If you suffer from chronic heartburn, or gastroesophageal reflux disease (GERD), your doctor might recommend trying a proton pump inhibitor (PPI) a popular type of heartburn and GERD medications. Medications in this group of drugs, which includes well-known brand names like Prilosec and Nexium, are commonly prescribed to treat GERD and can be highly effective at reducing stomach acid levels. By decreasing stomach acid, these drugs help alleviate painful heartburn symptoms and reduce the risk of developing stomach or intestinal ulcers. However, they also come with their own potential side effects, and it’s important to discuss the risks versus the benefits with your doctor before you start taking this type of medicine.
In most cases, the side effects of PPIs are fairly minor. The most commonly reported side effects for pantoprazole (Protonix), for example, include headache, mild diarrhea, nausea, and abdominal pain, and only a small percentage of people who use this medication actually experience any of these side effects.
The risk of side effects for all PPIs may increase with long-term use or when combined with certain other medications. Below are some more serious potential side effects.
A 2009 study found that discontinuing a PPI after regular use can cause painful ‘rebound’ heartburn symptoms for several weeks. When someone uses a PPI, the stomach cells that produce acid begin to multiply in an effort to combat the drug’s effect. This means that when someone stops using their PPI, the stomach produces more acid than before, leading to worsening acid reflux symptoms.
Increased Heart Attack Risk with Clopidogrel
The antiplatelet drug clopidogrel (also available as Ceruvin, Clopilet, and Plavix) is sometimes prescribed to prevent blood clots in people with heart disease. However, this medication increases the likelihood of gastrointestinal problems, so some doctors will also prescribe a PPI. Unfortunately, there’s some evidence that PPIs make clopidogrel significantly less effective, increasing the risk of heart attack and stroke as a result. Results from observational studies and clinical trials are inconclusive, and the benefits of using a PPI with clopidogrel may still outweigh the risks for some patients.
C. Difficile Infection
Taking a PPI may change conditions in the gut, making it easier for the bacteria Clostrium difficile to thrive. The most common symptom of a C. difficile bacterial infection is severe diarrhea, and patients are advised to contact their doctor if they experience persistent diarrhea, severe stomach or abdominal pain, or blood or mucus in their stool while using a proton pump inhibitor.
PPIs significantly reduce stomach acid levels, which can in turn lead to an increase in bacteria. It is thought that bacteria in the stomach may travel up through the esophagus, where it can be inhaled into the windpipe and lungs, leading to a slight increase in the risk of developing pneumonia.
PPIs may also slightly increase the risk for bone fractures. By lowering stomach acid levels, these drugs inhibit the absorption of calcium. Bones that are calcium-deficient become weaker and are more likely to fracture.
It’s important to keep in mind that the risk of serious side effects with proton pump inhibitors is relatively low, and most people who use this type of medication for GERD respond well to treatment. If you’re considering using a PPI, discuss your medical history with your doctor to make sure it’s safe for you. Your doctor should prescribe the lowest effective dose for the shortest effective treatment period to reduce your risk of side effects.
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