I've been Googling PPIs because yesterday I was prescribed them along with my NSAIDs for the first time. My usual GP is reluctant to prescribe them, despite them being commonly recommended, so I thought I'd try to find out more.
It turns out there is evidence that long-term use of PPIs may be associated with several different risks including bone thinning/osteoporosis/risk of fracture; and new research also suggests they may increase the risk of heart attack. There is also an advice note out that says their use may be associated with SCLE/lupus (Twitchy - are you aware?)...
There are pros and cons of every drug; many of them have risks, but these are generally outweighed by their benefits, I reckon... What you take or don't take is a matter for discussion with your own GP. So this is just for information - I thought I'd share some of the references, for anyone (like me) who didn't realise and is interested...
My h had to come off his 40mg daily omeprazole recently as the PCU doctor queried it from the test bloods before his latest iron infusion & advised he stopped omeprazole immediately & advise his GP he'd not to take any of the 'prazoles'. It's considered it could be part causal for his magnesium & calcium deficiency. He's now prescribed ranitidine which itself has caused problems as it did many years ago when it was first prescribed so also he's back on Gaviscon Advance. At the mo he's being tested under Gastro to ensure nothing sinister is going on & awaiting results.
I'm taking omeprazole, 20mg daily, & have discussed this with my GP, she's happy with my most recent levels but I am due my annual CV check so we'll see.
This Advance is yucky, far too thick but then it must be 15 years or more since he had it last. I've suggested he asks to go onto the original aniseed flavoured one if he's to take it long term.
Thanks for your hopes! Are you thinking of challenging your GP about omeprazole?
Well, my normal GP doesn't prescribe them; I was given them by another GP when she renewed my NSAID prescription, without me asking for them. So I wouldn't be challenging my GP, probably - if he's not prescribing them, I suspect he's wary of them himself... But I am thinking of not taking them, and of discussing it with him next time I see him...
Yes it's often prescribed (or a ppi is) when on NSAIDs. I'd discuss it as I did then you what's considered best for you, especially if you've a history of ulcers or tum related problems.
I was taking Lansoperazole because Omaprazole gave me a horrible taste. It's still on my repeat sheet and I have it in my drug bag.
When I took the latter with MTX I became very sick indeed and my pharmacist pointed out that they can contraindicate so I was switched to Ranitidine - which didn't touch my GI symptoms. I know that my old GPs tried to keep me on the minimum possible medication always but there were a few they encouraged me to take with awful consequences. So nothing the media comes up with about pharmaceutical products surprises me now.
Equally there's a place for pragmatism. Stomach ulcers and GERD aren't good and can cause oesophageal and throat cancer and PPIs can help prevent GI problems. The drugs that I fear the most now aren't the DMARD family or PPIs - they are the serotonin ones used for nerve pain - but the pragmatist in me has dumped PPIs for the time being nonetheless. Knowledge is power but I think it's okay for occasional use when my GERD plays up. Fortunately I don't have very bad upper GI problems since my gallbladder was removed. Tx
I don't have much of a history of upper GI problems, and although I had quite a bit of indigestion when I was flaring before diagnosis, I haven't had ANY since I upped my NSAIDs/started DMARDs/had my steroid depo/gave up sugar (who knows which of those have helped most?!)... No indigestion, no acid reflux, nothing. It seems odd to be taking a PPI without any adverse GI symptoms... I'm thinking I might not...
Perhaps Ranitidine would be a better option for you? I can't take NSAIDs anymore after many months of taking them to max dosage before my RA was diagnosed over four years ago. My GP prescribed them without a PPI - so I would be concerned about taking them without a stomach protector if I were in your shoes.
After years of upper GI problems mine disappeared when I dropped wheat and refined foods, sugar etc five years back. Then I'd have occasional outbreaks of severe gastritis which seemed to tarry with drops in dosage of DMARDs. I don't know if this was just coincidence though but was always enormously relieved when they stopped again. The Azathioprine last year caused me such terrible pain in my upper GI that it's the form of pain I just fear far more than any other now.
