There was a time when people treated heartburn symptoms with simple remedies. A half-teaspoon of baking soda in a glass of water was one standby. If you wanted to get a little fancier you could chew a few Tums or Rolaids or pour yourself a spoonful of Maalox or Mylanta.
In the 1980s, acid-suppressing drugs like Tagamet (cimetidine), Zantac (ranitidine) and Pepcid (famotidine) became popular. Once they lost their patent protection, however, they went over the counter and lost their glamour.
Now, even more powerful acid-suppressing drugs called proton pump inhibitors (PPIs) are among the most prescribed pills in the pharmacy. More than 100 million prescriptions are filled each year for drugs like Aciphex (rabeprazole), Nexium (esomeprazole) and Protonix (pantoprazole). Prilosec (omeprazole) and Prevacid (lansoprazole) are available over the counter as well as by prescription.
Proton pump inhibitors are a pricey way to relieve heartburn symptoms. According to an editorial in the Archives of Internal Medicine (May 10, 2010), more than half the prescriptions for PPIs are inappropriate. Although these drugs are useful for complicated conditions such as ulcers, Zollinger-Ellison syndrome and Barrett’s esophagus, they are overkill for indigestion.
New research suggests that the risks are higher than most people realize. A study published in the same journal show that PPIs increase the risk for fracture, perhaps by changing bone metabolism.
Two other studies in the same issue show that acid-suppressors increase the risk of a serious gastrointestinal infection known as Clostridium difficile. This infection causes severe diarrhea that is sometimes lethal.
Pneumonia is another unexpected complication of the routine use of PPIs (Journal of the American Medical Association, Oct. 27, 2004). Because such infections aren’t an obvious consequence of drugs for reflux, it took a long time for researchers to uncover these adverse effects.
It also took time to realize that stopping such medicines suddenly can trigger rebound hyperacidity (Gastroenterology, July 2009). This makes withdrawal a challenge.
People who wonder if they will ever be able to get off their Nexium or Protonix may be interested in our Guide to Digestive Disorders, in which we offer tips for stopping these drugs and non-drug ways to deal with heartburn.
While there certainly is a role for strong drugs to treat serious digestive disease, one of the recent studies shows that even people with bleeding peptic ulcers don’t need high-dose PPI treatment. Regular doses work just as well (Archives of Internal Medicine, May 10, 2010).
Perhaps it is time for doctors to become less aggressive with these therapies. Patients might ask whether the prescription is really necessary, or whether they could manage their heartburn with common-sense old-fashioned measures such as consuming fewer carbohydrates (and maybe less junk food in general) or raising the head of the bed. An occasional antacid, when necessary, might be less risky than a steady regimen of PPIs.