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Stomach Acid Drugs May Raise Pneumonia Risk

Risk From Acid-Suppressing Drugs Greatest in Frailest Patients
By
WebMD Health News

Oct. 26, 2004 -- Common but powerful stomach acid-suppressing drugs -- some available without prescription -- may raise your risk of pneumonia.

The risk is not huge. But the drugs work so well and so safely -- and are advertised so aggressively -- that they're among the most-used drugs in the U.S. With so many users, any risk would involve lots of people.

There seems to be one extra case of pneumonia among every 100 people who take acid-suppressing drugs for one year. The finding comes from researchers Robert J.F. Laheij, PhD, of the University Medical Center St. Radboud in Nijmegen, Netherlands. Laheij and colleagues report their findings in the Oct. 27 issue of The Journal of the American Medical Association.

"These drugs are not as safe as everybody thinks," Laheij tells WebMD. "If it is not necessary for you to use them, don't. Keep in mind that these medicines can have serious side effects -- especially in more fragile patients who can have serious problems."

The researchers analyzed computerized medical records for some 500,000 Dutch patients. Those taking acid-suppressing drugs for heartburn and indigestion were four times more likely to have pneumonia than those who did not.

Since people taking these drugs tend to be less healthy, the researchers did a second, more meaningful analysis. They compared those still taking the drugs with those who used to take them but stopped. Current use of acid-suppressing drugs doubled the risk of pneumonia.

Who Needs Acid-Suppressing Drugs

The drugs in question are called proton pump inhibitors or PPIs. They block the chemical "pump" needed for stomach cells to make acid. The drugs include:

  • Prilosec (called Losec in Europe)
  • Nexium
  • Prevacid
  • Protonix
  • Aciphex

Also implicated in pneumonia risk to a lesser extent are the acid-fighting drugs called H2 receptor antagonists. They block a different step in the manufacture of stomach acid. These drugs include:

  • Tagamet
  • Pepcid
  • Axid
  • Zantac
  • Rotane

Acid-suppressing drugs work wonders for people who really need them, says David Peura, MD. Peura is spokesman for the American Gastroenterological Association and associate chief of gastroenterology at the University of Virginia in Charlottesville.

"PPIs are appropriate for people who truly have GERD [acid reflux], where their symptoms are affecting their quality of life," Peura tells WebMD. "These are people who have difficulty sleeping, who are altering their lifestyles for the better and still are not able to control their symptoms. Most of these people have serious heartburn three or more times a week."

The H2 antagonists are "ideally suited" for people with only occasional heartburn, Peura says. Most people need these drugs only once in a while.

"If you were going to eat a pizza and thought you would have a problem, you'd be better off taking Zantac or Pepcid before going out instead of taking the drugs on a regular basis," Peura says. "But there are others who when they just bend over, acid comes up into their esophagus. These people need regular acid suppression."

Lifestyle changes can reduce the risks of heartburn, such as:

  • Avoid foods and beverages that contribute to heartburn: chocolate, coffee, peppermint, greasy or spicy foods, tomato products, and alcoholic beverages.
  • Stop smoking.
  • Lose weight.
  • Eat slowly.
  • Do not lie down after eating.

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