PPI and Diabetes Drugs

[Sleepybunny]

Hi,

I put most of this info in recent replies on forum but thought might be of interest to others.

Curious to know if any long term users of these drugs had regular testing of B12 levels in the past.

NHS link omeprazole

nhs.uk/medicines/omeprazole/

See section 9 Common Questions about Omeprazole.

One of the questions is about whether it is safe to take for a long period ...mentions possibility of B12 deficiency.

It also says that patients who are on omeprazole for more than a year will be checked regularly by GP.

I'm not convinced this regular checking happens. I would have thought an annual B12 test would be sensible for long term omeprazole users and metformin users.

BNF/NICE link omeprazole

bnf.nice.org.uk/drug/omepra...

Scary that the BNF link, as far as I can see, does not mention the possibility of B12 deficiency under Cautions or Side Effects. BNF stands for British National Formulary. BNF is UK doctors' guide to what to prescribe for various conditions.

BNF/NICE link metformin

bnf.nice.org.uk/drug/metfor...

Lists B12 deficiency as a possible rare/very rare side effect. I suspect that B12 deficiency as a consequence of long term metformin use is more common than this link suggests.

Risk Factors for PA and B12 Deficiency

pernicious-anaemia-society....

b12deficiency.info/what-are...

b12deficiency.info/who-is-a...

Article about PPI drugs

pulsetoday.co.uk/clinical/c...

I am not medically trained.

[Ritchie1268]

I was on Omeprazole for around 18 months, but never checked. It was only when I kept going back & feeling like a hypocondriac, as we all do! That I was given another FBC, that's when I was diagnosed. I don't believe Omeprazole caused the PA, it was the other stuff I'd been on for years, but it would've definitely added to it. Now I've waffled on, to answer your question, no, I wasn't tested after 12 months 😁

When I went for the nerve testing that the neurologist sent me for, I was asked how long I had been taking Metformin & when diagnosed. I've never taken Metformin, he checked my name & address & said, are you sure? Yes absolutely I said. That's strange he said! You have PA & B12D don't you? Yes I do, but never had Metformin. Hmmmm, that's strange he said after checking my notes again.

Very strange & I never did get to the bottom of it

[wedgewood]

I’m really glad that you are not medically trained. I had no help at all from those medically trained doctors and consultants for my Pernicious Anaemia . It was this forum that pointed me in the right direction , and helped me to get rid of the horrible symptoms of PA , and my numb feet . . Thank you for all those useful links .

Yes, you are right about the awful side effects of long -term medication with PPIs and Metformin . I have come across 2 people who took PPIs for over 10 years , never had a B12 test , and ended up with irreversible damage . . I don’t think it’s all that rare .

[Ritchie1268 in reply to wedgewood]

Absolutely wedgewood. Thanks to this place & yourself, I've found more answers than I've ever had from the "Professionals"!! 👍

[buster_uk]

I was on a ppi and metformin for approx five years. I was tested for b12 deficiency but I was never made aware of the very low readings. It was only after I lost everything due to b12d I found out about my previous low levels now I've had my online access refused from seeing test results. Go figure.

[fbirder]

It's only in the last five years or so that the link between PPIs and low B12 has been suspected. Even less time for metformin. So it's not that surprising that not all doctors know about it. Medicine advances happen every day It's impossible for doctors to keep up with everything.

However, they should listen to their patients when they try to tell them about these changes.

[Gambit62 Administrator in reply to fbirder]

This article references a number of studies dating back to the last century that actually indicated that metformin interfered with B12 absorption so think it has been known about for a lot more than 5 years.

ncbi.nlm.nih.gov/pmc/articl...

Probably truer to say that there has been a great deal more investigation into B12 and metformin in the last 5 years and investigating the causal links (though I believe they still aren't understood) rather than just identifying the correlations.

Metformin isn't used just for diabetes - it has a number of medical uses - though it is most commonly known for its use in diabetes. Unfortunately many GPs dealing with diabetes aren't really that up on the complexities of the competition. Many aren't aware that there are other treatments available, particularly when people don't respond or when they have adverse reactions to metformin - not the norm but they do occur.

[fbirder in reply to Gambit62]

My diabetes nurse is very up to date on various diabetes treatments. When I had a horrible reaction to metformin we discussed, together, all of the various options.

We decided to see what happens if I took no drugs at all and just relied on lifestyle changes. So far it’s working. To as good as the metformin, but good enough. And my quality of life is far better.

But I may be very lucky with the staff at my practice. They seem very good on everything I’ve had problems with.

[clivealive Forum Support]

I've been on PPIs for nigh on twenty years and Metformin for more than four but as I've been on B12 injections for over 47 years, personally (and selfishly perhaps) neither will have had an adverse affect on my B12 levels.