Proton Pump Inhibitors (PPIs) are some of the most over-prescribed medications out there. You might have seen popular advertisements for them.
You know them by names like Prilosec, Prevacid, Nexium, and Protonix. Some varieties require prescriptions, others you can get over the counter.
Scientists are now looking into the safety of PPIs, questioning if doctors are prescribing them too frequently.
An article in Social Science and Medicine determined that during the 1990s, prescriptions for PPIs increased by over 400%. There is considerable debate among researchers about the safety of PPIs.
Some scientists believe PPIs are safe. A study in the World Journal of Gastroenterology investigated the potential side effects of PPIs including vitamin B12 deficiencies, weakening bones, and carcinoid tumor development.
In general, doctors in this study found little evidence to support the idea that PPIs were dangerous, however they still recommended that they be used only for people who absolutely needed them.
Despite the lack of side effects noted by some researchers, Harvard Medical School still acknowledges a myriad of potential side effects.
Harvard researchers continue to cite fracture risk, pneumonia risk, C. dificile infection, Iron and B12 deficiency as potential side effects.
Their study of FDA warnings and analysis of the current state of PPI research suggests that taking PPIs “is a risk-benefit balancing act.”
Additional research has pointed out that prolonged use might lead to hypomagnesmia or abnormal blood magnesium levels that can disrupt the circulatory and other organ systems.
Research is still murky on this one, but enough evidence exists to suggest that PPIs may have a negative interaction with clopidogrel (known by the names Plavix, Ceruvin, and Clopilet).
Many doctors prescribe clopidogrel and PPIs simultaneously. Clopidogrel works to reduce blood clots but it is hard on the stomach. PPIs can protect the stomach lining. The problem is that PPIs can inhibit the enzyme CYP2C19 that makes clopidogrel work.
The FDA issued a warning about this in 2009—debate still rages between doctors and drug companies about prescribing PPIs and clopidogrel together.
Researchers understand that PPIs are generally over-prescribed. One of the biggest problems with prescribing PPIs to patients might be developing dependence.
Social Science and Medicine published an article which discussed the challenges of over-prescribing PPIs and efforts to step-back dosages.
In many cases, doctors were not actively taking steps to ask for patient input on medicine reduction. During the study, most patients who reduced their dosages of PPIs ended up back at the same or higher dose later.
The prescription of PPIs rose drastically in the 1990s. Now over-the-counter use is rising too. Researchers debate extensively over potential side effects.
At this point, it is unclear which side effects occur and which don’t. Most studies demonstrate PPIs as safe and effective drugs. The main problem, however, is that they are over-used.
For hundreds of years before their development in the 1970s, people got along without PPIs. For those who really need them, they are an excellent drug.
For everyone else, it might be time to question if PPIs are really needed or if they would be better suited with fast acting H2 blockers like Zantac that are better understood.