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Evidence of PPI danger grows
Extended use of common heartburn medication has been linked to potentially fatal cardiovascular disease, stomach cancer and chronic kidney disease.
The latest research indicates the risk of fatality increases with the duration of PPI use, even at low doses.
Proton pump inhibitors (PPIs) have been associated with an increased risk of premature death since 2015. New research has now found correlations between their use and negative health outcomes.
According to the Pharmaceutical Benefits Advisory Committee (PBAC), high-dose PPIs appear to be overprescribed in Australia, for excessively long periods of time and particularly among older people.
Across 2013–16, 95% of prescriptions were considered ‘high’ or ‘highest’ dose, leading the PBAC’s Drug Utilisation Sub Committee (DUSC) to recommend changes to the restriction levels and number of repeats.
The recommendation resulted in restrictions being placed on the prescription of PPIs listed on the Pharmaceutical Benefits Scheme (PBS) General Schedule in May, as well as changes to the terminology, criteria and the number of repeats.
However, the latest research indicates the risk of fatality increases with the duration of PPI use, even when the drugs are taken at low doses, as more than 80% of analysed PPI users were on low doses of the prescription drug, or those equivalent to doses offered in over-the-counter versions.
‘This suggests the risk may not be limited to prescription PPIs, but it also may occur at over-the-counter doses,’ lead author Assistant Professor Ziyad Al-Aly said.
‘Taking PPIs over many months or years is not safe, and now we have a clearer picture of the health conditions associated with long-term PPI use.’
The Washington University School of Medicine study utilised 157,625 medical records, sourced through the US Department of Veterans Affairs, of people who had been recently prescribed PPIs, and 56,842 people who had been newly prescribed H2 blockers.
They followed the patients – 214,467 in total – for up to 10 years and discovered a 17% associated increased risk of death in the PPI group compared with the H2 blocker group. Death rates for PPIs were 387 per 1000 people, compared with 342 per 1000 for H2 blockers.
Specifically, 15 per 1000 PPI users died from heart disease; four per 1000 from chronic kidney disease, and two per 1000 from stomach cancer.
Death rates due to cardiovascular disease were 88 among the PPI group and 73 among the H2 blockers group, while death rates for stomach cancer were six in the PPI group and four in the H2 blockers group.
Death rates due to chronic kidney disease were eight and four in the PPI and H2 blocker groups, respectively.
The researchers therefore concluded, ‘taking PPIs is associated with a small excess of cause specific mortality including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer.’
Additionally, the study found that more than half of the people taking PPIs did so without a medical need, and that this group had the highest mortality rate.
‘Most alarming to me is that serious harm may be experienced by people who are on PPIs but may not need them,’ Assistant Professor Al-Aly said.
‘Overuse is not devoid of harm.’
Note: This article has been amended to show an association rather than causative effect between PPIs and negative health outcomes.
heartburn PPIs proton pump inhibitors
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