Risks could outweigh benefits of heartburn drugs
Millions of people pop a pill to reduce heartburn and stomach acid making the class of drugs one of the highest sellers in the nation. But the remedies could actually pose more risks than benefits for most people, according to a package of new studies published in the Archives of Internal Medicine.
Known as proton pump inhibitors (PPIs), drugs such as Prilosec and Prevacid -- available over-the-counter -- and by-prescription Nexium were associated with a type of bacteria infection and bone fractures, the studies found.
In one study, people who took the PPIs daily had a 74 percent increase in a bacteria infection called Clostridium difficile. In another, postmenopausal women who took the drug were more likely to have spine, wrist and forearm fractures.
This is not the first research to raise concerns about the risks of the drugs. We reported on this a few years ago when a study first suggested that the medications were associated with weakened bones among older people.
While the risks of developing complications were relatively small overall, the bigger problem is that the drugs are overused, says Dr. Mitchell H. Katz, of the San Francisco Department of Public Health, in an accompanying editorial.
The market for the drugs is huge with 113.4 million prescriptions for PPI's are filled each year, accounting for $13.9 billion in sales -- the third highest seller nationwide, he writes.
The reason? Many people take the drugs to relieve the symptoms of dyspepsia, a fancy word for persistent indigestion and a condition that affects some 25 percent of adults. The next step -- medicine designs a pill to treat the common condition and overuse ensues, he writes.
"The problem with this paradigm is that for most patients the adverse effects of PPIs outweigh the benefits. Reducing the unnecessary use of these medications will require action by both physicians and patients."
"Harm will result if these commonly used medications are prescribed for conditions for which there is no benefit, such as non-ulcer dyspepsia," write Dr. Deborah Grady, of the University of California, San Francisco and Dr. Rita F. Redberg, in another editorial.
The research and the opinion pieces are part of the journal's "Less is More" series, highlighting the need for the medical community, and the public at large, to question when certain medical interventions are appropriate.
photo: stock.xchng
Comments
You are better off taking Maalox or Mylanta for heartburn. It's primary active ingredient is a natural mineral that is precipated from seawater.
Posted by: John Yevonishon | May 11, 2010 9:50 AM
If I don't take Prevacid daily, my GERD is unbearable and I end up taking a dozen or more Tums or drinking half a bottle of Mylanta. I have been suffering from GERD for almost 30 years and Prevacid is my only relief.
Posted by: Suz | May 11, 2010 2:22 PM
The approach of giving "medicine" to basically healthy people in a bid to either prevent future disease or treat a symptom of a disease is more often than not a losing proposition. There are probably few foods one could eat every single day for years on end and not expect some difficulty. To suspect that one can take, the latest synthetic laboratory chemical concoction, heretofore unseen by human physiology or even nature, and derive a net benefit over years of use is at best blithely optimistic and more likely something akin to pharmaceutical Russian Roulette. Consider for instance, the case reports now accumulating on the use of bisphosphonates and "low-impact femur fractures" -ouch!
Unfortunately, if one considers corporations to be amoral, their concern is not with health it is with profits, which is why so many drugs are designed for chronic conditions which still allow the user to be a wage earner while taking the drug. From the company's point of view, if chronic exposure to the drug causes a second condition, which does not debilitate the customer but allows them to continue to earn a wage while needing a second chronically administered drug this would be a "win/win".
As a compromise, companies should begin by going back and characterizing all the off-target effects of currently approved drugs, thus allowing them to pursue additional indications while improving drug safety.
Paul D. Maher, MD MPH
http://healthjournalclub.blogspot.com/
P.S. While not making light of people who suffer with GERD, and with alternative health being outside my area of expertise, I have found from personal experience that, counter-intuitively enough, a little dollop of apple cider vinegar does wonders for me if I have indigestion.
Posted by: Paul | May 11, 2010 2:24 PM
I have been taking Prevacid for 12 years. When my pain started it felt like I was having a heart attack. The pain persisted for almost a year despite taking Prilosec, then Prevacid. Nothing else works for me, by the way. Finally, the drug started to work and it's been very effective. Yes, I've been concerned about the side effects, so sometimes I stop for a while until the pain returns. What is considered "unnecessary use"? I am also concerned about getting Barrett's esophagus, which could lead to esophageal cancer. Is that a risk I want to take if I stop taking the drug? C. dif is also a concern, since my mother almost died and required a total colectomy after receiving antibiotics for pneumonia. i also had a stomach ache for a year after taking three 400 mg Motrin for dental work, despite the Prevacid. So I have a very sensitive stomach. Again, the benefits outweighed the risks. But it is hard to decide very often what to do.
Posted by: Leonard | May 11, 2010 6:15 PM
What is the problem of regulating you diet accordingly and eating foods that are not highly acidic? No need for expensive OTC drugs in order to eat whatever pleases you temporarily. Just a thought.
Posted by: tere | May 17, 2010 12:42 PM