Trade-offs to Long-Term Use of Antacids and PPIs

Trade-offs to Long-Term Use of Antacids and PPIs

The parent who grabbed an antacid after a big meal can eventually become the parent who relies on antacids or other acid-reducing medications every day. Seniors may treat heartburn as a minor issue, but it can relate to B12 and calcium levels, bone health, nutrition, kidney function, and other medications. The family focus should be to provide relief without letting an old prescription escalate to no-review status.

Long-term use of antacids/PPI medications should be reviewed frequently, especially for your parents. Treating heartburn can involve the senior's overall nutrition and bone health, and the rest of the medication they have taken. The goal is not to stop antacid or PPI use without consulting a physician. The goal is to evaluate the reason for the original prescription and the potential for long-term use.

What Are Antacids and PPIs?

Antacids neutralize acid in the stomach. Examples include products with calcium carbonate or magnesium. The effects of antacids are short-lived.

PPIs are a class of medications that reduce the production of stomach acid. Examples include omeprazole, pantoprazole, esomeprazole, and lansoprazole. PPIs take longer to act compared to a simple antacid, but have a prolonged effect.

PPIs are prescribed by doctors for reflux, stomach ulcers, inflammation of the food pipe, and to prevent ulcers for people using certain pain medications. Some seniors may need them for protection against ulcers or irritation caused by long-term use of certain medications. Some may continue to take them after the original reason for use was resolved.

The reason for treatment is important. For example, someone with a history of bleeding ulcers has different needs than someone who takes a PPI for occasional mild heartburn.

Impact of Long-Term Use of PPIs on Vitamin B12

Stomach acid helps break down Vitamin B12. Intrinsic factor helps the body absorb B12 in the small intestine. For some people, the prolonged lack of stomach acid will result in the body’s inability to absorb B12.

There are already numerous risk factors for the elderly resulting in B12 deficiency including, but not limited to, loss of appetite, limited diets, various digestive issues and gastrointestinal conditions, and changes relating to the aging process. Long-term use of PPIs also causes a need to assess B12 status.

There are a number of symptoms associated with a lack of Vitamin B12 including fatigue, loss of energy, paleness, a sore tongue, a decreased appetite, anemia, tingling sensation and numbness, balance problems, and a general lack of concentration.

Many of these symptoms can be attributed to other age-related conditions. Therefore, it is best not to assume that the PPI is the cause of symptoms.

It is important to consider other issues such as unexplained anemia, falls, or a restricted diet, as well as balance problems. Memory changes also require a B12 blood test.

Keep in mind that high doses of Vitamin B12 are not appropriate without the guidance of a doctor. Many forms of B12 are available; the product and dosage depend on the test results as well as digestion and kidney issues.

Calcium, Bones, and the Risks of Fracture

Digestion of some forms of calcium requires stomach acid. Some studies show an increased risk of fractures from PPI use, especially in older populations with comorbid risk factors of low body weight, low mobility, smoking, and/or alcohol use, as well as in those who have low levels of vitamin D and who have previously fractured.

These studies confirm an association but do not show that PPIs directly cause every fracture. For some older adults, continued PPI treatment may be important to manage serious reflux or reduce ulcer risk. Severe, unexplained symptoms and/or bleeding can occur if a PPI is stopped.

Families should protect bones by ensuring that older adults have bone-density assessments, review their levels of vitamin D and calcium in their diet, as well as review their falls risk, ensure that they are engaging in walking and/or resistance exercise, and ensure that their vision is protected from falls. A well-balanced diet can provide the body with all the calcium you need, with different types of calcium found in milk, curd, paneer, tofu, leafy vegetables, and fortified foods based on tolerance and under the advice of a health practitioner.

Different forms of calcium supplements can be used; however, careful consideration must be made on the form of calcium as some need acid for absorption. Calcium carbonate should be taken with food as it relies more on normal functioning of the stomach, thus more on stomach acid. Calcium citrate has different absorption and is often recommended for those with lower stomach acid; however, the decision should still be made by a health practitioner. Constipation, kidney disease, and the interaction of other medicines, such as thyroid medicines and iron, must also be considered when deciding on the treatment.

Kidney Health and Long-Term PPI Use

The trade-off with kidney health must be considered in older adults as declining kidney health is often silent and progressive with aging.

