Proton Pump Inhibitors Overused, Carry RisksOct 4, 2010 | Parker Waichman LLP
Are proton pump inhibitors over-prescribed? According to a report in the Minneapolis Star Tribune, there is a growing consensus that some people are taking the heartburn drugs needlessly, or far longer than necessary. Such overuse could be putting them at at risk for serious side effects, including fractures.
Proton pump inhibitors, available by prescription and over-the-counter (OTC), work by reducing the amount of acid in the stomach, and are approved to treat conditions such as gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus. Prescription versions of the drugs include Nexium, Dexilant, Prilosec, Zegerid, Prevacid, Protonix, and Aciphex. OTC brands include Prilosec OTC, Zegerid OTC and Prevacid 24HR.
According to the Star Tribune, 119 million prescriptions were written for proton pump inhibitors last year, making them one of the best-selling medications on the market. One gastroenterologist told the Star Tribune that he was concerned that the pills were being “handed out like water” and have become a “front-line therapy if you so much as belch.” Proton Pump inhibitors are indicated for short term use, but in many cases people take the drugs for far longer than they should.
According to the Star Tribune, several studies have suggested that many people are taking proton pump inhibitors for no apparent reason. For example, a 2005 review of patient charts in one Michigan hospital found that 60 percent of those taking the drugs were doing so without a valid reason. In May, an editorial in the Archives of Internal Medicine claimed that 53 to 69 percent of the prescriptions for acid suppressors are “for inappropriate indications.”
This misuse of proton pump inhibitors is putting patients at risk for some pretty serious side effects. In May, for example, the US Food & Drug Administration (FDA) announced it was changing safety labels on proton pump inhibitors to reflect a possible increased risk for fractures. The FDA announced the label change after a review of several epidemiological studies that reported an increased risk of fractures of the hip, wrist, and spine with proton pump inhibitor use. Some studies found that those at greatest risk for these fractures received high doses of proton pump inhibitors or used them for one year or more.
Other side effects of proton pump inhibitors include pneumonia and an intestinal infection called C. difficile. There’s also concern the medications may interfere with a heart drug, Plavix, the Star Tribune said. Researchers have also linked proton pump inhibitors to something called a “rebound effect.” This occurs when long-term users of the drugs stop taking them, only to experience even harsher heart burn symptoms.
These concerns may be starting to change doctors’ attitudes about proton pump inhibitors. Last month, we reported that one survey had indicated that some -22 percent – had plans to decrease their use of the drugs after the FDA issued its fracture warning. Sixty-one percent said the FDA’s action would change how they advise patients.