Increasingly I think the whole leaky gut theory has more credibility than doctors are willing to acknowledge. Our understanding of the immune system is terribly incomplete. PPIs have only recently been linked to CV and kidney problems -so things change all the time in medicine. For this reason I'm increasingly inclined to trust my instincts and avoid drugs unless I really have no choice - and am increasingly willing to research functional medicine - if only I knew where to start!
I've had two successive nights up with reflux/ heartburn for the first time in many months and my small fibre neuropathy is flaring again too right now. Hard to know the cause - could be wheat, sugars, stress/ excitement of getting keys to our new house on Friday - anything. But I'm not going to take a Lansoperazole this
Heartburn is horrible, so you have my sympathy! If I could take one just when I had symptoms, I'd probably do that, but I've been prescribed 15mg/day prophylactically... I take your point about gastro-protection, and it certainly is a consideration - I've been on daily NSAIDs for about 5 years without it, which has got to carry some risk, even though they're the gastro-resistant ones...
Interesting to hear your GI symptoms stopped when you stopped sugar/junk too... I agree there's more to it than most doctors think...
I have been on them for 4 years and I can't live without them as I have a hiatus hernia and GERD. What's one more toxic chemical in the cocktail I take anyway!
I know we aren't allowed to comment medically -,but I can't help wondering why you are only on Hydroxy despite a diagnosis of RA/ inflammatory arthritis? If you were on MTX you may not need NSAIDs at all- in which case it could be a case of trading in two sticking plaster medications for one very effective one? Just a thought. Xx
I've had the same thought already, Twitchy. I think the answer is that it is my hospital or consultant's belief that sero-neg RA doesn't need treating so aggressively, and they start with hydroxy because it has the fewest side effects, and then work up to the 'big guns' if that doesn't work...
I definitely DO need my NSAIDs at the mo: I know because I forgot to do my repeat prescription before the w/end, and ran out, did 36 hours without my arcoxia... And I HURT. 48 hours on, I am still aching...
Yes I can understand the thinking now you explain it. I know that MTX did make a big difference to me and I'm seronegative - but I'd already tried Sulfasalazine (bad reaction). I wasn't offered Hydroxy - I read about it here and suggested it myself when my liver didn't like increasing MTX. I think that for me it was important to knock my RA on the head hard in the first two years with a combination of therapies but maybe other things got me there instead of DMARDs, such as exercise and AdCal D3 - which coincided with the greatest improvement with my joints.
But then I was allergic to Hydroxy and NSAIDs give me bad GI issues within a few days despite stomach protection. Sp the rationale my rheumy plumped for with me actually worked better than your rheumy's would have done for me. X
I have exactly the same concerns. When I was redisgnosed with SpA I was put on Naproxen and Omeprazole as well as the methotrexate I was already taking. As I also have osteoporosis in my spine it seems counterintuitive to take a PPI that stops you absorbing calcium. I have never really had any GI problems - other than occasional mild burning in throat when I have a glass of wine. But doctors say that the problem is you can have a gastric bleed with no warning. So we are basically between a rock and a hard place.
I did, however, read an interesting paper on some research which found lesions in the lower intestines of those taking Naproxen and Omeprazole. They did a clinical trial with a pharmaceutical grade probiotic (VSL3) and found the lesions disappeared in those taking them. I checked this out with my GP and doctor son to make sure it was good science and they both agreed that though there was no way of ever knowing whether they were doing any good I may as well try the probiotics as a kind of insurance policy. Rather an expensive one as it turns out!
I will ask about the Omeprazole at my next hospital appointment as I would love to stop taking it. But I fear a lifetime of Naproxen on its own is probably going to do some damage too...
I was taken off Naproxen and put onto Arcoxia a couple of years ago. It's a Cox-2 drug and is supposed to be less risky for GI problems/damage than the standard NSAIDs.
Interestingly, dhall, when I was undiagnosed and flaring, and getting IBS symptoms, live yoghurt was the only thing that ever helped me at all...
