Proton pump inhibitors

Ask the Pharmacist

By Stefanie Tagg
Pharmacist at James Bay Thrifty Foods

With the season approaching where many of us indulge in large meals like Thanksgiving dinner and Hallowe’en candy, heartburn is a very common compliant that brings people into the pharmacy. There are many types of medications used to treat this but this article is focused on proton pump inhibitors.

Proton pump inhibitors (PPIs) are medications used for lowering stomach acid. This type of therapy may be initiated for a variety of different reasons. Some conditions caused by too much stomach acid are heartburn or gastroesophageal reflux disease (GERD) and ulcers (sometimes caused by H. Pylori bacteria). They are also sometimes prescribed if you are taking an NSAID (like ibuprofen or naproxen) or as a result of being in hospital.

Examples of PPIs are omeprazole, pantoprazole, lansoprazole, esomeprazole, and rabeprazole. All PPIs are considered equally effective, but individual responses to the different types may vary. Differences in cost and insurance plan coverage are something to keep in mind. PPIs are very effective medications, especially in regards to heartburn, where most people will have little to no symptoms after 4 to 8 weeks (possibly sooner).

Overall, the benefits of PPI therapy outweigh the potential risks but there are a few risks. PPIs may reduce the amount of calcium that your body absorbs, which could increase risk of fractures. Fracture risk further increases if you are over 50, take a high PPI dose, or use a PPI for a year or more. To help reduce the risk, ensure you get enough calcium and vitamin D in your diet and from supplements. Calcium citrate is the best supplement for people taking PPIs because it is better absorbed when you have lowered stomach acid.

There has also been some evidence that PPIs put you at higher risk of getting C. Difficile (an infection that affects the bowel) and pneumonia. These infections were seen in patients in hospitals.  

If you have been on PPIs for a long time and are wondering if you still need to take them, you may be able to decrease or discontinue them. Talk to your doctor or pharmacist first though. You may get rebound acid so these medications need to be tapered off (either by decreasing dose or taking every other day) instead of just stopping. Sometimes, it will be recommended to use antacids or H-2 blockers while you are doing this.

For mild GERD symptoms, stick with lifestyle changes such as maintaining a normal weight, eating smaller meals more often, reducing foods that make symptoms worse, and making sure not to eat at bedtime. Symptoms can be treated by using an antacid (Tums) or an H2-blocker (ranitidine) which have fewer side effects than PPIs.

Soon, in BC, you will be able to buy PPIs without a prescription. You can already purchase these without a prescription in the US and other provinces. Ask your pharmacist if you have any questions about these when they do become available.

The James Bay Beacon receives monthly contributions from the following pharmacists:

Jason Cridge - Cridge Family Pharmacy;
Stefani Tagg - Thrifty Foods Pharmacy; and
Robert Wojtas - James Bay Pharmasave