Topping the list of PPI drawbacks is the
specter of bone fractures. Metz and colleagues reported in the Journal of the
American Medical Association in 2006
that people who had been taking a PPI for
more than a year had a 30 to 60 percent
increased risk of hip fracture over those
not taking acid blockers. A higher dose of
PPIs boosted the risk to more than double. A Danish study, published the same
year in Calcified Tissue International, also
found that PPIs increased the risk of a
broken hip by about half.
The U.S. Food and Drug Administration
earlier this year slapped a fracture warning label on PPIs, both prescribed and
over-the-counter, citing these and four
other studies that showed an increase of
fractures in people using the drugs.
While scientists are still sorting out
how PPIs might affect bone, some theorize that acid is needed to dissolve calcium
compounds, making calcium available in
the blood and thus to the bone.
Another risk linked to PPIs is bacterial infection. Hospitalized patients
getting a daily PPI are more likely to
contract a Clostridium difficile bacterial
infection than are people not taking any
acid blockers, Harvard Medical School
pulmonologist Michael Howell and colleagues reported in the May 10 Archives
of Internal Medicine. Those getting the
drugs more than once a day faced double
By Nathan Seppa
Wonder drugs they may be, but PPIs are
overprescribed and pose some health risks
In the arms race against heartburn, one class of drug outperforms the competition by going straight to the source. The proton pump inhibitors,
PPIs for short, block acid manufacture
at the subcellular level. In contrast, acid
reflux drugs such as Tums and Maalox
neutralize the acid. Others, like Zantac
and Tagamet, slow down its production
by blocking the histamine 2-receptor.
PPIs do require a day or two to start suppressing the symptoms of acid reflux.
But once PPIs kick in, they put out the
fire with stunning efficiency.
“No question about it. They are far
more effective than anything we had
before,” says Randolph Regal, a clinical
pharmacist at the University of Michigan in Ann Arbor.
When PPIs first hit the market in the
1980s, the acid-blocking pills — sold as
Nexium, Prilosec and Aciphex, among
other brand names — looked like wonder drugs. Since then, U.S. sales of PPIs
have grown to roughly $14 billion a year.
But PPIs now risk becoming a victim
of their own success. Several reports
indicate these drugs are overprescribed,
often in hospitals and to older patients.
And other studies suggest that long-term
use of the best-ever drugs for dousing
heartburn carries its own risks. PPIs have
accumulated a rap sheet linking them
to a heightened risk of broken bones,
bacterial infections and a few rare con-
ditions. Other research suggests that
weaning oneself off unnecessarily pre-
scribed PPIs can be difficult and can
cause, of all things, heartburn. These
potential drawbacks are forcing regula-
tors to rethink labeling on the drugs and
leading doctors to reevaluate prescribing
PPIs for some patients.
Unnecessary risk among other concerns,
ppis have been linked to infection with the
bacterium Clostridium difficile. in one hospital,
a team identified 138 patients with C. difficile.
of these, 88 were on a ppi, though only 34 had
a clear medical reason for taking the reflux drug.
source: m.n. choudhry et al/QJM 2008
PPI use in C. difficile–infected patients