I take Esomeprazole every day and have done so since 2000. If I don't take it regularly, my hiatus hernia slides up into my chest, causing so much pressure that I can't even swallow water. So I won't be giving it up in a hurry. Clemmie
PPIs also have a risk of B12 deficiency when used long term. This is because they suppress stomach acid, which is needed by the intrinsic factor produced by your stomach lining to extract B12 from your food. PPIs should only be used for 6 weeks or less unless you are under the care of a physician who can watch for the signs of B12 deficiency. A B12 deficiency is serious, it can cause depression, fatigue, and nerve damage among many other problems. Listen to your doctor, he/she is rightfully reluctant to prescribe them.
Sometimes the real problem is insufficient stomach acid, not too much, especially if you are older as stomach acid production diminishes (older people also have a B12 deficiency risk). I've read that low stomach acid causes similar symptoms as too much acid.
For those dealing with indigestion or GERD, you might try boosting your stomach acid for a few days (if you can tolerate it), this is cheap and easy. Drink some fresh lemon juice or cider vinegar in water just before a meal. Natural cider vinegar is best, like Bragg's here in the US. Use a straw, and rinse your mouth afterwards as the acid is hard on tooth enamel. If your problem or pain worsens, stop this treatment.
If you read my post, tracy, you will see the reason I'm asking questions is because I have been prescribed PPIs by a doctor for the first time.
Saying "PPIs should only be used for 6 weeks or less" is not relevant or accurate in a group where many people are prescribed them long-term alongside their NSAIDs. The 6 week 'rule' is for people taking PPIs for indigestion, not for those of us on long-term NSAIDs. And yes, vinegar may help indigestion, but it offers no gastro-protection, so is useless for NSAID users.
The medical wisdom is that if you're taking NSAIDs, the gastro-protection provided by PPIs outweighs their risks and the risks of taking NSAIDs without them. The question is whether those risks are fully understood...
I agree, it's important to fully understand the risks. If symptoms of B12 deficiency do appear after long term PPI use, it's important for doctors to know what it could be so they can prescribe B12 supplements. There needs to be more awareness of B12 deficiency within the medical community but here in the US few doctors know much about it.
Patients need to take charge of their own health. I'm glad to see that you are thoroughly researching this before making your own decision.
Agreed Flow, though from my viewpoint & somewhat relative cardiac issues have been considered a far greater risk for conditions such as ours with the addition of COX-2's (Arcoxia in both our cases) & why it's recommended checks are performed annually. That said I recently read a research article on Imperial College London's news site to the contrary & evidence suggests this no longer holds true, but until my GP says so I'll happily have annual CV checks. Interestingly within the same article a Professor at Imperial College was quoted "Currently we are prescribing and selling other non-steroid anti-inflammatory drugs (NSAIDs) that, at a therapeutic dose, have the same risk of cardiovascular side effects as the COX-2 drugs but with the additional danger of gastrointestinal side-effects.” More evidence if it were needed of the advantage of ppi's being prescribed for long term use alongside NSAIDs.
Do ask your GP to perform annual vitamin tests too if you don't have them already, always best to cover all bases!
For the record my GP only prescribes enteric coated gastro resistant Arcoxia, not generic.
My hubby was given naproxen without ppi after a few weeks he felt a little sick and then within a matter of hours his "cold or flue thing" had him lyingon the sofa .He turned white ,cold and I got him into a&a just as he was going into a coma due to bleeding duodenal ulcer caused by the naproxen.He survived after one unit of blood after another and iv meds.Hospital ward for ten days and on lanzooerasole for life.It was touch and go!
Taking them can save your life if on such drugs as naproxen.He has regular blood tests to see that they aren't causing any untoward problems which are much easier to do than 2nd guess a bleed.Please take medical advice about these as i was nearly widowed because of none prescription of lanzoperasole.
Don't want to scare folk but I would hate anybody to go through the same so although there are reported risks with ppi drugs ,there are with paracetamol,they are essential in certain circumstances.
So sorry to hear that littleeffie, it really does shock you when such adverse reactions happen when they can be avoided so easily. I trust he's doing ok now.
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I'm glad your hubby was OK!
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