PPI's --- maintaining a sense of perspective (2) ..... no cause for alarm but need to continue vigilance.

[gutlesswonder]

The Fremantle Diabetes Study is a major, well constructed and hence authoritative medical research programme.

The following is a selective extract from the latest publication of on-going results.

QUOTE

Timothy M. E. Davis; Jocelyn Drinkwater; Wendy A. Davis

J Clin Endocrinol Metab. 2017;102(8):2985-2993

The PPI group of drugs is known to cause acute interstitial nephritis, which can progress sub-clinically to chronic interstitial nephritis.[3] Most cases of acute interstitial nephritis are reversible, but the development of fibrosis may herald an irreversible progression to endstage renal disease,[25] a situation that emphasizes the importance of an awareness of the nephrotoxic effects of PPIs, especially in a vulnerable population such as patients with type 2 diabetes. One animal study has, by contrast, shown that lansoprazole is associated with renoprotection,[26] an effect attributed to the anti-inflammatory and antioxidant properties of PPIs,[27] but the relevance to human disease is uncertain given the present and other data.

The PPI group of drugs has radically changed the management of acid-related diseases in recent decades, but these drugs are expensive and associated with adverse effects when used for prolonged periods.[31]

The present data provide a note of caution in the context of type 2 diabetes.

Regular assessment of their appropriateness as part of chronic pharmacotherapy, as well as regular monitoring of renal function during chronic use, appears important, and there is an argument that CVD risk factor management should be optimized if PPIs are prescribed given the present association with CVD risk after their initiation.

UNQUOTE

THESE FINDINGS SHOULD NOT BE TAKEN TO INDICATE ANY CHANGE IN CURRENT MEDICAL ADVICE NAMELY THAT THE BENEFITS OF PPI's FOR UPPER GI SURGERY PATIENTS OUTWEIGH THE POTENTIAL FOR ANY POSSIBLE LONG-TERM ADVERSE EFFECTS.

[Kate1503]

I don't know whether my story is of any interest but my endocrinologist thought so.

In June 2016 I was prescribed metronidazole for a tooth abscess and took it exactly as prescribed. Despite this, I developed very bad gastric pain for which my GP prescribed lanzoprazole. I continued to take this but a couple of months later started to get palpitations and severe face, neck and chest flushing. I had repeated ECGs and all was ok. The incidences of the flushing and palpitations increased until a particularly severe episode at the beginning of March this year. I was admitted to hospital and since my trop levels were raised, a MI was suspected. Whilst waiting to be transferred to Papworth for an angiogram, I was given double the dose of lanzoprazole to offset all the aspirin and other anticoagulants I was being given. The palpitations and flushing increased to daily (usually after eating) and I was feeling most unwell. After 10 days, I had the angiogram and all was normal thank goodness! I was discharged with instructions to continue with the double dose of lanzoprazole. Once at home, I continued to feel most unwell until one of my GPS suggested stopping the lanzoprazole to see how I felt without any medication. After a couple of days I started to get my appetite back and to eat and feel better. It took a few more weeks to feel "normal" again as I'd lost quite a bit of weight during this time.

I eventually saw an endocrinologist (I'd had a 24 hour wee collection in hospital to check my adrenaline etc which was normal). Since stopping the lanzoprazole at the end of March, and having no further episodes, he found the correlation between the lanzoprazole and my symptoms too great to be merely coincidence.

I haven't heard or read of this being a side effect of this PPI, but I certainly would never take it again!

[gutlesswonder in reply to Kate1503]

How alarming for you, I am sorry to hear it, but you are far from alone; according to the FDA.

See here:- ehealthme.com/drug-interact...

How about sending this URL to your endocrinologist?!

[Kate1503 in reply to gutlesswonder]

Thanks for that. I will read it in detail when I can get my head round it and am not so tired!

Much appreciated x

[Kate1503]

I should have added to my previous post that I am not diabetic and am a slim, fit 68 year old female and was (and now still am) on no prescribed medication. Apart from giving birth to my children and having my tonsils out when I was 5, I'd never been in hospital.