Important Update on Heartburn Drugs

You heard it first here on FaceBook! (Because I’m on the other side of the international date line) and the SE Asian and Australian news is abuzz with the latest bad news about Proton Pump Inhibitors; drugs taken by millions around the world for frequent heartburn.

Actually, I predicted this – that use of PPI’s like Prilosec and Nexium increase risk for heart attack in my FaceBook NOTE of June 15, 2014, entitled: From Tums to Tragedy. If you are taking one of these drugs, or know someone who is, please send them this NOTE. From Tums to Tragedy can be found on the left side of my timeline page. Just scroll down to the June 15 2014 entry, which explores the history of drug development for what is for most people, a preventable condition.

Now comes confirming evidence that PPI’s increase risk for heart attack even in people with no other cardiac risk factors. The study  should sound a serious alarm throughout the public health arena. But it probably won’t. Worldwide sales of the top PPI’s this year will top $32 billion dollars.

Here’s the problem:

PPI’s inhibit the production of hydrochloric acid by the stomach. Stomach acid activates pepsin, an important digestive enzyme. Without pepsin, protein digestion is seriously impaired.  Calcium and other minerals must be ionized by stomach acid in order to be absorbed. Thus PPI use is associated with increased risk for osteoporosis and fractures. The absorption of vitamin B12 is also reduced in the absence of HCL.

PPI’s can affect the absorption and metabolism of a raft of prescription drugs. Manufacturers simply say: “May interfere with drugs for which gastric pH affects bioavailability;” which is good information for your doctor, but how is the average Walgreens shopper going to figure that out? Remember, the average 65 year old in America uses six Rx drugs in a year, many concurrently. PPI’s can decrease the absorption of some meds and increase blood levels of others. With digoxin, a drug commonly prescribed for heart disease, this increases risk for a serious adverse effect including life-threatening arrhythmias.

PPI’s decrease the activity of Clopidogrel (Plavix™), a common blood thinner. So think about this: Millions of people take Plavix or the generic version every day to prevent a heart attack or stroke. But even a slightly increased dose of their PPI (like some people would take on Thanksgiving) can completely inactivate this drug.

And, as I mentioned, this new study found increased incidence of heart attack even in people with no other risk factors.

Here’sthe citation and link:

Proton Pump Inhibitor Usage and the Risk of MyocardialInfarction in the General Population

Nigam H. Shah et al. June 10,2015DOI: 10.1371/journal.pone.0124653

Link:

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124653

For Health Care Professionals: An excellent overview entitled

Overutilization of Proton-pumpInhibitors: What the Clinician Needs to Know, can be found here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3388523/

Citation: Therap Adv Gastroenterol.2012 Jul; 5(4): 219–232.

doi: 10.1177/1756283X12437358

PMCID: PMC3388523

Onward!

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