Proton pump inhibitors (PPIs) are among the most popular drugs used to treat acid reflux and ulcers. They are sold under brand names like Nexium (the famous “purple pill”), Prilosec and Prevacid, and generate “$13.5 billion in sales. In 2009, approximately 119 million PPI prescriptions were written in the US, making the medicines part of the third-largest selling class of drugs. The six available PPI medicines are roughly equal in effectiveness and safety but differ markedly in cost. Two—omeprazole (Prilosec, Prilosec OTC) and lansoprazole (Prevacid,)—are available as both a prescription and a nonprescription drug. Taking effectiveness, safety, cost, and other factors into account, if you need a PPI, consider following Consumer Reports Best Buy Drugs:
■ Prilosec OTC
■ Generic omeprazole OTC
Both of these drugs are available without a prescription. You could save about $200 a month or more by choosing one of these drugs over a more expensive medication listed above. See this informative report.
Unfortunately, like all drugs, PPI’s have problems. The Wall Street Journal reviews several recent reports from the medical literature about complications, and CNN reported on its website that medical experts claim the risks of taking PPIs may outweigh the benefits for people with less serious conditions. PPI’s can have rare but serious side effects, including an increased risk of GI bacterial infection and bone fracture, according to several new studies in the Archives of Internal Medicine. Over prescribing these drugs for simple heartburn or dyspepsia has become almost reflexive.
The Boston Globe (5/10, Cooney) “WhiteCoat Notes” blog reported that patients on PPI’s had a 47 percent increased risk of spine fractures, a 26 percent increased risk of forearm or wrist fractures, and a 25 percent increased risk of other fractures.”
Doctors at the Beth Israel Deaconess Medical Center in Boston, analyzed data on more than 100,000 patients discharged from the hospital over a five-year period, HealthDay (5/10, Goodwin). They found that taking a proton pump inhibitor each day increased the chances of a serious diarrheal disease, C. difficile infection by 74 percent,” and “patients who took proton pump inhibitors longer than that had more than double the chance.”
Five years ago, I wrote that “the oldest and still the most widely used first line drugs for heartburn and dyspeptic symptoms are the antacids, such as Tums, Maalox, Mylanta, Rolaids, etc. These have the advantage of rapid relief in most patients, and low price. …With GERD and ulcer, the H2-receptor antagonists, Zantac (ranitidine), Pepcid (famotidine), and Tagamet (cimetidine), etc. are in most cases as effective as the PPI’s.
“Proton pump inhibitors are often over prescribed in long-term care, disregarding published guidelines for their use..” It is interesting to note that PPI’s are not approved for treatment of simple dyspepsia or uncomplicated heartburn.