Even so, there are relatively few people who need lifelong medication. They not only relieve symptoms, they are also prescribed in hopes of reducing the risk of developing cancer of the esophagus. The data on this are still not clear. For people with acid reflux also called gastroesophageal reflux disease , PPIs are usually not needed lifelong. However, it may still be reasonable to use these drugs long term if the prescriber feels the benefit outweighs the risk.
There are several risks of long-term use of PPIs. Stomach acids are important in protecting against bacteria, and two kinds of bacterial infections are more common in PPI users. There are other OTC drug products used to provide immediate relief for heartburn.
These include antacids and acid reducer drug products such as Pepcid, Zantac, Tagamet, and Axid. Prilosec OTC should not be confused with these products because it works differently and is not intended for immediate relief.
Although side effects from Prilosec OTC are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:. The company marketing Prilosec OTC makes the decision on availability. For further information, please contact the manufacturer, Procter and Gamble, directly. Prilosec OTC stops the stomach from making acid. Medications in the PPI class are widely available with or without a prescription.
Currently, the U. PPIs are used for the treatment of many gastric conditions including peptic ulcer disease, eradication of Helicobacter pylori infections, treatment and prevention of nonsteroidal anti-inflammatory drug NSAID gastroduodenal ulcer, Zollinger-Ellison syndrome, and gastroesophageal reflux disease GERD.
Long-term use of any medication raises safety concerns, especially if that product is available OTC. This article is a review of the recent literature and guideline recommendations regarding the possible long-term consequences of chronic PPI pharmacotherapy and opportunities to prevent these complications.
In animal studies, PPIs raised concerns about a potential for hypergastrinemia, but human studies failed to show an association. For the rest of this article, the authors use long-term to designate therapy greater than 14 days, the maximum therapy for the OTC products. The first potential long-term consequence of chronic PPI use is malabsorption of key minerals in the body, namely calcium and magnesium.
The loss of these minerals could lead to bone fractures or cardiac abnormalities. Due to the decrease in acidity from the pharmacologic effect of PPIs, a potential loss of calcium absorption occurs. This reduction in calcium absorption leads to decreased osteoclastic activity and thus decreases in BMD, thereby increasing fracture risk. It was concluded that OTC products do not warrant label changes to include warnings of fracture risk.
However, several studies have demonstrated an association between long-term PPI use and risk of fractures, but they contain numerous confounders. Common risk factors for fractures such as a sedentary lifestyle and concomitant use of certain medications e. Targownik et al reported that patients using PPIs did have lower BMD; however, these patients were significantly older Data remain relatively inconclusive and conflicting regarding the magnitude of the PPI and fracture association in the absence of additional risk factors.
According to the ACG guidelines, there is insufficient evidence to warrant routine BMD tests, calcium supplementation, or other routine precautions because of PPI use. Symptoms of hypomagnesemia include seizures, arrhythmias, hypotension, and tetany. Hypomagnesemia is also potentially fatal. All PPIs are associated with decreased magnesium absorption.
Concurrent use of medications that also decrease magnesium increases the risk of significant hypomagnesemia. Patients who present with clinically significant hypomagnesemia may require discontinuation of PPI therapy, magnesium replacement via oral or IV methods, and treatment with an alternative class of drugs for GI conditions such as an H 2 RA. In addition to decreased magnesium and calcium absorption, patients on long-term PPIs may be at an increased risk of infection. The hypothesis for the mechanism of action is that the gastric acid secretions act as a defense mechanism against enteric bacteria, and the increased gastric pH during PPI use allows for colonization of opportunistic microbes.
Clostridium difficile: In a retrospective study, researchers found that patients who were taking PPIs had a hazard ratio HR of 2. For patients over the age of 80 years, the HR increases from 1. Swallow the capsule and tablet forms of omeprazole whole. Do not open the capsule. Do not crush, break, or chew the capsule or the tablet. If you cannot swallow the omeprazole delayed-release capsules, you may open it and sprinkle the pellets contained in the capsule on one tablespoon of applesauce.
This mixture must be swallowed immediately with a glass of cool water. The applesauce should not be hot and should be soft enough to be swallowed without chewing.
Do not chew or crush the pellets. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine.
If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine.
Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
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