You Wanted to Know: PPIs


Proton pump inhibitors (PPIs), acid-reducers often used to treat heartburn and indigestion, are among the most commonly taken medications in the U.S. Thousands of Americans take over-the-counter PPIs like omeprazole (Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium) now and then to ease abdominal discomfort, usually with few side effects. But for many with severe symptoms, GERD or other stomach conditions like ulcers, taking a PPI can become a daily necessity that can continue for years. One of our viewers asked us about the potential long-term consequences of taking PPIs:  


Generally, PPIs carry few side effects and are believed to be safe to use in the short- and long-term. However, recent research has begun to uncover a few concerning effects linked to moderate or long-term use. The first is acid rebound, in which stomach acid secretion significantly increases to above-normal levels after people stop taking their PPI. This increase may lead to worsening heartburn and indigestion soon after cessation or even after several weeks or months.

However, this increase in stomach acid is usually temporary and should eventually return to usual levels. How severe it is and how long it takes to return to normal may depend on the dose and length of the PPI therapy. Stopping a PPI regimen gradually, rather than going cold-turkey may help diminish the effects of acid rebound. If you are considering reducing or stopping your PPI, you should talk to your doctor before changing your medication regimen.

There are a few other emerging worries about long term PPI use, though most are still being debated. They include:

  • Increased fracture risk – Decreasing the amount of stomach acid may impact how the body absorbs calcium. One study showed that adults over 50 who took PPIs for a year or more had a higher rate of hip fractures.
  • Vitamin B12 deficiency and anemia – Long-term use may affect the body’s ability to absorb vitamin B12 and iron, which can lead to anemia.
  • Increased infection risk – The risk of gastrointestinal infections from bacteria like C. difficile or Campylobacter may be increased by PPI use, especially in hospitalized patients who are also taking antibiotics. PPIs may also slightly increase pneumonia risk.
  • Drug interactions – While PPIs tend to have few drug-drug interactions, some may decrease the effectiveness of clopidogrel (Plavix), which is an anticoagulant used to reduce the risk of blood clots.

Though this evolving research is concerning, for the most part these complications are uncommon and many people who need PPIs use them for years without experiencing significant problems. If you’ve been taking a PPI for a long time, don’t forget to touch base with your doctor at your next appointment about whether they are still right for you.

Many people taking PPIs may be able to control their symptoms with simple changes in lifestyle and diet. For natural ways to minimize heartburn and acid reflux, read more here.