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Proton pump inhibitors: Increasingly linked with stroke, serious conditions: PPIs are some of the world's most commonly prescribed drugs for heartburn, despite warnings about risks and complications.

Fifteen million Americans regularly use prescription proton pump inhibitors (PPIs) to reduce stomach acid and treat heartburn. Millions more use over-the-counter PPIs.

But people who take PPIs should be aware of new evidence that shows an association between long-term, high-dose PPI use and ischemic stroke.

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An ischemic stroke is the most common type of stroke and is caused by insufficient blood reaching part of the brain. The blockage could be caused by a blood dot in an artery leading to the brain or by an embolus that is formed elsewhere and carried to the brain.

Other PPI Issues. Stroke is not the only concern. Studies have indicated an association between PPIs and kidney damage, dementia, infection, fractures, and heart attack.

The mechanism by which PPIs may damage the body's organs or systems is unknown, but theories include altering the environment of the gut, affecting the absorption of vitamins and minerals, and changing the way drugs interact with each other.

The findings are understandably disturbing, but do not mean that PPI use should be stopped. PPIs effectively treat gastrointestinal disorders which carry their own risks.

Four Findings. A study conducted among 244,679 patients in Denmark and presented at the 2016 American Heart Association's Scientific Sessions sought to determine if strokes occurred while patients took one of four PPIs: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid), and esomeprazole (Nexium). The researchers found that:

1) Overall stroke risk increased by 21 percent among patients who took a PPI;

2) Those who took PPIs at the lowest doses had a slightly increased risk of stroke or no risk at all;

3) At the highest doses, PPI stroke risk increased 30 percent with Prevacid and 94 percent with Protonix;

4) There was no increased risk of stroke associated with acid-reducing medications (H2 blockers), which include famotidine (Pepcid) and ranitidine (Zantac).

Proton pump inhibitors come in tablet or capsule form and are supposed to be taken 30 minutes before the first meal of the day. They work by reducing the amount of stomach acid produced by glands in the lining of the stomach, and multiple studies have shown that they are very effective for most patients. The table at right lists four PPIs and the dosages at which they are sold.

The lead author and researcher at the Danish Heart Foundation, Copenhagen, Thomas Sehested, MD, commented on PPI effectiveness in light of the new evidenc: "At one time, PPI's were thought to be safe, without major side effects. This study further questions the cardiovascular safety of those drugs."

What To Do. The effectiveness of PPIs now has to be weighed against health-threatening risks. There are lifestyle strategies that can lessen or prevent those risks.

To prevent a stroke, the Centers for Disease Control and Prevention suggests that you:

* Eat plenty of fresh fruits and vegetables.

* Maintain a healthy weight.

* Get at least two hours and 30 minutes of physical activity per week.

* Drink only in moderation.

* Don't smoke.

To lessen the probability of acid reflux, the National Institutes of Health recommend decreasing fatty foods, eating small frequent meals, and avoiding specific foods such as chocolate, coffee, tomato products, and spicy foods.

Lowest Dose, Shortest Period Of Time. To reduce the risk of PPI-relatedischemic stroke, the authors make two suggestions: Physicians who prescribe PPIs should carefully consider whether their use is warranted, and for how long, and the drugs should be prescribed at the lowest possible dose for the shortest length of time.

Another option is not to take PPIs at all, but that decision should be made only after discussing the problem with your physician.

THE VIEW FROM DUKE

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SHEYAHSH SHAH, MBBS

Critical Care Spedalist, Duke

Try Lifestyle Changes

Before Taking Medications

"This study again highlights the importance of educating yourself about risks and benefits before taking any medication. While proton pump inhibitors have been available over-the-counter for a number of years now, OTC medications also carry side effects and interactions with other medications. Stroke seems to be another uncommon, but alarming, harmful effect that researchers have found to be associated with PPI. Patients should attempt non-pharmacological measures, like changes in eating habits before using medications for acid reflux disease."
WHAT YOU SHOULD KNOW about PPIs

DRUG      LOW DOSE  HIGH DOSE

Prilosec  20mg      40mg
Protonix  20mg      40mg
Prevacid  15mg      30mg
Nexium    20mg      40mg

Drug potency, frequency of use, and duration of administration depend on
the condition, the patient, and the prescribing physician.
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Article Details
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Author:Shah, Sheyahsh
Publication:Duke Medicine Health News
Date:Jun 1, 2017
Words:740
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