A doctor has warned that taking a common medication for longer than six months can lead to a number of concerning side effects
A medical expert has raised concerns about anyone taking a widely used medication and the potential risks that may develop from prolonged usage. Across the UK, omeprazole – a proton pump inhibitor commonly known as a PPI – is extensively prescribed and can be purchased both on prescription and from pharmacies without a doctor’s note.
Latest figures reveal that 73 million NHS prescriptions for proton pump inhibitors were dispensed in England during 2022-2023, with omeprazole ranking among the most commonly prescribed medications in this category. The drug is primarily used to tackle problems like heartburn and acid reflux, reports the Mirror.
The NHS explains: “Omeprazole is a medicine that reduces the amount of acid in your stomach. It’s used to treat conditions such as heartburn. You can buy some types from pharmacies and shops, but most types are only available with a prescription.” Typical side effects of omeprazole include headaches, abdominal discomfort, nausea or vomiting, constipation or diarrhoea, and increased flatulence.
‘Long term use’ of any medicine generally means consuming a drug for three months or more, though the precise duration can vary considerably depending on the specific medication and the ailment being treated. For omeprazole, long-term usage usually commences following the standard four to eight-week treatment course for indigestion.
Various research studies regard six months as a benchmark timeframe. However, when it comes to over-the-counter (OTC) omeprazole, long-term use is defined as exceeding 14 days without consulting a doctor. On the other hand, prescription omeprazole is prescribed for conditions such as Barrett’s oesophagus and Zollinger-Ellison syndrome, which may necessitate extended treatment under medical supervision.
Either way, British private GP Dr Ahmed, MBBS, MRCGP, is urging people who are taking the medication for six months or longer to be aware of the risks – including gut infections, bone fractures, kidney damage and more. In a video on TikTok, the doctor said: “I saw a patient today who’s been taking this one medication for the last eight years that’s meant to be used short term – and that’s not even the crazy part. I bet the vast majority of you have even been prescribed or are currently taking his medication.
“This is medication everyone seems to be on, and some people for many years, and it’s not right because it has many side effects and shouldn’t be taken long term. This medication is a omeprazole, a lanzoprazole, or any anti-acid for reflux.
“So, this is the common story: you come in to see a doctor because you’ve got heartburn or acid reflux. We will examine you, check your bloods, check your stool for H pylori or a blood test H pylori, and so they all come back normal or even if the H pylori comes back positive. Everyone seems to get started on omeprazole or lanzoprazole… patient is stuck on them for many months or even years.”
He went on: “But, here’s the crazy thing. Long-term use of omeprazole has many, many side effects. For example, if you use it for three months or more, your magnesium levels will become low, making you feel tired, which can cause bone problems and heart problems. In six months to a year, your potassium may go low, and your B12 may become low. Chronic low B12 can cause things like pins and needles and nerve damage.
“And any longer than a year, you’re at risk of bone fractures. The thing is, our stomachs are meant to be acidic; therefore, omeprazole and all the other PPIs essentially neutralise our stomachs to try and control the symptoms of heartburn and reflux. Heartburn and reflux are just symptoms of an underlying cause, which you need to get investigated for”.
“If you’ve been taking omeprazole for months or even years, you need to go to your doctor and ask why you’ve been on it for so long. Generally speaking, things like ulcers, bacterial or fungal overgrowth, lower oesophageal sphincter dysfunction, oesophageal muscle dysmotility need to be ruled out, just to name a few.”
1. Increased risk of digestive infections
Extended use of omeprazole can heighten your chances of developing gut infections, such as Clostridium difficile (C. diff) and other problems in the intestines. This heightened risk is associated with long-term use and primarily results from omeprazole’s ability to alter the gut microbiome by reducing beneficial bacteria and diminishing the gastric acid barrier, thereby fostering an environment conducive to the proliferation of harmful microbes. For more information about C. diff, you can visit the NHS website.
Omeprazole, a proton pump inhibitor (PPI), reduces stomach acid levels, leading to alterations in the gut’s bacterial composition. This can diminish the number of beneficial bacteria and create an imbalance, making the digestive system more vulnerable to infections.
Watch out for severe diarrhoea or stomach pain whilst taking omeprazole. Use omeprazole and other PPIs only when necessary and for the shortest duration possible. If you’re concerned about your use of omeprazole and C. diff, consult your doctor to determine the best treatment plan for your situation.
2. Increased risk of kidney damage
Extended use of omeprazole can heighten the risk of kidney damage, including acute interstitial nephritis (AIN) and chronic kidney disease (CKD). Studies have indicated that there may be a higher probability of developing CKD and potentially progressing to end-stage renal disease with prolonged PPI usage.
It’s advisable to limit PPI use to the minimum duration required. Any patients receiving long-term treatment should be monitored by their GP for potential kidney problems. Research has suggested that omeprazole could cause cell death in kidney tubular cells, which is linked to kidney disease.
If you’re currently using omeprazole, discuss these potential risks with your doctor. If you notice any changes in urinary function, contact your doctor immediately. Enquire about non-drug methods or alternative treatments, such as histamine H2 blockers, to ease acid reflux symptoms. Without medical advice, refrain from using over-the-counter PPIs for longer than the recommended 14-day period.
3. Increased risk of bone fractures
Omeprazole may heighten the risk of bone fractures, particularly in older patients, when taken in high doses or for extended periods, especially beyond a year. Studies suggest a slight increase in the probability of hip, wrist, and spine fractures.
While the exact process isn’t yet fully understood, one theory suggests that omeprazole might interfere with calcium absorption. Some research has drawn a connection between long-term use of omeprazole and decreased bone mineral density.
Patients on this medication should discuss the associated risks and potential benefits with their doctor. Assess your risk and determine whether the benefits of the medication outweigh the possible hazards. Your doctor might suggest taking calcium and vitamin D supplements to maintain bone density, but this should be done under their guidance.
4. Increased risk of nutrient absorption problems
Omeprazole can reduce stomach acid levels, which can affect nutrient absorption. An adequately acidic stomach is crucial for the proper absorption of several essential nutrients, such as vitamins B12 and C.
Long-term use of omeprazole is linked with decreased absorption of vitamin B12, vitamin C, and minerals like calcium and magnesium, which could lead to deficiencies. Extended use of omeprazole increases the risk of these deficiencies, making it vital for patients undergoing long-term treatment to monitor their nutritional intake and consider supplementation.
The risk of nutrient deficiencies escalates with prolonged use of omeprazole. Anyone on this medication should be aware of the potential for vitamin and mineral deficiencies, and it may be recommended to supplement these nutrients.
Who can and cannot take omeprazole
The NHS says: “Most adults and children can take omeprazole. But the tablets you can buy from pharmacies and shops without a prescription are only for adults over 18 years old. Omeprazole is not suitable for some people”. For example, it may not be suitable if:
- you’ve had an allergic reaction or serious side effect from omeprazole or another proton pump inhibitor (PPI) medicine that reduces stomach acid
- you have a kidney or liver condition
- you have osteoporosis (weakened bones)
Before starting omeprazole, inform your doctor or pharmacist about any medical conditions you have. Omeprazole may also influence the outcomes of certain tests, such as blood tests, screenings for specific types of tumours, and examinations of your oesophagus and stomach (gastroscopy). If you are scheduled for a test, you might need to discontinue omeprazole for several days or weeks prior to the test. Consult with the personnel at the hospital or clinic conducting the test.
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