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PPIs are Proton Pump Inhibitors – a group of drugs that greatly reduce gastric acid production and are used for the treatment of Dyspepsia, Peptic ulcer, GERD, Barretts esophagus, and other gastric conditions.
These drugs are available as prescription (Nexium, Dexilant, Prilosec, Zegerid, Prevacid, Protonix, Aciphex, Vimovo) medications and over-the-counter (Prilosec OTC (omeprazole), Zegerid OTC (omeprazole), Prevacid 24HR (lansoprazole)) remedies.
Like all medicines, the use of PPIs carry with it some risks, and those must be weighed against the (sometimes considerable) health benefits of taking them.
Last year the FDA warned consumers to:
- Be aware that an increased risk of fractures of the hip, wrist, and spine have been reported in some studies of people who use PPIs. The greatest increased risk for these fractures was seen in those who receive high doses of these medications or use them for a year or longer.
- Read and follow the directions on the “Drug Facts” label when considering the use of an over-the-counter PPI.
- Be aware that the over-the-counter PPIs should only be used as directed for 14 days for the treatment of frequent heartburn. If your heartburn continues, talk to your health care professional. No more than three 14-day treatment courses should be used in one year.
Prolonged use of PPIs has also been associated with low magnesium levels, increased incidence of Clostridium difficile, and a number of studies – going back several years – have suggested a link between their use and increased risks of hospital and community acquired pneumonia.
A couple of examples include:
In 2009, Herzig et al. wrote in a JAMA article (doi: 10.1001/jama.2009.722) that : In this large, hospital-based pharmacoepidemiologic cohort, acid-suppressive medication use was associated with 30% increased odds of hospital-acquired pneumonia. In subset analyses, statistically significant risk was demonstrated only for proton-pump inhibitor use.
Earlier this year, the CMAJ published a systematic review and meta-analysis of the literature on PPIs (CMAJ. 2011 Feb 22;183(3):310-9) that found: Use of a proton pump inhibitor or histamine(2) receptor antagonist may be associated with an increased risk of both community- and hospital-acquired pneumonia. Given these potential adverse effects, clinicians should use caution in prescribing acid-suppressive drugs for patients at risk.
Which brings us to today’s study, which adds some more weight to the concerns expressed by these earlier studies.
This time, the study appears in the European Respiratory Journal, and it suggests that recent initiation (< 30 days) of PPI treatment was associated with a three-fold increased risk of CAP (community acquired pneumonia).
Microbial evaluation of proton pump inhibitors and the risk of pneumonia
S.C.A. Meijvis, M.C.A. Cornips, G. Paul Voorn, P.C. Souverein, H. Endeman, D.H. Biesma, H.G.M. Leufkens, E.M.W. van de Garde
The authors compared the characteristics of 430 hospitalized adults admitted with community-acquired pneumonia against 1,720 patients from a population control group. The authors write:
'After adjusting for co-morbidities, age, sex and pneumonia severity score, recent PPI initiation was independently associated with intensive care unit admission, although this was a small patient group.'
None of this should be viewed as a condemnation of PPIs, of course. For many patients, their use can improve the quality, and even duration, of their lives.
While a number of studies have indicated an increase in the relative risk of developing complications such as pneumonia and bone fractures, in terms of absolute risk, the dangers appear relatively small.
Of course, if you are taking PPIs – or any medication for that matter – that you don’t really need to be taking, you are incurring a health risk without enjoying an offsetting therapeutic benefit.
Which means that even though they are available O-T-C, you should discuss using PPIs with your health care provider, especially if you intend to use them longer than the FDA recommended maximum of three 14-day treatment courses in one year.
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