Proton pump inhibitors (PPIs) are generally perceived to be safe and effective, but like any pharmacologic agent, they have the potential for side effects
Common side effects
- Gastrointestinal symptoms: PPIs can cause gastrointestinal symptoms such as nausea, vomiting, diarrhea, and abdominal pain.
- Headache: Headache is a common side effect associated with PPI use.
Long-term use side effects
- Fractures: Long-term PPI therapy has been associated with an increased risk of fractures, particularly in elderly women
- Hypomagnesaemia: Chronic PPI use can lead to hypomagnesaemia, a condition characterized by low levels of magnesium in the blood
- Clostridium difficile infection: There is an increased risk of Clostridium difficile infection with long-term PPI use
- Pneumonia: Chronic PPI use has been associated with an increased risk of pneumonia
Drug interactions
- Clopidogrel: PPIs may negatively affect the clinical outcome in patients treated with clopidogrel, a medication used to prevent blood clots
- Methotrexate: PPIs can increase serum methotrexate levels, especially in patients receiving high-dose methotrexate
Other potential side effects
- Acute interstitial nephritis: PPI use has been associated with an increased risk of acute interstitial nephritis, a condition characterized by inflammation of the kidneys
- Cardiovascular risk: PPIs may increase the risk of major adverse cardiovascular events in patients with acute coronary syndrome
In conclusion, while PPIs are generally safe and effective, they can cause a range of side effects, particularly with long-term use. Therefore, it is important to regularly review the ongoing indications for PPI use and consider deprescribing in patients without a definitive indication for chronic use