What are PPI drugs?
A proton pump inhibitor (PPI) is a drug used to reduce the production of stomach acid giving the esophagus, stomach, and duodenum (first part of the intestines) time to heal from irritation and erosive damage. The decrease in acid production will also help reduce acid reflux related heartburn.
Stomach acids are necessary for the proper digestion of our foods. But stomach acid can erode the body when not contained in its proper place. The stomach has a protective mucous barrier that protects its lining. When this mucous barrier is compromised, acid can eat away at the stomach causing ulcers. If stomach acid refluxes into the esophagus, irritation occurs. The esophagus doesn’t have a mucous barrier to withstand acid like the stomach. This irritation is the cause of heartburn. If left untreated, erosion of the esophagus may occur.
PPIs are the strongest inhibitors of acid available but are not used for immediate relief of heartburn. It may take days before a PPI will start providing relief from acid irritation. Relief will vary depending on the reason for taking the drug and the rate at which the body heals. If taking to treat an ulcer, relief may take longer.
PPIs are available in prescription and over the counter (OTC) versions. They include:
- AcipHex (rabeprazole)
- Dexilant (dexlansoprazole)
- Kapidex (dexlansoprazole)
- Losec (omeprazole)
- Nexium (esomeprazole)
- Prevacid (lansoprazole)
- Prilosec (omeprazole)
- Protonix (pantoprazole)
- Rapinex (omeprazole)
- Vimovo (esomeprazole, magnesium, and naproxen)
- Zegerid (omeprazole and sodium bicarbonate)
What can be treated with PPI therapy?
PPIs are typically used:1
- To treat damage to the lower esophagus caused by acid reflux and gastroesophageal reflux disease (GERD).
- To relieve GERD symptoms and prevent further complications of GERD.
- To treat erosive esophagitis.
- For maintenance to prevent esophagitis from recurring after the esophagus has healed.
- To treat Barrett’s esophagus.
- To treat esophageal, gastric, and duodenal ulcers by reducing acid allowing ulcers to heal.
- In combination with antibiotics for eliminating Helicobacter pylori (H. pylori), which can contribute to the formation of esophageal, gastric, and duodenal ulcers.
- For excessive gastrointestinal acid secretory disorders.
Taking a PPI
PPIs are taken by mouth as tablets or capsules with a glass of water before the first meal of the day. It is important to drink the water along with the pill. Not drinking enough water can prevent it from working properly.
What are the PPI side effects and precautions?
PPIs are for temporary use and not intended for long-term daily use. When taken properly, they can be an effective treatment option. Long-term use, however, may lead to serious complications.
Please see the warnings that come with your particular PPI for a full list of possible side effects and precautions.
Common side effects found in temporary use are:
- Abdominal pain
Precautions when taking a PPI:
Tell your doctor or pharmacist if you are taking other medicines. PPIs can cause serious drug interaction issues. PPIs also reduce stomach acid needed to break down certain medications, thus affecting their absorption.
PPIs may not be advised if you are taking:
- Certain anti-seizure medicines such as phenytoin
- Blood thinners such as warfarin, clopidogrel, or cilostazol
- Prescription antifungal or anti-yeast medicines
- Diazepam (anxiety medicine)
- Digoxin (heart medicine)
- Tacrolimus (immune system medicine)
- Prescription antiretrovirals (medicines for HIV infection)
Specific precautions for women:
- If you are breastfeeding, pregnant, or may become pregnant, talk to your health care provider before taking these medicines. They expose the baby to some level of risk, though it is considered minimal.2
Precautions when using long term:
- Long-term use may lead to a 16 to 20 percent increase risk of heart attack depending on which PPI you are taking.3
- PPIs increase risk of chronic kidney disease.
- PPIs increase risk of pneumonia.
- PPIs increase risk of death.
- Stomach acid is beneficial in killing harmful bacteria introduced to the body through foods.
- There is increased risk of having an Clostridium difficile infection, a bacteria that causes persistent diarrhea.4
- Inefficient digestion leads to decreased absorption of vitamin B12, calcium, magnesium, iron and other nutrients.
- Higher levels of acids are useful in closing the lower esophageal sphincter (LES). When the LES is tightening properly, it prevents acid from refluxing into the esophagus.
- Increased risk of Barrett’s esophagus.7
- Getting off PPIs after long-term use can cause a painful rebound in acid. Weaning off PPIs is advisable.
Tags: acid reflux medication bacterial infection barretts esophagus complications gerd medication gerd prevention gerd treatment heart disease heartburn relief kidney disease medication side effects ppi