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Recently I saw a patient who has been taking Zantac, an acid-blocking drug prescribed for ulcers and reflux, for the last seven years! Zantac and other similar medications including Prilosec, Nexium, Tagamet, Pepcid and Prevacid, all belong to a group of drugs used to treat gastroesophageal reflux disease (GERD) and ulcers. All of these drugs are recommended by their respective manufacturers to take for four to eight weeks–not seven years!

Confused

To further enlighten myself I went to WebMD to see what kernel of wisdom could be gotten from “medical experts”. Regarding the treatment of GERD, WebMD stated the following:

“Doctors usually try to choose a treatment that uses enough medicine to control your symptoms but not so much that side effects become a serious problem. Depending on how bad your symptoms are, you may need to take medicines every day or only now and then when GERD symptoms occur. Long-term-often lifelong-medicine treatment is usually needed for GERD symptoms that are more severe, because symptoms tend to return when the medicine is stopped. Surgery is the only other effective option to prevent GERD symptoms from recurring.”

Interesting. There are no long-term studies on acid-blocking drugs and yet WebMD is claiming that a person may need to take one of these meds lifelong! Let me repeat myself: there are no studies that have examined the repercussions of taking this class of drugs for over one year. Furthermore, manufacturers of these drugs never recommend to take them for more than 12 weeks. Apparently the doctor who had been prescribing Zantac for my patient isn’t aware of this fact. Or perhaps he was getting his treatment advice from WebMD? Joking aside, the reality is that standard-of-care in treating acid reflux has become the indiscriminate long-term use of one of these medications.

Some facts may shed some light on the magnitude of the phenomenon. In 2010, Nexium was the second best-selling drug in the U.S., bringing in $6.3 billion in revenue. And Prilosec was the sixth most-prescribed drug with 53.4 million prescriptions dispensed. The number of Americans suffering from GERD is extraordinary and the improper use of these medications are associated with a litany of side effects:

Body As a Whole: Hypersensitivity reactions including anaphylaxis, anaphylactic shock, angiodema, bronchospasm, interstitial nephritis, urticaria, (see also Skin below); fever; pain; fatigue; malaise.

Cardiovascular: Chest pain or angina, tachycardia, bradycardia, palpitations, elevated blood pressure, peripheral edema

Endocrine: Gynecomastia

Gastrointestinal: Pancreatitis (some fatal), anorexia, irritable colon, fecal discoloration, esophageal candidiasis, mucosal atrophy of the tongue, stomatitis, abdominal swelling, dry mouth. During treatment with omeprazole, gastric fundic gland polyps have been noted rarely. These polyps are benign and appear to be reversible when treatment is discontinued.

Gastroduodenal carcinoids have been reported in patients with ZE syndrome on long-term treatment with PRILOSEC (omeprazole) . This finding is believed to be a manifestation of the underlying condition, which is known to be associated with such tumors.

Hepatic: Liver disease including hepatic failure (some fatal), liver necrosis (some fatal), hepatic encephalopathy hepatocellular disease, cholestatic disease, mixed hepatitis, jaundice and elevations of liver function tests [ALT, AST, GGT, alkaline phosphatase, and bilirubin]

Metabolic/Nutritional: Hypoglycemia, hypomagnesia, hyponatremia, weight gain

Musculoskeletal: Muscle weakness, myalgia, muscle cramps, joint pain, leg pain, bone fracture

Nervous System/Psychiatric: Psychiatric and sleep disturbances including depression, agitation, aggression, hallucinations, confusion, insomnia, nervousness, apathy, somnalence, anxiety and dream abnormalities; tremors, paresthesia; vertigo.

Respiratory: Epistaxis, pharyngeal pain

Skin: Severe generalized skin reactions including toxic epidermal necrolysis (some fatal); photosensitivity; urticaria; rash; skin inflammation; pruritis; petichia, purpura; alopecia; dry skin; hyperhidrosis.

Special Senses: Tinnitus, taste perversion

Ocular: Optic atrophy, anterior ischemic optic neuropathy, optic neuritis, dry eye syndrome, ocular irritation, blurred vision, double vision

Urogenital: Interstitial nephritis, hematuria, proteinurea, elevated serum creatinine, microscopic pyuria, urinary tract infection, glycosuria, urinary frequency, testicular pain

Hematologic: Agranulocytosis (some fatal), hemolytic anemia, pancytopenia, neutropenia, anemia, thrombocytopenia, leukopenia, leucocytosis

I apologize for the amount of space occupied by the side-effects, but I wanted to be comprehensive and help the reader to understand just how hazardous these drugs can be. Be aware that these side-effects do occur…and they can be devastating.

About a year ago I had a patient come to see me who had some strange, inexplicable muscle pain and severe fatigue. He was getting acute muscle breakdown known as rhabdomyolysis, a potentially life-threatening condition characterized by elevated creatine kinase. He also had elevated liver enzymes. When reviewing his medications I noticed he had been taking Prilosec, and knowing the potential side-effects of this drug, I inquired whether he had asked his doctor if Prilosec could be causing his symptoms. The doctor had responded no. However, a quick check of Prilosec indicated otherwise and confirmed my suspicions: the drug Prilosec was the cause. Liver disease and elevated creatine kinase are a side-effect of Prilosec as listed by the manufacturer of the drug. I may not be a rocket scientist, but if it looks like a duck…

Needless to say, it was the Prilosec that was causing his problems and after appropriately treating his GERD and getting him off of the medication, his liver enzymes and creatine kinase quickly became normal and his fatigue and muscle pain disappeared. Granted this was an unusual case, but it underscores the need for caution when using acid-blocking medications. There is a time and a place for these drugs and they are best suited for the short-term treatment of ulcers…not GERD.

So how did I get this individual off of Prilosec? I did food allergy testing and changed his diet. Sadly, conventional medicine largely ignores diet when it comes to gastrointestinal disease and is resigned to the use of drugs that focus on symptoms rather than cause. It is baffling to me and defies logic.