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When it comes to heartburn drugs, less may be more

Consumer Reports News: May 11, 2010 06:08 AM

When a bout of heartburn flares up, you may be tempted to reach for powerful drugs like Nexium (esomeprazole), Prilosec (omeprazole) or Prevacid (lansoprazole) also known as proton pump inhibitors, or PPIs—to extinguish the flames. Three PPIs are now available without a prescription, but if your heartburn is mild, this may be like putting out a candle with a fire hose. Several new studies released Monday by the Archives of Internal Medicine confirm earlier warnings in a recent Best Buy Drugs report: these drugs are routinely overprescribed and come with serious risks, including bone fractures and bacterial infections.

Instead, for mild and infrequent heartburn, you should first try lifestyle changes, like reducing how much alcohol and caffeine you drink, quitting smoking, eating smaller meals and losing weight if you need to. If those don’t work, try an inexpensive over-the-counter antacid, such as Maalox, Mylanta, Rolaids, Tums, or their generic equivalent, or drugs called H2 blockers, which include Pepcid AC, Zantac 150 or their generic equivalent.

Heavy advertising has helped propel this class of drugs to the top of the pharmaceutical best-seller list. Here’s a good example: One of these drugs, Nexium, (aka " the purple pill") racked up nearly $6.3 billion in sales in 2009, according to figures from IMS Health, making it the second highest-selling drug in the U.S. last year. And, more than $13.6 billion were spent last year on this entire group of PPI drugs. Not surprisingly, several studies have shown that many people who are prescribed a PPI—up to nearly 69 percent—do not actually need the medicine.

These drugs are approved by the FDA for treating a severe heartburn condition called gastroesophageal reflux disease, or GERD, that can inflame or erode the lining of the esophagus.

But PPIs are not a good first option for mild or occasional heartburn. The five studies released Monday underscore why. Two of the studies found people taking PPIs faced an increased risk of infection with Clostridium difficile, a bacteria that can cause severe diarrhea. This is likely because PPIs reduce the amount of stomach acid, which normally helps kill off "bad" bacteria.

And that’s not all. A separate study found that women, ages 50 to 79, who took PPIs had an increased risk of wrist, forearm, spine and overall fractures. Earlier studies have suggested that such fractures are due to the body’s inability to absorb calcium properly while taking these medications.

You should know that in addition to bacterial infections and bone fractures, PPIs can increase the risk of contracting pneumonia. Also, some studies indicate these drugs may reduce the effectiveness of clopidogrel (Plavix), a blood thinner used to prevent clots after heart attacks and stent placement. Our medical advisers recommend that people taking clopidogrel should not take PPIs unless other remedies have not been adequate.

Bottom line: If you have occasional heartburn and have not been diagnosed with GERD, try lifestyle changes first. If those don’t provide you with relief, the next step is to try an inexpensive over-the-counter antacid.

If you suffer from heartburn twice a week or more for weeks or months on end, you should see a doctor because you may have GERD, also known as acid reflux, and may need a PPI. If that’s the case, you may be able to skip the expensive treatments, since three over-the-counter PPI drugs are our Best Buy picks: generic omeprazole, Prilosec OTC and Prevacid 24HR.

People ages 65 and over, and those with chronic medical conditions should be vaccinated against pneumonia and get a flu shot every year—and this is especially true for people in those categories who are also taking a PPI.

Steve Mitchell, associate editor, Best Buy Drugs 

For more details on the PPIs drugs, heartburn and GERD, check out our free Best Buy Drugs report.

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