 2015