Proton pump inhibitors are PPI drugs are often prescribed for heartburn. These drugs are often not your best option and you may experience some serious adverse effects if you use them for too long. Know the facts before you take PPI drugs for acid reflux or GERD.
What’s heartburn?
Heartburn is a condition affects most of us at some point. If you have heartburn, you get a burning pain in your chest behind your breastbone. Sometimes, the pain might get worse when you lie down or bend over, and you could get a bitter taste in your mouth as well.
Heartburn is different to GERD or gastroesophageal reflux disease in that heartburn is a symptom of GERD. You can have heartburn, but not have GERD. If you get heartburn more than twice a week on a regular basis, you should see your physician to check if you have GERD.
Besides heartburn, other symptoms of GERD include:
- nausea
- chest pain
- pain or difficulty swallowing
- cough
- rough, scratchy voice
- bad breath
What are Proton Pump Inhibitors or PPIs?
PPIs are very strong medicines that significantly reduce the amount of acid secretion in your stomach.
PP drugs target the tiny proton pump cells in the lining of your stomach. These cells make your stomach acid, which is actually hydrochloric acid. So, PPI’s tell your proton pumps to reduce stomach acid production.
And in turn, your stomach acid doesn’t have a chance to reflux into the food pipe and cause heartburn.
Names of PPIs and PPI drugs list
Usually you can tell PPIs by their names. Here are some common ones:
- Omeprazole (Prilosec)
- Lansoprazole (Prevacid)
- Esomeprazole (Nexium)
- Rabeprazole (Aciphex)
- Ilaprazole (Protonix)
- Dexlansoprazole (Dexilant)
OTC PPI meds
Generally OTC PPI drugs are recommended to be taken over a two week course of treatment, up to 3 times per year. Always follow directions on the pack.
- Prevacid 24 hour
- Nexium 24 hour
- Prilosec OTC
- Zegerid (combination PPI and antacid)Source: USPharmacist.com
When should PPI drugs be used?
While there may be other reasons physicians prescribe you PPIs, the most common are:
- Ulcers in the stomach that are bleeding
- Zollinger-Ellison syndrome which is a rare condition where your stomach produces excess acid
- GERD, where acid reflux has happened over a prolonged period that has already damaged your esophagus
- Helicobacter pylori bacteria has caused infection in your stomach.
All of the conditions mentioned above are more serious than heartburn.
Adverse effects of PPI drugs
If you take PPI drugs for a long time you are actually exposing yourself to more harm, including:
- Prolonged use of PPI meds may increase your risk of kidney disease.
- The acid in the stomach actually kills off bacteria and infection in the food you eat. When you don’t have enough acid in your stomach bad bacteria can get out of control and lead to more infections. One example is Clostridium difficile, very harmful bacteria that actually infects your intestines.
- You are at increased risk of hip, wrist and spine fracture due to the bone density loss, thought to be caused by reduced stomach acid, which in turn leads to reduced calcium absorption.
- There is an increased risk of pneumonia and lung infections associated with certain PPI meds.
- You can build up a level of tolerance to PPI drugs, and this means you need to take more to get the same effect. The response from medical professionals is usually to increase dosage or change PPIs.
- It can be really hard to stop taking PPI drugs because your symptoms can get much worse.
By mid-2019, lawsuits against PPI manufacturers became the second largest mass litigation in the United States. In fact, there are many lawsuits that argue PPI manufacturers didn’t do enough to warn patients and medical professionals about the possible risks as the companies became aware of links with kidney diseases.
FDA warning for proton pump inhibitors
In 2011, the FDA issued a warning about magnesium levels for PPI users. Low levels of magnesium can cause the following conditions in some people who take PPI drugs:
- muscle spasm
- irregular heartbeat
- convulsions or seizures however, patients do not always have these symptoms.
It was recommended that physicians monitor magnesium level prior to patients taking PPI drugs, and consider magnesium supplements.
The problem with PPI drugs
PPIs are among the most commonly used drugs in the world, yet up to 70% of people taking PPIs don’t get any benefit. So why are so many people taking PPIs?
Should you be having PPI drugs for heartburn?
If you just have heartburn, then the answer is no, you probably should not be taking PPIs. And in spite of this, quite a few people suffering from heartburn get prescribed PPIs or take over the counter (OTC) PPIs.
In the case of OTC PPIs, often people don’t do enough to investigate whether PPIs are right for them. It is also possible that some medical professionals are misinformed about PPIs and their risks.
Heartburn may be caused by too little or too much stomach acid. Now remember, PPIs significantly reduce stomach acid production. So, if you’re not producing enough stomach acid, taking PPI’s are going to make things worse.
