Popular Proton Pump Inhibitors linked to higher risk of stroke


Many people all over the world are taking proton pump inhibitors for treating acid reflux and heartburn. These medications are considered very safe and effective and that’s why these are highest-selling classes of drugs in the U.S. Some PPIs such as omeprazole and pantoprazole are available over the counter and people can take these medications without the prescription of doctor. In recent study presented in American Heart Association’s Scientific Sessions 2016, it is showed that these medications increase the risk of Ischemic strokes which is the most common type of stroke. In Ischemic stroke blood clot blocks or plugs a blood vessel in the brain as a result flowing of blood to the brain is stopped and brain cells began to die.

How PPIs work:
Our stomach Produces acid for digesting foods and killing germs (bacteria). Though the acid is corrosive it cannot corrodeour stomach linings because of natural mucous barrier which protects the lining of the stomach. Whenthe barrier is broken acid, it can damage the stomach and cause ulcer. Muscular band (the sphincter) is present at the top of the stomach which keeps the stomach tightly closed and because of problem with the sphincter acid goes to gullet (oesophagus) and cause irritation. It is known as acid reflux which causes heartburn or inflammation on oesophagus.Proton pump inhibitors irreversibly blocks the hydrogen/potassium adenosine triphosphatase enzyme system (commonly known as Proton Pump) of the gastric parietal cell. By inhibiting terminal stage in gastric acid section it reduces acid which helps in the healing of ulcers and reduces the pain of heartburn.

Recent study:
Study was presentedat the American Heart Association’s Scientific Sessions 2016, held in New Orleans, LA by Lead study author Dr. Thomas Sehested, of the Danish Heart Foundation in Copenhagen, Denmark. Danish Heart Foundation funds for these study. The research was performed in Denmark. In this study 245,000 Danish patients participated who were suffering from stomach pain and indigestion and their average age was 57. They had undergone endoscopy to identify the cause of indigestion and stomach pain. One of four PPIs: Prilosec, Protonix, Prevacid orNexium were given to them. In this study researchers saw that stroke risk increased 21% among patients who were taking these medications. In case of the dose is low, chances of stroke is less or none but when the dose is high  they found that stroke risk increased 33% for Prilosec and Prevacid patients, 50% for Nexium patients and 79% for Protonix patients. In another group patients were given H2 blockers as acid-reducing medications and they show no increased risk of stroke. Sehested believes that because of their findings from now on these medications (PPIs) will be used cautiously. “At one time, PPIs were thought to be safe, without major side effects,” he said, “This study further questions the cardiovascular safety of these drugs.” Though they did not find any link between H2 blockers and stroke but they are not claiming H2 blocker as a better option.

Company’s opinion to this study:
Company named P&G the maker of Prilosec emailed to CNN and claimed that their drug is FDA approved safe and effective. This OTC drug has a longest history of safe and effective consumer use. Takeda, the maker of Prevacid, said they will not comment until full data of the study is published and they will ensure patient safety first. AstraZeneca, the maker of Nexium also believes in patient’s safety and they think there PPIs are much safer than others. On the Other hand Pfizer, the maker of Protonix, did not said anything until now.

Alternatives of PPIs:
To treat acid reflux or heartburn PPIs are not the only solution. We can reduce this discomfort by changing our lifestyle such as reducing weight, by stopping smoking and removing fatty foods from our menu. For longer relief H2 blocker can be a good option. Antacids can also be used but it gives short term and instant relief. Always contact with your doctors before taking any medicines.

S. M. Hasan Morshed is completing his undergrad program under department of pharmacy, East West University. He can be reached at s.mhasanmorshed@gmail.com

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