There are established connections between several types of kidney problems and long-term PPI use, often resulting in acute interstitial nephritis, a type of kidney inflammation. There are also some reported cases of PPI use leading to chronic kidney disease, though causation in these cases is unclear and original disease, dehydration, diabetes, hypertension, and other drugs and chemicals may be a factor in kidney disease.

Symptoms of acute kidney inflammation include reduced urination, fatigue, nausea, fever, skin rash, and swelling. Some people may show few or no symptoms. Creatinine levels in blood showing a sudden change may be the first indication to healthcare providers.

Your family’s doctor should suggest a regular kidney function test if your parent has diabetes, chronic kidney disease, dehydration, frequent hospital stays, or uses many prescription drugs, frequent hospital stays, and especially if he or she is on many prescription drugs.

Low Magnesium and Other Antacid Considerations

Long-term PPI use may lead to low magnesium levels, though it is rare. Low levels may cause muscle tremors, confusion, seizures, and changes in heart rhythm. It is a serious concern when a person is taking diuretics or other medications that affect electrolyte levels.

Antacids have their own issues when used long-term. Loose stools, especially in kidney failure, may be caused by the use of magnesium-based antacids. Constipation may be caused by the use of aluminum-based antacids. Calcium-based antacids, in general, may worsen constipation and increase the risk of kidney stone formation in people with chronic kidney disease.

Maintain a list of all products, even nonprescribed antacids, such as powders, chewable, and tablet forms. Many families bring up prescriptions during appointments, but forget to mention products used for acidity.

Things to Consider When Reviewing Daily Use

Record the name of the medicine, its strength, the dose, the timing, and the reason for its use. Record whether the symptoms return if a dose is missed. Record nighttime symptoms, difficulty swallowing, vomiting, weight loss, black stools, and chest discomfort. Request a medication review from your doctor or pharmacist. Ask the following:

• Does the original reason for this treatment still exist?
• Has the current dose and the scheduling of the treatment been adequate?
• Does the older adult require a test of B12, magnesium, or calcium levels; a test of renal function?
• Is one or more of the other treatments that the older adult is taking increasing the risk of ulcers or contributing to renal insufficiency?
• Is there a reason to consider a low-dose, short-duration treatment or a gradual, controlled decrease of the treatment?

PPIs are usually best reduced in a planned fashion rather than abruptly discontinued. Stopping a PPI abruptly can lead to rebound acid production and an increase in symptoms. Depending on the diagnosis, a clinician may adjust the dose of the therapy, change the timing of the dose of the therapy, or provide an alternative therapy.

Daily Tips for Safe Reflux Management

Loosen the belt and eat smaller meals on a regular basis. Encourage them to remain in an upright position post-meal and discourage them from lying down for a few hours following a meal. Reflux at night may benefit from an elevated head of the bed. Monitor the personal triggers rather than eliminating all foods. Consider large, fatty meals, tobacco, alcohol, peppermint, coffee, and spicy foods.

Symptoms may become more bothersome due to changes in weight, constipation, poor sleep, and tight clothing around the waist. Easier relief may be achieved by eating small meals and avoiding excessive food. Gentle movements after meals, establishing regular bowel movements, and adequate hydration are all helpful solutions, so long as they do not stress the person's heart or kidneys.

To purchase a natural anti-acidity product, families may consider AGEasy Acidity Calm. You must review the list of ingredients and the instructions prior to use. It should be considered a complementary therapy and should not take the place of more frequent evaluations for persistent symptoms.

When Should Symptoms Be a Medical Concern?

There are certain symptoms that require an immediate trip to the hospital, such as severe vomiting, blood found in vomit or stool, unexplained weight loss, persistent chest pain, fainting, or if you feel extremely weak. If your parents have chest discomfort and feel dizzy with nausea or pain in your back, arm, or jaw, you should seek emergency care. These symptoms may mimic having a heart attack.

Long-term use of an antacid may not be harmful, but the long-term use of an antacid may not be necessary either. The safest approach will require a clear medical reason, implementation of the lowest required dose, regular assessments, and a focus on nutrition. Caregivers must keep track of the symptoms and ask for reassessment when treatment is provided every month.

Disclaimer

This article is a resource for caregivers. It is not a replacement for diagnosis, treatment, or advice from a physician, dietitian, or pharmacist. Care is needed for symptoms that are severe, sudden, or worsening.