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Heartburn drugs come with new warnings- Courtesy of Consumer Reports

June 29, 2010

Heartburn drugs called proton pump inhibitors, or PPIs, can squelch that fire in your belly, but given the a recent warning from the Food and Drug Administration about a possible increased risk of bone fractures, you should make sure you really need such a potent medicine before taking them. Our newly updated Best Buy Drugs report on these PPI drugs talks about this serious side effect plus another study that confirms the risk.

About 15 million Americans suffer from heartburn every day, but not everyone needs to take a PPI. Although they’re a very effective and generally safe heartburn medicine for heartburn, gastroesophageal reflux disease (GERD), and gastric ulcers, they can carry serious risks.

This recent FDA warning cites studies indicating that taking a high dose or taking the drugs for longer than a year could possibly increase the risk of fractures of the hip, wrist or spine. The agency said it was adding a warning about this possible risk to the labeling of PPIs, which include the drugs dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid),omeprazole (Prilosec, Zegerid, and generic), pantoprazole (Protonix), and rabeprazole (Aciphex). Four are also available over-the-counter: generic omeprazole, Prilosec OTC, Prevacid 24HR and Zegerid OTC. Broken bones aren’t the only risk with these drugs. PPIs also increase the risk of bacterial infections and pneumonia, and can also negatively interact with other medications. 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.

PPIs have been heavily promoted, which has led to overuse in people with garden-variety heartburn who could likely find relief without taking one of these medications.

So if your heartburn is mild and infrequent, you should first try lifestyle changes, such as:
• Reduce your alcohol and caffeine intake
• Quit smoking
• Eating smaller meals
• Lose weight if you need to

If these changes 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.

If you suffer from heartburn twice a week or more for weeks or months on end, you may have GERD, and may need a PPI. Our Best Buy picks are three over-the-counter PPIs—generic omeprazole, Prilosec OTC and Prevacid 24HR. But before you start taking one of these, see a physician to make sure you actually suffer from GERD and that a PPI is appropriate for your condition. And if you are already taking a PPI, discuss with your doctor whether you could try a lower dose or stopping.


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