Proton Pump Inhibitors

Treatment for gastroesophageal reflux disease (GERD) usually follows three stages, according to the Robert Wood Johnson University Hospital. The first two stages include incorporating diet and lifestyle changes and trying medications. The third stage, surgery, is generally used only as a last resort in very serious cases that involve complications such as hiatal hernia.

Most people will benefit from first-stage modifications by adjusting how, when, and what they eat. However, lifestyle changes alone may prove ineffective for some. Your doctor may recommend using medications to reduce or stop acid production in your stomach if this is the case for you.

You may be directed to take another type of medication, called proton pump inhibitors (PPIs) if over-the-counter antacids don’t work. Other kinds of medications are also available to stop acid production, including H2 blockers like Tagamet AB or Pepcid AC.

The Cleveland Clinic notes that PPIs are more effective than H2 blockers and can relieve symptoms in the majority of people who suffer from GERD.

How Do Proton Pump Inhibitors Work?

PPIs work by blocking and reducing the production of stomach acid, allowing time for any damaged tissue that lines the esophagus to heal. They also help prevent heartburn. The Merck Manual states that PPIs are the most powerful drugs for reducing acid production because even a small amount of acid can cause significant symptoms.

PPIs help to reduce stomach acid over a four to 12-week period, which is required for proper healing of the esophageal tissue. It may take longer for a PPI to help your symptoms than an H2 blocker, which usually starts reducing stomach acid within an hour. However, symptom relief from PPIs will generally last longer and are most appropriate for those who experience heartburn more than twice a week.

Approximately 21 million patients filled PPI prescriptions at outpatient retail pharmacies in the United States in 2009, according to the U.S. Food and Drug Administration (FDA). Patients who take prescription PPIs usually take the medications for an average of six months.

Are There Different Types of Proton Pump Inhibitors?

PPIs are available both over-the-counter and by prescription. Over-the-counter (OTC) PPIs include Prevacid 24 HR (lansoprazole), Prilosec OTC (omeprazole), and Zergerid OTC (omeprazole and sodium bicarbonate).

Prevacid, Prilosec, and Zergerid are also available by prescription, as are the following PPIs:

  • dexlansoprazole (Dexilant, Kapidex)
  • esomeprazole magnesium (Nexium)
  • pantoprazole sodium (Protonix)
  • rabeprazole sodium (AcipHex)

A prescription combination drug product called Vimovo is also available. It contains a PPI (esomeprazole magnesium and naproxen). Prescription and OTC strength PPIs seem to work equally well in preventing GERD symptoms, according to the U.S. Department of Health and Human Services (HHS).

What Are the Risks of Using Proton Pump Inhibitors?

PPIs have traditionally been considered to be safe and well-tolerated. However, research now suggests that certain risks may be involved with long-term use (usually longer than one year) of these drugs.  

Ohio State University Medical Center (OSUMC) reports that using PPIs over extended periods of time can increase the risk of both osteoporosis and the incidence of hip fractures in some patients.

Another recent study points to a potential increased risk of heart disease for patients who combine use of the drug Plavix (used to prevent strokes and heart attacks) with PPIs.

The University of California at San Francisco Medical Center states that if taken for long periods of time, PPIs may also increase your risk of pneumonia and gut infections.

The FDA issued a public safety announcement in 2011 which stated that long-term use of prescription PPI drugs may be associated with low magnesium levels. This can result in serious health problems, including muscle spasm, irregular heartbeat, and convulsions. In about 25 percent of the cases the FDA reviewed, magnesium supplementation alone didn’t improve low serum magnesium levels and the PPI had to be discontinued.

Unlike prescription PPIs, OTC versions of the drug are marketed at lower doses and are generally intended for a two-week course of treatment no more than three times a year. Because of this, the FDA emphasizes that there is little risk of developing low magnesium levels when using OTC PPIs as directed.

The Merck Manual reports that PPIs are usually the most effective treatment available for GERD, despite possible side effects. Your healthcare provider can help you weigh the potential risks against the benefits for your particular condition.