When Heartburn Drugs Turn Deadly

Do you gorge on spicy foods, stay stuck to your office chair all day long, drink way too much caffeine and never get enough sleep because you bring your work home or love late-night binge-watching on Netflix? Any of these can trigger acidity, gas or heartburn, which we tend to treat with a handful of over-the-counter pills. The instant relief they bring has made them popular, but the problem starts, say doctors, when you self-medicate and take multiple pills a day to treat your symptoms. Of course, you have never connected these medicines to fatal health risks such as cancer, chronic kidney disease or even dementia. However, they have hit the headlines due to potential health risks, making it all the more essential to exercise caution.

The US Food and Drug Administration has already alerted patients on the possible dangers of some cancer-causing impurities in ranitidine, an old molecule widely prescribed for intestinal and stomach ulcers, acid reflux (where stomach acid flows into the food pipe) and more. Several companies voluntarily recalled it from the market. In another case, the Drug Controller General of India asked some antacid makers to mention the risk of kidney damage on packets and patient information leaflets. Most of these drugs fall under a class called H2 (histamine 2) blockers - ranitidine is one of them - but you will also come across proton-pump inhibitors (PPIs) such as omeprazole and pantoprazole, mostly used for long-lasting reduction of stomach acid production and treating ulcers and gastroesophageal reflux disease (GERD).

According to doctors, prolonged use of PPIs, for three years or more, has adverse effects on health. To start with, these drugs aggravate diminished bone mineral density in postmenopausal women and may lead to fractures in some cases. "The PPIs are used rather freely," affirms Dr Devi Prasad Shetty, a leading cardiac surgeon and Founder and Chairman of Narayana Health, a chain of multispeciality hospitals. "I treat cardiac patients, and I have found a good number of them on PPIs. Now, that is not always prescribed by their doctors. A doctor might have prescribed those at some stage, perhaps a few years ago, but the patient keeps taking it after experiencing a dramatic relief. That is why PPIs are used so indiscriminately. It is a common medicine that heart patients take along with regular cardiac drugs."

Some may need them, though, as part of the treatment. "Most cardiac patients tend to be on aspirin, and it is notorious for causing hyperacidity and heartburn. Hence, some do have a reason to take them but not for a long time. Doctors normally prescribe it for a few days or a few weeks," says Dr Shetty.

Is there a way to stop PPI dependence? You can do it if you are cautious about food and lifestyle. "If you have hyperacidity, try and identify what type of food is causing it. In people with lactose intolerance, it could be yoghurt and milk. If you have spicy food in the afternoon, you tend to develop acid reflux later in the day. The real and easy solution is to modify the diet. Most of the times, dietary changes alone will address the issue unless people have an acid-peptic disease, which is not very common," says Dr Shetty.

Dr Kiran Reddyvari, a Consultant Gastroenterologist at Narayana Health, is also in favour of a 'stop strategy' whenever it is possible. "In 50 per cent cases that we handle, there is no indication that patients need to be on these drugs on a long-term basis. They need to stop immediately while others must restrict the use to a limited period as prescribed," he adds.

Nevertheless, PPI dependence continues to thrive, and the antipeptic ulcerants market (includes plain PPIs as well as combination drugs apart from H2 blockers) is estimated to be around Rs 6,000 crore in India (per annum sales). Also, sales are growing at an annual rate of 10 per cent, similar to overall medicine sales in India. This indicates widespread usage, but now that you know the pros and cons, consult your doctor instead of routinely taking the little pills. They may cause serious side effects.