Is the frequent prescription of PPI medicines a boon or a bane?

Husna, Amity University Kolkata

Proton pump inhibitors (PPIs) are a class of medicines that work on the cells which are lining the stomach, reducing the production of acid in our stomach. They can treat heartburn and gastric acid reflux by irreversibly binding with the Na+ H+ ATPase located on the surface of gastric parietal cells.
PPIs include pantoprazole, omeprazole, rabeprazole, lansoprazole and various other brands. 

These medicines can be used safely for up to 14 days daily with not over 3 such treatment courses in a year and their short-term use is well tolerated. However, the concern is that if such medications are prescribed more frequently and consumed excessively then they can cause tremendous side- effects. A study found that PPI was used by 66.6% of the patients and most of the physicians were found to be prescribing such medications for the long term by ignoring their adverse effects which are mentioned below:

1. Magnesium deficiency: The US FDA warned in 2011 regarding the danger of taking PPIs excessively which leads to a deficiency of magnesium within the body known as hypomagnesemia. Low amounts of magnesium can cause muscle stiffness, spasm and seizures.
2. Bone fracture risk: When patients with type-2 diabetes use PPI frequently then, there’s a 40% high risk of hip fractures in them.
3. Vitamin B-12 deficiency: In a case study it was observed that people who consumed more than one PPI pills every day for up to 2 years suffered from Vitamin B-12 deficiency which can cause major health issues like anaemia, dementia and neurocognitive damage.
4. Persistent Diarrhoea: The gut composition gets altered if we take a medication excessively and in higher doses which leads to the development of certain risky infections like Clostridium difficle infection. This is associated with high morbidity and may even cause death. 
5. Diabetes: A recent study on gut found that active PPI users have 24% greater risk of developing diabetes.
6. Renal dysfunction: Excessive use of PPI for long-term causes of’ kidney failure.

Therefore, all these studies on PPI highlight that the need of the hour is to reduce our practice of consuming PPI which has become a commonly purchased over-the-counter drug. Clinicians should prescribe PPI to the patients only when necessary and they can advise the patients to take a specified amount of dose rather than over-consumption.

Also read: The Critical role of UGP2 – Pancreatic Ductal Adenocarcinoma Treatment

Source:

https://medicaldialogues.in/medicine/perspective/prescribing-proton-pump-inhibitors-need-paradigm-shift-in-the-practice-70573

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