Heartburn medicines are some of the most widely used drugs in the world. Many are sold over the counter, and plenty of people take them every day for years. For short-term relief, they are generally safe and very effective. But research over the past 15 years has raised questions about long-term use, particularly of one class of drugs, and its effects on bones, kidneys and nutrient levels. Here is what you should know.
Not all heartburn medicines are the same
- Antacids such as calcium carbonate tablets work by neutralizing acid that is already in your stomach. They act quickly and are meant for occasional use.
- H2 blockers such as famotidine reduce the amount of acid your stomach makes.
- Proton pump inhibitors (PPIs) such as omeprazole, esomeprazole and pantoprazole block acid production more strongly and for longer.
Most of the long-term concerns involve PPIs, because they are so effective at lowering stomach acid and are often taken for years.
Bones and fractures
Several large observational studies have found that people who take PPIs for a long time, especially at high doses, have a somewhat higher risk of hip, wrist and spine fractures. In 2010, the FDA added a warning about possible fracture risk to PPI labels.
Why might this happen? Stomach acid helps you absorb calcium from some foods and supplements, particularly calcium carbonate. Lower acid may mean less calcium absorbed. The research cannot fully prove cause and effect, because people who need long-term PPIs may also differ in other ways.
What helps:
- Get enough calcium, mostly from food. If you take a calcium supplement while on a PPI, calcium citrate is better absorbed than calcium carbonate because it does not need stomach acid. See calcium and bone health.
- Get enough vitamin D. See our vitamin D guide.
- Stay active, with weight-bearing exercise such as walking and strength training.
- Ask your doctor whether a bone density test makes sense for you.
Magnesium
Long-term PPI use, usually more than a year, can lead to low magnesium levels in some people. The FDA issued a warning about this in 2011. Low magnesium can cause muscle cramps, tremors, an irregular heartbeat and, in severe cases, seizures. Your doctor may check your magnesium level, especially if you also take diuretics or certain heart medicines. See magnesium.
Vitamin B12
Stomach acid helps release vitamin B12 from food. Long-term use of PPIs and H2 blockers has been linked with lower B12 levels. If you take these medicines for years, ask about checking your B12. Supplements and fortified foods are well absorbed even when stomach acid is low. See vitamin B12 after 50.
Iron
Stomach acid also helps you absorb iron from plant foods and supplements. Some people on long-term acid suppression develop low iron. See iron supplements: who needs them.
Kidneys
Some observational studies have linked long-term PPI use with a higher risk of chronic kidney disease. PPIs can also, rarely, cause a type of kidney inflammation called acute interstitial nephritis. Again, the research shows associations, not proof, but it is one reason doctors are encouraged to use the lowest effective dose for the shortest time needed.
Antacids used heavily can also cause problems. Taking large amounts of calcium carbonate antacids over time can raise calcium levels in the blood and affect the kidneys. Follow the label limits.
Should you stop your heartburn medicine?
Not without talking to your doctor. PPIs are important and often essential for conditions such as severe reflux, Barrett's esophagus, stomach ulcers and for people taking certain medicines that irritate the stomach. Stopping suddenly can cause rebound acid that feels worse than before. Your doctor may suggest slowly lowering the dose or switching to an as-needed approach if your condition allows.
Lifestyle steps that reduce heartburn
- Eat smaller meals, and avoid eating within two to three hours of bedtime.
- Raise the head of your bed by a few inches.
- Notice your triggers. Common ones are fatty or fried food, chocolate, alcohol, coffee, mint, spicy food and tomato sauce.
- Lose weight if you are carrying extra, especially around the belly.
- Stop smoking.
- Avoid tight waistbands.
MedlinePlus has more on heartburn and when to see a doctor. Seek care if you have trouble swallowing, unexplained weight loss, vomiting blood, black stools, or heartburn more than twice a week despite treatment.
The bottom line
Heartburn medicines are safe and effective for short-term use. Long-term PPI use has been linked to bone fractures, low magnesium, low B12, low iron and kidney problems, though not every link is proven. If you take a PPI for years, ask your doctor whether you still need it, keep up your calcium, vitamin D and B12, and get your levels checked. Never stop a prescribed medicine without medical advice.