Contact The Doctor

Is It Safe to Take PPIs Like Prilosec and Nexium?

Acid Reflux
September 12, 2019
Share PostShare


Frequently used to treat acid reflux, PPIs, proton pump inhibitors, a class of acid-suppressant drugs—see list below—are among the most widely prescribed drugs in the U.S. with annual sales topping $12 billion and revenue growth of 4% per year.

  • For people with heartburn and indigestion (GERD), PPIs provide symptom relief in only 60%; and for people with throat and respiratory symptoms (LPR), it’s only 40%. In fact, PPIs alone never cure reflux, but there are safe and effective alternative medications and natural remedies.
  • While the proton pumps in the stomach make acid, proton pumps in most of the body’s organs (including kidneys, heart, and brain) perform many other important and vital functions. There is mounting evidence that taking PPIs is unsafe, even deadly.
  • The reported life-threatening complications of PPIs are depression, heart problems, esophageal cancer, and death; and the most common transient side effects of PPIs include nausea, headache, stomach pain, and rebound hyperacidity. 
  • PPIs should never have been allowed to be sold over-the-counter; they should be prescribed for no more than eight weeks; and they should be discontinued (tapered) under a physician’s supervision. Based upon the already available data, the Food and Drug Administration should consider banning PPIs altogether. 

You’ve probably seen hundreds of TV commercials showing tiny stomach pumps churning out acid and then just giving up at the sight of a purple pill. Besides the purple pill, Nexium, there are many other PPIs, but despite advertising, they are all pretty much the same. 

In the PPI list below, the drug's trade name is on the left and the generic name is on the right.

Most Commonly Used PPIs

Nexium / esomeprazole
Prilosec / omeprazole
Protonix / pantaprozole
Prevacid / lansoprazole
Aciphex / rabeprazole
Dexilant / dexlansoprazole
Zegerid / omeprazole

What Happens If I Don’t Have Enough Stomach Acid?

Contrary to popular belief, the purple pills never make those tiny stomach pumps give up. Here is the figurative truth: If you took a bucket of PPIs every day, instead of making a ton of acid, you would still make half-a-ton, because no acid-suppressive medication including PPIs completely turns off stomach acid. That's a myth; and by the way, people with no stomach acid from any cause are very rare. There is a condition achlorhydria (no hydrochloric acid), and it is almost always associated with associated with a disease called pernicious anemia. Furthermore, despite some reports to the contrary, taking PPIs does not cause B12 deficiency or pernicious anemia. Finally, there is discussion on the Internet about some people just not having enough stomach acid; that is nonsense, which falls into the broad category of Medical Bullsh*t.

PPIs Are NOT Very Effective Treating Reflux

For people with heartburn and indigestion (GERD), PPIs provided symptom relief for only 60% of patients; and for LPR, the numbers are reversed, almost 60% fail medical treatment. 

PPIs alone never cure acid reflux; and there are safe and effective alternative medications and natural remedies; see the Diet & Lifestyle section of this blog.

What Are Proton Pumps and What Do They Do? 

The arrogance of big Pharma! While the proton pumps in your stomach to make acid, what about the proton pumps and the rest of your body? 

Proton pumps aren’t just located in the stomach; they’re in almost all of the body’s tissues where they perform functions that have nothing to do with acid production. Proton pumps, part of virtually all cell membranes, are related to cell energy regulation, nutrient uptake, and cell-cell communication. 

Proton pumps are found throughout the gastrointestinal tract, in all muscle, including cardiac muscle, and in all neural tissue including the brain. It’s no wonder that researchers are finally discovering significant unintended consequences of widespread PPI use. 

Life-Threatening Complications of PPIs

Reports in the medical literature have linked PPIs with a host of life-threatening complications, including depression, kidney disease, hip fractures, and heart problems (arrhythmias, heart attacks, heart failure and sudden death. 

In 2014, the author completely stopped using PPIs in my practice after publication of the Danish Study that found that long-term use of PPIs increased the risk of developing esophageal cancer. That study made clear that even if PPIs improve patients' reflux symptoms, they fail to control the progression of the underlying disease. 

