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Chronic use of Proton Pump Inhibitors

January 2, 2017 by ProntoCare0
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Proton Pump Inhibitors or PPIs are frequently used medications for treatment of many conditions including Peptic Ulcer Disease , Gastroesophygeal Reflux Disease( GERD), prevention and treatment of Non Steroidal Anti inflammatory Drugs ( NSAIDs)-induced gastric ulcers. They are superior to Histamine2-Receptor Blockers such as Zantac or Pepcid.

The side effects of long term use of PPI would include malabsorption of of important elements such as Calcium and Magnesium, Vitamin B12,

Calcium absorption depends on acidic medium which is being suppressed by PPIs.which would lead to Osteoporosis and subsequent increased risk for bone fractures. If a patient with Osteoporosis needs PPI therapy, then a choice of Calcium Citrate is preferred in this case because it can be absorbed in absence of acidic environment.

PPIs also interfere with the absorption of Magnesium which is important for proper Neuro- Muscular coordination, stability of heart rhythm, thus periodic checking of serum Magnesium level on PPIs therapy is important as it significant low Magnesium level is found , this may warrant stopping PPI therapy and switch to H2 Blocker therapy.

In addition, serious infections such as Clostridium Difficle Infections manifested with severe Diarrhea as well as Community acquired Pneumonia have been associated with chronic use of PPIs. So, decreasing acidity for a short period of time may be beneficial to heal gastric ulcer ,erosion or give relief of GERD symptoms . But if used for a long time chronically will lead to many side effects mentioned before.

So,patients need to know they have to obviously follow the instructions for the Over The Counter PPIs taking into consideration that the duration of therapy should not exceed 14 days for the treatment of frequent heart burns , then immediately follow up with their healthcare providers for advise and guidance. Patient education is so important and this is what we provide to our patients

Hopefully, this will help millions of people taking PPIs chronically for long time and they are unaware of the serious side effects associated with the chronic use.

The message here if you have to use PPIs, go ahead and use them on a short term basis, not for months or years!


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Adel M. Eldin MD, FACC, FACP
Internal Medicine
Wellness and Preventive Cardiology

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