Stomach acid is a valuable contributor to digestion, but too much can lead to heartburn and sometimes ulcers. Several types of medications are used to treat excess acid. One group commonly used for this are the proton-pump inhibitors (PPIs), such as Prevacid (lansoprazole), Prilosec (omeprazole), and Nexium (esomeprazole). These are generally considered to be safe and effective. But according to the April 2011 issue of the Harvard Health Letter, there are some new doubts about the safety of PPIs, including the following concerns:
Interaction with clopidogrel. Clopidogrel (Plavix) is a drug that discourages the formation of artery-clogging blood clots. But clopidogrel is hard on the lining of the stomach and intestines, so many doctors prescribe a PPI to be taken along with it. Two years ago, the FDA issued a strong warning that said some PPIs may cut clopidogrel’s effectiveness in half. However, two recent studies showed that those taking a PPI with clopidogrel had no increase in heart attack or stroke and did have substantially less risk for gastrointestinal bleeds.
Fracture risk. Some research shows that suppression of stomach acid could reduce the body’s ability to absorb calcium, which could lead to osteoporosis, weaker bones, and a greater chance of breaking a bone. The risk is probably pretty small, but it’s another reason to take PPIs only when necessary.
Pneumonia risk. Several studies have shown that people who take a PPI are more likely to catch pneumonia than those who don't take one.
The Harvard Health Letter notes that the PPI-clopidogrel interaction seems to be less important than once feared, but there are other reasons to be cautious about PPIs. All PPI prescriptions should be reviewed periodically by a doctor to be sure the drug is still needed to treat symptoms. And PPI prescriptions should always be for the lowest dose that’s effective.
Read the full-length article: "Proton-pump inhibitors"