The last worrisome nail in the PPI coffin was publication of Risk of death among users of proton pump inhibitors. This was a Veterans Administration report with a large study cohort comparing reflux patients on H2-Antogonists (n=73,335) with those on PPIs (n=275,977); the study found that the death rate was 25% higher in the PPI group.

What Are the Side Effects of PPIs?

The prevalence of PPI use isn’t only caused by the physicians who prescribe them. They’re widely advertised on television and available over the counter. In my opinion, the FDA never should’ve allowed PPIs to be sold OTC. 

When people abruptly stop taking OTC PPIs, they can experience rebound hyperacidity, which means that reflux symptoms get much worse. And since the package label states that PPIs should be taken for just two weeks, people usually comply and only take them for this short amount of time. After days or weeks of misery after stopping their OTC PPI, many people feel it’s necessary to retake them. While this start-and-stop self-medication is good for drug sales, it’s not good for reflux sufferers.

How Do I get Off PPIs? The proper way to taper off PPIs is to take the other class of acid-suppressive, H2-antagonists (H2As), such as Pepcid/famotidine and Tagamet/cimetidine. Until recently, Zantac/ranitidine was also a popular H2A; however recent reports suggested that Zantac may contain traces of a carcinogen. BTW, Pepcid and Tagamet are clean. 

H2As are available over the counter and can be taken before each meal and before bed, four times a day to start. Then, after a few weeks, after the rebound has passed, the H2As can be tapered as well, going from four times daily to three to two to once per day as symptoms ease. H2As are a safe class of drugs and have fewer side effects and generally less serious complications compared to PPIs. 

Rebound is the most common transient side effect of PPIs, but the other common ones are headache, diarrhea, constipation, gas/flatulence, nausea, vomiting, and abdominal pain. The latter seems to be a fairly common side effect, but it’s often misdiagnosed. That is, doctors order a lot of unnecessary diagnostic tests to work up the pain while forgetting that PPIs can cause this particular symptom.

What Are the Alternatives to PPIs?

In my practice, almost all of my patients come to me already on PPIs without benefit. If a patient is currently on PPIs, we stop them the day of the first visit, tapering with H2As as described above. I’ve successfully managed (cured) reflux in thousands of patients without using any PPIs. 

Diet and lifestyle are effective treatments for reflux, especially respiratory reflux (LPR) along with H2As and Gaviscon Advance. Reflux is curable with effort and commitment to change, which includes early eating, cutting out soft drinks, and a diet that’s lean, clean, green, and alkaline. I’ve written four books about these topics: Dropping Acid: The Reflux Diet Cookbook & Cure, The Chronic Cough Enigma, Dr. Koufman’s Acid Reflux Diet, and Acid Reflux in Children: How Healthy Eating Can Fix Your Child’s Asthma, Allergies, Obesity, Nasal Congestion, Cough & Croup (on Amazon and soon to be released).

What Can I Do? — Potential Regulatory and Consumer Action Points

Here are a few ways that consumers and other health professionals can take action against the epidemic of over-prescription and use of PPIs.

Boycott PPIs: Tell your doctor that you don’t want to be on a PPI, and tell your doctor to read this post.

Boycott PPIs: Tell your doctor that you don’t want to be on a PPI, and tell your doctor to read this post.

  • Stand up to the FDA: PPIs should never have been allowed to be sold OTC, and they should be removed now. Petition the FDA to take PPIs off the shelves in our drugstores.
  • Regulation: PPIs should be regulated with maximum use of eight weeks per year, except in extraordinary cases.
  • Warning labels: Like cigarettes, PPIs should come with warning labels on them stating the potential adverse reactions and that they can cause death.
  • Eliminate PPIs: Petition the FDA to remove PPIs from the market entirely.
  • Legal action? Here’s an idea for an enterprising attorney: a class action lawsuit against PPI manufacturers by people who developed esophageal cancer while on PPIs. Those patients assumed that the PPI was effectively treating their reflux disease and protecting them from cancer when in fact the opposite is the case

More Posts

View All Posts


Subscribe now to get notified about new posts and books from Dr. Koufman. We will never share your email.

The Voice & Reflex Institute of New York | Transnasal Esophagoscopy
Copyright 2019 | Dr. James Koufman | Privacy Policy + Disclaimer
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram