Yesterday I posted asking if anyone had issues with long term use of Lisinopril, but what I really wanted was feedback on long term usage of Lansoprozole! (Take your pick: brain fog, senility etc.)
I was prescribed Lansoprozole to minimise the risk of stomach damage from Clopidogrel, following a TIA. However I noticed that Lansoprozole guidance is that usage should be reviewed if taken for 12 months or more. One of the 'uncommon' side effects that I am particularly concerned about is bone fracture, which I believe can be due to the impact on vitamin B12 and calcium absorption.
So if you have any experience of this, I would love to hear from you.
Meanwhile, I'm off to find a dark corner........
Take care
John
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The long-term use of any PPI can have various adverse effects, including nutritional deficiencies. Magnesium deficiency is a particular risk. I am on long-term Nexium to treat GERD. I have measured deficiencies in Vit B/folate, vit D, and magnesium. I take supplements for the above to restore nutritional balance. I also recently had a DEXA scan due to the long-term PPI use. Results showed no problems with bone density.
All of the treatment choices we make come with a risk/benefit profile. The GERD has caused significant problems for me. The benefits of PPIs outweigh the risks/adverse effects for me. You will have to analyse your own risk/benefit profile for your use of a PPI to prevent something that may or may not happen due to Clopidogrel use. It is not a black-and-white decision. If you are concerned, I would suggest doing a nutritional analysis, looking at magnesium, Vit B/folate, Vit D, and calcium. Depending on your age and profile, you could also consider a DEXA scan.
I've been on Lanzaprozole for about 20 years due to stomach problems and now to protect from aspirin. I was on Omeprazole for about 10 years prior to Lanzaprozole. I've never had a problem, although a blood test in July showed low vitamin B12. I had low dose B12 tablets for 6 weeks. Blood test 2 weeks ago showed B12 all OK. Next blood test form has B12 test on it, so will see if it's holding its own. Don't want to speak too soon but never had a bone fracture problem. I am quite adventurous even at 67 and had a few tumbles without any problems.
I did find this in looking for the effects of Plavix/clopidogrel on stomach/GI bleeding "
Conclusion
Clopidogrel use is associated with an increased risk of adverse GI events such as gastritis, ulcer and bleeding, yet the risk is only modest with an odds ratio of less than 2.0. The well-known benefits of clopidogrel in patients at increased cardiovascular risk thus must be weighed against an increased GI risk. The decision to treat a patient with clopidogrel ultimately relies on the balancing of benefits and risks.
and:
The use of aspirin only increased the risk of GI events marginally. However, dual antiplatelet treatment (low-dose aspirin + clopidogrel) does not necessarily increase bleeding risk compared to clopidogrel alone, as shown in a recent large registry study.
As to the possible adverse effects of long-term PPI [proton pump inhibitor] therapy:
Abstract
Proton pump inhibitors have an excellent safety profile and have become one of the most commonly prescribed class of drugs in primary and specialty care. Long-term, sometimes lifetime, use is becoming increasingly common, often without appropriate indications. This paper is a detailed review of the current evidence on this important topic, focusing on the potential adverse effects of long-term proton pump inhibitor use that have generated the greatest concern:
B12 deficiency
iron deficiency
hypomagnesemia
increased susceptibility to pneumonia, enteric infections, and fractures
hypergastrinemia and cancer
drug interactions
and birth defects.
We explain the pathophysiological mechanisms that may underlie each of these relationships, review the existing evidence, and discuss implications for clinical management. The benefits of proton pump inhibitor use outweigh its risks in most patients.
Elderly, malnourished, immune-compromised, chronically ill, and osteoporotic patients theoretically could be at increased risk from long-term therapy.
I forgot to add that I am on omeprazole/Prilosec 20 mg BID and have been for at least 2 decades because even when I was trying to back off of the PPI wagon, and take famotidine/Pepcid twice daily, [An H2-blocker, so in essence, an acid-reducing-antihistamine, which is considered to be safer than PPIs] I was getting severe heartburn.
I recently completed a continuing education exercise regarding de-prescribing PPI's using a rational algorhythm and by the medical standards espoused by the authors I am at less risk taking it than not, given my persistent and severe gastro-esophageal reflux [GERD] without it,
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