Proton Pump Inhibitors (PPIs)

Millions of Americans struggle with heartburn, gastroesophageal reflux disease (GERD), stomach ulcers, and other conditions related to the overproduction of stomach acid. To treat these conditions, doctors often prescribe medications like H2 antagonists and proton pump inhibitors (PPIs), which help control acid production. Proton pump inhibitors are especially effective for treating these conditions, but often come with potentially serious long-term effects.

What Is a Proton Pump Inhibitor and How Does It Work?

Stomach acid is a natural and vital part to digesting food. This substance helps break down food after we eat, helping our bodies absorb nutrients easily and move food through the digestive tract. However, if our stomach produces too much acid, we can experience unpleasant symptoms such as heartburn, nausea or vomiting, abdominal discomfort, and bloating.

In some cases, serious chronic conditions can occur due to the overproduction of stomach acid, such as GERD and painful stomach ulcers. Lifestyle changes, such as dietary modifications and changing mealtimes, can sometimes help alleviate these symptoms. Doctors will often prescribe medication to regulate stomach acid production and treat these conditions.

A proton pump inhibitor, also known as a PPI, is a medication that reduces the production of stomach acid by blocking enzymes known as proton pumps. Proton pumps trigger chemical reactions that produce stomach acid. When you take a PPI, the medication will block these enzymes and reduce the production of stomach acid, allowing for damaged esophageal tissue to heal and preventing symptoms like heartburn. PPIs usually provide up to 24 hours of symptom relief.

PPI Brands vs. Generic PPIs

You can purchase over-the-counter (OTC) PPIs or ask your doctor for a prescription PPI, which are typically stronger than their OTC counterparts.

There are several name-brand PPIs available in the United States:

• Prilosec and Prilosec OTC, also known as omeprazole
• Nexium and Nexium 24HR, also known as esomeprazole
• Dexilant, also known as dexlansoprazole
• Prevacid and Prevacid 24HR, also known as lansoprazole
• Protonix, also known as pantoprazole
• Vimovo, also known as naproxen-esomeprazole
• AcipHex, also known as rabeprazole
• Zegrid, also known as omeprazole

You can purchase prescription-strength versions of these eight medications. Some of them are also available in OTC formulations, such as Prilosec and Prevacid. You can purchase generic versions of all of these PPIs except for Dexilant and Vimovo. Additionally, there are pediatric formulations available for AcipHex, Prilosec, Prevacid, Zegrid, and Nexium. Speak to your doctor to determine which PPI is right for your condition.

What Are Proton Pump Inhibitors Used For?

Generally, proton pump inhibitors are used to treat conditions involving the overproduction of stomach acid, also known as gastric acid. Prescription PPIs are typically used for serious and chronic conditions, while OTC PPIs are best suited for more common conditions like frequent heartburn.

Some conditions treated best by prescription PPIs include the following:

• Erosive esophagitis: A condition involving the inflammation of the esophageal lining
• Gastroesophageal reflux disease (GERD): A chronic digestive condition caused by frequent acid reflux, or stomach acid flowing into the throat
• Gastric ulcers: A condition that involves raw sores embedded in the stomach or intestinal lining
• Zollinger-Ellison syndrome: A rare and chronic condition that causes the stomach to overproduce acid

OTC Proton Pump Inhibitors

Over-the-counter PPI medications include Nexium 24HR, Prilosec OTC, and Prevacid 24HR. Usually, doctors recommend taking OTC PPIs for frequent heartburn. You may have frequent heartburn if you experience symptoms more than twice per week, which may include a burning feeling in your chest or throat, pain in your chest when you bend over or lay down, or an unpleasant, acidic, or sour taste in the back of your throat.

Unlike other heartburn medications, PPIs are not effective immediately. These medications may require a several-day grace period before they begin working. However, PPIs do provide up to 24 hours of relief from symptoms – making them one of the stronger options for treating heartburn symptoms.

PPI Off-Label Uses

Doctors may recommend taking a PPI for a condition other than what is listed on the label. A physician may also recommend that you take OTC PPIs for longer than 14 days, which is the recommended limit on the medication’s label. However, this practice is not approved by the FDA and may lead to adverse health conditions. If you are unsure whether your physician is recommending safe PPI use, speak to another medical provider for a second opinion.

PPI Side Effects

Like all medications, PPIs can lead to some side effects in a small number of patients. These can range from minor discomfort to serious, life-threatening conditions. Common side effects for PPIs include the following:

• Headache
• Diarrhea
• Constipation
• Stomach pain
• Fever
• Vomiting
• Nausea
• Rash

Generally, long-term PPI usage is not recommended due to the risk of serious conditions, such as low levels of magnesium and an increased risk of osteoporosis-related fractures. Other serious PPI side effects include the following:

• Allergic reactions
• Reduced liver or kidney function
• Permanent liver or kidney damage
• Toxic epidermal necrolysis
• Pancreatitis
• Stevens-Johnson syndrome

Proton Pump Inhibitor Interactions

Proton pump inhibitors may react with certain medications, which can impact their effectiveness and lead to unpleasant symptoms. In some cases, PPIs can prevent the liver from breaking down certain drugs, leading to an increase in their concentration in the bloodstream. These may include diazepam (Valium), warfarin (Coumadin), and phenytoin (Dilantin).

Some PPIs may reduce the impact of clopidogrel (Plavix) by preventing the medication from activating. Additionally, PPIs can reduce the absorption of medications like ketoconazole (Nizoral), leading to ineffectiveness, and increase the absorption of digoxin (Lanoxin), leading to toxicity. Always speak to your physician about these potential interactions.

Differences Among Proton Pump Inhibitors

Both generic and name-brand PPI medications are very similar in action and chemical composition. As a result, these medications usually operate at the same level of effectiveness. Certain types of PPIs may be more effective at treating certain conditions than others; for example, Nexium may be more effective at healing esophagitis, while Prilosec may be better at treating GERD. To determine which PPI medication is right for you, ask your doctor for advice.

Zantac is a common alternative to proton pump inhibitors that has been linked to certain cancers. If you are a former Zantac patient and developed cancer after taking the drug, you may be eligible for financial compensation. In these situations, it is important to speak to a Zantac lawyer. After receiving treatment for your condition, contact an attorney as soon as possible to discuss your case eligibility and legal options.