Heartburn Drug Danger?

I keep hearing bad things about the heartburn drug I take – a proton pump inhibitor. I now read it is linked to dementia, kidney disease, and bad infections. The latest bad news is that these drugs even increase the risk of death. What should I do?

– August 24, 2017

I’ve reported elsewhere on this site about the problems associated with proton pump inhibitors (PPIs). These drugs are meant to help relieve heartburn and gastroesophageal reflux disease (GERD), in which stomach acid backs up into the esophagus. They work by blocking production of stomach acid. PPIs include Nexium, Prilosec and Prevacid. All told, some 50 million Americans take either prescription or over-the-counter versions of these drugs.

The latest news on the potential danger of PPIs comes from a Washington University School of Medicine study suggesting that longtime use of the drugs is linked to an increased risk of death. To reach this conclusion, the researchers examined medical records of some 275,000 veterans who had been prescribed PPIs between October 2006 and September 2008, as well as some 73,000 people prescribed H2 blockers over the same period of time. H2 blockers, which include Tagamet, Pepcid and Zantac, are another class of medications that reduce stomach acid. The researchers then looked at how many patients taking the two types of drugs died over the following five years. (They were not able to ascertain the causes of the deaths.)

“No matter how we sliced and diced the data…we saw the same thing: there’s an increased risk of death among PPI users,” reported senior author Ziyad Al-Aly, M.D. He added that when his team compared patients taking H2 blockers with those taking PPIs for one to two years, the data showed that those on PPIs had a 50 percent increased risk of dying over the next five years. They calculated that for every 500 people taking PPIs for a year, there is one extra death that otherwise wouldn’t have occurred. That may not sound like a lot, but given the enormous number of people who take these drugs, one death per 500 could translate to thousands of excess deaths annually.

The researchers also calculated the risk of death in people who were prescribed PPIs or H2 blockers who didn’t have the conditions the drugs are meant for. In this group, they found a 24 percent increased risk of death among those who took PPIs compared to those who took H2 blockers. The longer patients were on PPIs, the higher their risk of death.

PPIs are supposed to be taken for only a few weeks, but many people end up refilling prescriptions for months or years if their doctors don’t tell them to stop. Dr. Al-Aly says that most of the time, people don’t need to be on PPIs for that long. The FDA recommends taking over-the-counter PPIs for no longer than four weeks before seeing a doctor.

Instead of using these drugs long-term, I urge you to make lifestyle changes that can help eliminate the need for medication altogether.

Andrew Weil, M.D.



Ziyad Al-Aly et al, “Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans.” BMJ Open, June 1, 2017, DOI: 10.1136/bmjopen-2016-015735

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