The Headache of Heartburn

Proton Pump Inhibitors are used to treat conditions related to excess gastric acid (protons), such as gastroesophageal reflux disease or heartburn. Nexium, Protonix, Prevacid and Prilosec prevent the acid producing or parietal cells from pumping acid into the stomach. Of course, stomach acid is there for a reason: it helps in digestion and subsequent absorption of nutrients; one could therefore expect that the proton pump inhibitors may have serious side effects. These medications also interfere with the function of enzymes (CYP2C19 and CYP2C9), which are essential for the action of the liver in breaking down various toxins, pollutants, and drugs. Consequently, there are multiple possible adverse drug interactions and side effects, including headache, diarrhea, constipation, stomach pain.

In May 2010, the Food and Drug Administration (FDA) released a more serious warning: proton pump inhibitors increase the risk of wrist, hip and spinal fracture by 25%. The research paper alerting the medical community to these issues was published in the Journal of the American Medical Association, four years before the FDA warning was released. The risk of contracting a serious gastrointestinal infection with Clostridium difficile was even higher—74%, as were the chances of hospital-acquired pneumonia (30%).

In an article published in May 2010, Jonathan LaPook MD pointed out that the proton pump inhibitors are the “third most popular class of prescription drugs in America.” In fact, they total about $13.5 billion/year in sales. But note, these medications are often prescribed for conditions that could easily be treated in other ways: weight loss, giving up smoking, and changes in diet such as limiting sugar, alcohol and caffeine intake. More trouble for the patient and less lucrative for the pharmaceutical industry, but ultimately much less expensive for the American public who otherwise end up paying inflated medical insurance premiums and possibly suffering with the drug-related health issues that are much more serious than heartburn!