January 19, 2016

Proton Pump Inhibitors (PPIs) such as omeprazole (Prilosec), Pantoprazole (Protonix), and rabeprazole (AcipHex) can put you at risk of multiple conditions including acute[i] and chronic kidney disease[ii], acute interstial nephritis[iii], clostridium difficile infection[iv], community acquired pneumonia[v], and bone fractures.[vi] Chronic kidney disease is very common affecting 13.6% of adults in the US[vii] and is associated with higher chance of cardiovascular disease.[viii] These are some of the most prescribed meditations in the US and there is significant evidence that these medications are over prescribed and not clinically indicated in 25-75% of individuals [ix] In a prospective community-based cohort study of more than 10 000 adults, they found that use of PPIs was independently associated with a 20% to 50% higher risk of incident CKD.[x]

List of PPIs from Wikipedia

  • Omeprazole (OTC; brand names: Gasec, Losec, Prilosec, Zegerid, ocid, Lomac, Omepral, Zolppi, Omez, Omepep, UlcerGard, GastroGard, Altosec)
  • Lansoprazole (brand names: Prevacid, Zoton, Monolitum, Inhibitol, Levant, Lupizole)
  • Dexlansoprazole (brand name: Kapidex, Dexilant)
  • Esomeprazole (brand names: Nexium, Esotrex, esso)
  • Pantoprazole (brand names: Protonix, Somac, Forppi, Pantoloc, Pantozol, Pantomed, Zurcal, Zentro, Pan, Controloc, Tecta)
  • Rabeprazole (brand names: AcipHex, Pariet, Erraz, Zechin, Rabecid, Nzole-D, Rabeloc, Razo, Superia. Dorafem: combination with domperidone[citation needed]).
  • Ilaprazole (not FDA approved as of October 2013; brand names: Noltec, Yili’an, Ilapro, Lupilla, Adiza)

[i] Antoniou T, Macdonald EM, Hollands S, et al. Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study. CMAJ Open. 2015;3(2):E166-E171. doi:10.9778/cmajo.20140074

[ii] Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81(5):442-448.

[iii] Blank ML, Parkin L, Paul C, Herbison P. A nationwide nested case-control study indicates an increased risk of acute interstitial nephritis with proton pump inhibitor use. Kidney Int. 2014;86(4):837-844.

[iv] Dial S, Alrasadi K, Manoukian C, Huang A, Menzies D. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. CMAJ. 2004;171(1):33-38.

[v] Lambert AA, Lam JO, Paik JJ, Ugarte-Gil C, Drummond MB, Crowell TA. Risk of community-acquired pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis. PLoS One. 2015;10(6):e0128004. doi:10.1371/journal.pone.0128004

[vi] Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006;296(24):2947-2953.

[vii] Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-1305.

[viii] United States Renal Data System. 2014 USRDS Annual Data Report: an overview of the epidemiology of kidney disease in the United States. http://www.usrds.org/2014/view/Default.aspx. Published 2014. Accessed April 3, 2015.

[ix] Forgacs I, Loganayagam A. Overprescribing proton pump inhibitors. BMJ. 2008;336(7634):2-3.

[x] Benjamin Lazarus, MBBS12; Yuan Chen, MS1; Francis P. Wilson, MD, MS3; Yingying Sang, MS1; Alex R. Chang, MD, MS4; Josef Coresh, MD, PhD15; Morgan E. Grams, MD, PhD15 Adverse Effects Associated with Proton Pump Inhibitors JAMA Intern Med. Published online January 11, 2016. doi:10.1001/jamainternmed.2015.7193.