Pills that turn off the stomach's acid spigot are some of the most popular medicines in the world.
It may be time to rethink drugs like Prilosec for mild heartburn.
But a bunch of new studies looking at their side effects could lead doctors and patients to rethink their casual use.
Each day tens of millions of people take the pills, which belong to a category called proton pump inhibitors, or PPIs. Nexium is one that still requires a prescription. But you can buy others, including Prilosec and Prevacid, over the counter because the side effects have generally been considered so mild.
But the package of studies just published in the Archives of Internal Medicine could change perceptions. One study finds women who took the pills after menopause were more likely to break bones. Two studies find that people taking the drugs had a heightened likelihood of infection or reinfection with Clostridium difficile, a bacterium that poses an increasing health risk for hospitalized patients.
Another study found high doses of the drugs weren't any more effective treating bleeding ulcers than normal doses.
What to make of it all? Lay off the PPIs unless you really need them. The drugs are great for severe gastroinstestinal reflux disease (GERD) ulcers and a few other conditions. But half or more of the time, the medicines may be prescribed inappropriately.
That's a problem because of the increasing evidence of side effects. Or as one editorial on the studies puts it, "Harm will result if these commonly used medications are prescribed for conditions for which there is no benefit, such as nonulcer dyspepsia," or regular old heartburn.
For that sort of problem, non-drug approaches such as losing weight or tilting your bed up may do the trick. If medicines are needed, antacids and drugs like Pepcid may get the job done with less trouble than PPIs.
Stopping PPIs once you start isn't so easy. The stomach's acid-making machinery can jump into high gear, leading to a flare-up of symptoms. To avoid that, doctors recommend tapering the dose down gradually and using antacids to manage symptoms.