Lansoprazole

[ConstanceD]

Does anybody know if long term use of Lansoprazole reduces B12 levels? Not vegetarian or vegan but wondering if a supplement is advisable.

[PMRpro Ambassador]

First step is testing - because if it is low because of being on a PPI, oral supplementation is probably a bit pointless. Lack of acid makes it difficult for enough B12 to be absorbed in the stomach - and they use injections if required.

More Marmite on the breakfast toast ...

[ConstanceD in reply to PMRpro]

Thanks. I can't eat marmite (much as I love it) because of gout. On the list of things to avoid. I'll ask for a B12 test. Are PPIs known to reduce B12 levels? The NHS website suggests they can after some time but the pharmacist had never heard of this.

[PMRpro Ambassador in reply to ConstanceD]

Not impressed with your pharmacist!

journals.lww.com/ebp/Citati....

says "The use of PPIs for two or more years was associated with increased odds of vitamin B12 deficiency (odds ratio 1.7; 95% CI, 1.6–1.7). Among patients taking PPIs for at least 2 years, higher daily doses were associated with higher odds of vitamin B12 deficiency (see TABLE)."

ebmconsult.com/articles/vit...

"The chronic use of proton pump inhibitors such as omeprazole (Prilosec) is fairly common in medical practice especially for gastroesophageal reflux disease (GERD) or in patients at increased risk of peptic ulcer disease (PUD), but has been associated with causing vitamin B12 deficiency."

Which is why PPIs were never recommended for long term uninterupted use.

Another cause of B12 deficiency is pernicious anaemia - because that stops the stomach producing gastric acid and so you don't absorb it from food.

[PMRnewbie2017]

Just in case this is useful for anyone else, long term users of Metformin usually prescribed for type 2 diabetes or more unusually polycystic ovarian syndrome (PCOS) may be at risk of Vitamin B12 deficiency.