Prilosec LONG TERM SAFE??

[sojka123]

My GI doc has put me on Prilosec daily 20 mg from now on.  Is it safe to turn this acid production off for the rest of your life??  

[Ratnakar Kini, MD]

Hi,
Prilosec is a very safe medication.
After taking it for 4-8 weeks if you dont  have symptoms you may ask your GI doc whether you can stop it.
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The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.

[JDRoss19]

But is there any risk to taking Prilosec or Aciphex or Nexium for the rest of your life? What are the risks? For example - i take Nexium every day, and that prevents any uncomfortable acid issues. If i stop taking the pill, i feel the heartburn. So - if i take 1 pill every day for the rest of my life, of any of the above named medications, what are the risks?

[sojka123]

As the original question asks........ is it safe for lifetime use??  Clearly the instructions say 14 days or longer etc.  But we are significantly shutting down acid production (a normal function) for life and not sure anyone has done any long term tests to prove this will not cause other problems.  

Would like to know.  

[JDRoss19]

Yes- I've asked this question on this forum twice now, it appears the MD's are afraid to touch the subject of life-long use....probably because nobody knows!

[Ratnakar Kini, MD]

Hi,
If the acid production is shut down, it increases the secretion of gastrin by negative feedback mechanism. Long term use may result in gastric polyp formation which have been found to be harmless. In rats it has been found cause a tumor called carcinoid. But there are no reports of PPI causing carcinoids in humans.

The acid environment of stomach forms a protective barrier against infection. When it is altered due to acid suppression by long term PPI, bacteria and other organisms can gain entry in to the gut causing diarrhea which can be controlled by stopping PPI or by adding probiotics.

There is a recent controversy that PPI affects calcium absorption resulting in worsening of osteoporosis in very elderly patients.

All the above mentioned effects are not common associations.
PPI are less than 2 decades old . More time is required to know the effects of life long use of PPI.

Thats why I told in the previous message that it is better to use PPI when you have symptoms (on demand)  rather than continous therapy.
================================================================
The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.

[JDRoss19]

Dr. Kini, thank you for the informative response. The problem with your last sentence "it is better to use PPI when you have symptoms (on demand) rather than continuous therapy" is that i personally experience discomfort if i miss 1 day of taking a pill. The discomfort is borderline pain/heartburn, etc., so my goal is to not get to the point where i experience this.....my goal is to avoid the discomfort....thus, the preventative method of taking 1 pill per day.....it's not practical for me to wait until the pain/discomfort presents itself, because the Nexium takes awhile to work....see? Well....it's a little scary, but i guess i'll just keep taking 1 of those magic purple pills each day.

[sojka123]

Yes, Ross I agree, that was a much better answer - thanks Doctor.  However, you are right.  "taking it when you have symptoms" is an unhelpful guideline because when you have symptoms is prior to taking the med.  the whole idea behind daily use is to prevent symptoms.  waiting for symptoms then taking a PPI is like waiting for the flu then getting a flu shot.  

However, I do see the position both the drug companies and our doctors are in.  There is just not enough long term evidence in and so they have to be cautious.  I did see in one response that many of these drugs (like prilosec at 20 mg) only supresses about 80% of acid production.  Perhaps there in lies the key.  Not ALL acid is suppressed and therefore enough remains for homeostasis of stomach function in terms of bacteria, Ca absorption etc. etc.  

I think we as patients need to experiment with this.  I take prilo daily, then on occasion stop and see how it goes (especially if I'm careful with my diet).  If I have several days of heartburn, I'll go back on the daily preventive.  We certainly do not want to cause problems trying to prevent them, but both sides of the equation have issues - too much acid = heartburn, Barretts esophagus, and other changes in the esophagus OR too little acid and bacterial growth, Ca issues and polyps etc. etc.  

I'm sure in the upcoming years we'll know more.  Thanks Kini for the more detailed answer.  

[JDRoss19]

Nice summary Sojka. I visited my primary care physician a couple weeks ago, and when i told him i was taking Nexium each day, he gave me an alarmed look and recommended i only take when symptoms occur. I smiled, and said Doc, i hear ya, but those "symptoms" are REALLY uncomfortable. Acid and heartburn = no fun. I told him that if i miss 1 day of taking Nexium, the pain hits me, and it lasts several hours. He gave me a bunch of Prilosec samples - told me it was better to take Prilosec every day then Nexium. I said, "really?" He recommended i set up an appointment with a Gastro care Doc. So mayble i'll start taking the Prilosec instead of the Nexium, especially if it works just as well. Do we have confirmation that Prilosec long-term is better (healthier) than taking Nexium long-term? Or is that uncertain?

[JDRoss19]

I just pulled this article from the world wide web. http://health.msn.com/health-topics/articlepage.aspx?cp-documentid=100205363&page=2

Here's an interesting excerpt:

Prilosec and Nexium

Heartburn can be uncomfortable, but heart attacks can be fatal, which is why the FDA has investigated a suspected link between cardiac trouble and the acid-reflux remedies Prilosec and Nexium. In December 2007, the agency concluded that there was no "likely" connection. Translation: The scientific jury is still out. In the meantime, there are other reasons to be concerned. Because Prilosec and Nexium are proton-pump inhibitors, they are both incredibly effective at stopping acid production in the stomach — perhaps too effective.

A lack of acid may raise your risk of pneumonia, because the same stuff that makes your chest feel as if it's burning also kills incoming bacteria and viruses. You may also have an elevated risk of bone loss — in the less acidic environment, certain forms of calcium may not be absorbed effectively during digestion. "The risk of a fracture has been estimated to be over 40 percent higher in patients who use these drugs long-term, and the risk clearly increases with duration of therapy," says Dr. Rodgers.

[sojka123]

Great discussion, but as with so many things in medicine, no clear cut answer.