On the other hand, antacid and H2 blockers are much less harmful and help you tackle the heartburn without harming your system. And while they take care of the heartburn temporarily, you can try out other things to treat the underlying causes of the heartburn. So go for these as opposed to PPIs wherever a doctor hasn’t indicated that your condition needs you to be treated with PPIs.
And besides, if you have occasional heartburn, there are many things you can try before reaching for PPI’s.
LEARN MORE: 33 Proven Ways To Get Rid Of Heartburn Naturally
If you experience heartburn more than twice a week on a regular basis, and you’ve had no success with natural remedies for heartburn, you should see your physician.
Natural heartburn remedies
Given the serious potential side effects of PPI drugs, hopefully you have a better appreciation of the need to try natural heartburn remedies.
Lifestyle changes can often cure or reduce your heartburn and GERD symptoms:
- If you are overweight, losing weight can have a big impact on your heartburn and GERD symptoms
- Eat 4-5 small meals per day
- Try following a low acid or alkaline diet
- Try probiotics
- Wait at least 2-3 hours after eating or drinking before lying down
- When sleeping, elevate your upper body and sleep on your left side
- Reduce stress – this can have a big impact
- Do exercises that don’t aggravate your reflux most days
- Avoid alcohol, or drink moderate amounts of alcohol that doesn’t cause heartburn
- Quit smoking
- You could also try alternative remedies.
LEARN MORE: 25 Interesting Facts About Heartburn You Need To Know
Weaning off PPI drugs
If you are taking prescription PPI drugs and they aren’t working, you should consult with your physician about weaning off PPIs.
If you’re taking OTC PPI drugs and you think you should come off them, don’t go cold turkey because this will make your acid reflux worse. You need to reduce your intake slowly. You may want to see your physician for support with this, particularly if you’ve been taking PPIs for a long time.
If you need to wean yourself off PPI drugs, here are some suggestions, and you can find more online.
Other types of heartburn medication
If you feel you really do need medication for heartburn, OTC antacids or H2 blockers may be safer options. Always follow directions on the packaging or your physician’s instructions.
Antacids
Antacids are over the counter (OTC) heartburn medication that helps neutralize the excess acid in your stomach that is likely to reflux and give you heartburn.
You shouldn’t take antacids daily over a prolonged period of time. Instead, they are supposed to give you fast relief for occasional heartburn episodes.
Popular antacid brands include:
- Tums
- Mylanta
- Alka-Seltzer
- Rolaids
Antacids are safe for most people, but if you need to watch your sodium intake, have heart disease or kidney disease, you should consult your physician before taking antacids.
H2 Blockers
H2 blockers or histamine 2 blockers target a substance called histamine, which is part of your body’s immune defense system. This makes your stomach produce less acid, and therefore less heartburn.
You can get these products in a lower strength as OTC medications, and at a higher strength as prescription drugs. Commonly used H2 blockers are:
- Famotidine (Pepcid as a prescription, Pepcid-AC as an OTC medication)
- Cimetidine (Tagamet, Tagamet-HB)
- Nizatidine
PPI drugs FAQs
Can taking PPIs make reflux worse?
Taking proton pump inhibitors (PPIs) can make reflux a lot worse when you are weaning yourself of the medication. PPIs don’t work for everyone. Approximately 30% of patients with GERD still experience their symptoms when taking a full dose of PPI drugs.
Also consider, PPIs significantly reduce stomach acid production. So, if you’re not producing enough stomach acid, taking PPI’s are going to make your condition worse.
Can I use proton pump inhibitors in pregnancy?
You can use proton pump inhibitors for GERD in pregnancy. All PPIs except for Omeprazole are classified as category B drugs by the FDA, suggesting they are safe to use in pregnancy. Omeprazole is a category C drug, so that means animal studies show risk, but there is not enough human evidence to conclusively prove it’s safe to use in pregnancy.
However, since the rating was done multiple studies have show omeprazole to be safe for pregnant women.
Given the side effects, please consider whether there are suitable alternatives to using PPIs in pregnancy, including natural remedies for heartburn and GERD.
Only take proton pump inhibitors in pregnancy in consultation with your physician.
This is a good article to read if you are considering using proton pump inhibitors in pregnancy.
Last word on PPI drugs for heartburn
If you just have heartburn, PPI drugs should not be used unless your physician has good reason to prescribe them for you. And if you suffer from GERD or another condition that PPIs were designed for, it’s in you best interest to make sure there is no better alternative treatment.
There are usually better, safer treatments for heartburn and GERD than taking PPIs, including avoiding your reflux trigger foods, eating smaller meals, making some changes to how you sleep, reducing stress and trying some natural heartburn remedies.