Tag Archives: proton pump inhibitors

Acid Reflux Drugs Tied to Higher Kidney Disease Risk

An analysis of an FDA side effects database has found that taking proton pump inhibitor (PPI) drugs such as Prilosec (omeprazole) and Nexium (esomeprazole), used to treat acid reflux, is associated with an increased risk of kidney disease.

Researchers examined data from the FDA Adverse Event Reporting System (FAERS) database. They narrowed their study to reports on 43,000 people who took a PPI and no other medications and 8,000 people who took histamine-2 receptor antagonists (H2 antagonists), another class of acid-reducing drugs that includes Pepcid (famotidine) and Zantac (ranitidine).

Results, published in Scientific Reports, found that those who took only PPIs were 28.4 times more likely to have chronic kidney disease, 35.5 times more likely to report end-stage renal disease and 4.2 times more likely to have acute kidney disease compared to those on H2 antagonists.

“Although [H2 antagonists] have not been shown to be as effective as PPIs, they might be considered as alternatives for patients who are at high risk for developing renal and electrolytes imbalances,” the researchers concluded.

A 2017 study also found that long-term use of PPIs can lead to kidney damage.

3 Super Bowl-Watching Health Tips

When you think of the Super Bowl, concerns about health usually don’t come to mind. But with hundreds of millions of people watching the big game from home and doing a considerable amount of eating and drinking during it, it’s important to keep in mind that overindulging can potentially lead to some health problems, albeit short-term ones. Here are some tips to enjoying the Patriots-Rams matchup this weekend without any health hazards.

Keep Bacteria Away From Your Food

In the US, Super Bowl Sunday is the second-largest food consumption day of the year. Chicken wings are synonymous with football games, and more than 1.25 billion of them were eaten over the 2014 Super Bowl weekend, according to the National Chicken Council. Whenever handling raw food, there is a risk of bacterial contamination. If you are cooking up your own wings – or any other food – be sure to wash your hands with soap and warm water for at least 20 seconds both before and after handling the food. Also, do not allow raw or uncooked food to come in contact with cooked foods, as this can lead to food poisoning . Use separate plates and utensils for raw and cooked foods.

If you are cooking wings, foodsafety.gov says the frying oil should be at 375 degrees F before putting in the wings, and they should be cooked to an internal temperature of 165 degrees. Also, make sure not to put too many wings in the fryer at one time, as doing so can lead to some being undercooked.

If you have an array of food items out, it’s important that hot foods have a heat source to keep them hot and cold ones are on ice. Perishable foods should be kept out for two hours max. After that, throw them out.

You’ve Got Heartburn and Indigestion

Chowing down during the game is as much a part of the Super Bowl as the halftime show and the commercials. But overindulging can lead to discomfort and even a stomach ache in your gut. To avoid this, try to pace yourself so you don’t overeat. Of course, this is easier said than done, so if you find yourself with heartburn or indigestion, you might head to your bathroom for some Tums, Mylanta or Nexium.

Tums and Mylanta are antacids and work to neutralize acids in your stomach. Nexium (esomeprazole) is known as a proton-pump inhibitor (PPI), and works by cutting down acid production in the stomach. You should know that routine use of PPIs has been linked to a higher risk of death compared to another class of acid reducers known as H2 blockers, such as Zantac (ranitidine). Long-term PPI use has also been linked to kidney damage and weakened bones.

If you’d like to get rid of heartburn without turning to medication, there are a few natural options. Baking soda mixed with water can help neutralize stomach acid. Eating a little bit of ginger may also help, though avoid drinking ginger ale as carbonated drinks can actually make the problem worse. Diluting a bit of apple cider vinegar in water might do the trick, and some people say that licorice root can also help.

Go Easy on the Alcohol

Drinking beer during the game is a popular pastime, reinforced by the slew of beer ads shown during commercial breaks. As the game lasts about three hours (or more, if there is overtime!), that’s a long time for drinking. Although you might be persuaded to drink throughout the game, don’t. Not only might it lead to a hangover the next day, all that alcohol can seriously tax your liver — and beer has a lot of calories anyway.

If you insist on drinking a lot, have a glass of water with or after each alcoholic beverage. That’s because alcohol is a diuretic and removes water from your blood through urine. This can lead to dehydration, which contributes to a hangover. Also, don’t drink on an empty stomach. Having some food in your stomach will slow the absorption of alcohol into your bloodstream – but it still can’t prevent you from getting drunk if you drink too much too quickly.

Many Medications Taken Longer Than Recommended

Many people continue to take prescription drugs months after clinical guidelines recommend, a practice that increases the risk of side effects from individual drugs as well as from drug interactions.

New research examines the issue of legacy prescribing, which is when drugs are taken for longer than needed to treat a condition. A new study, published in the Annals of Family Medicine, examined 50,000 patients in Canada who were prescribed drugs that are typically taken for more than three months but not indefinitely. The drug classes were antidepressants; proton-pump inhibitors (PPIs), which are used to treat heartburn and acid reflux; and bisphosphonates, which treat osteoporosis by stemming bone density loss.

Nearly half of patients on an antidepressant – 46% – were on it for more than 15 months, even though a current recommendation states they should be prescribed it for only six months after a mood episode is resolved. PPIs shouldn’t be taken for longer than three months. However, 45% of patients were prescribed them for longer than 15 months. The recommendation for bisphosphonate prescriptions is 5.5 years, yet 14% of people on those drugs took them for at least six months longer than that.

For example, long-term use of PPIs has been linked to several health issues. In one study, patients who had taken the drugs for at least five years had a higher risk of developing kidney disease than those on another type of acid-reducing medication. Another study found long-term PPI use may be associated with an increased risk for stomach cancer.

Quick Hits: Antibiotics and Childhood Obesity, Alternative Therapies Don’t Cure Cancer & More

Children that are given antibiotics before the age of two are more likely to become obese in childhood, according to a new study. Researchers looked at the medical records of more than 333,000 toddlers. Those that were given an antibiotic by the time they were two years old were 26% more likely to eventually be diagnosed with childhood obesity. The risk increased the more antibiotic prescriptions a child received and the more classes of antibiotics that were prescribed. The study also found that infants given acid-reducing medications also had a higher likelihood of obesity, though the increased risk was only about 2%. The researchers said that antibiotics and acid-reducing medications can kill bacteria in the gut involved in regulating body weight. Posted October 30, 2018. Via Gut.

Nearly four out of 10 Americans incorrectly believe that cancer can be cured through alternative therapies alone, even though studies have shown this is not the case. A survey, commissioned by the American Society of Clinical Oncology (ASCO), found that younger people (18-53 years old) are more likely to believe in alternative medicine as a cancer cure, and 22% of people who have or had cancer do as well. Some of these alternative therapies include supplements, changes in diet and oxygen or enzyme therapy. However, a study published last year found that cancer patients who relied on alternative therapies alone were 2.5 times more likely to die than those who received standard cancer treatment, such as chemotherapy, radiation or surgery. Another study published this year found that patients with one of four types of cancer who used alternative treatment were twice as likely to die as those that used conventional treatment. Posted October 30, 2018. Via ASCO.

About three out of four doctors have received some type of benefit, such as free drug samples, free meals or payments as consultants, from drug companies. A national survey of 700 doctors found that drug samples were the most common benefit. About half of the physicians surveyed said they received a meal or beverages in their office courtesy of a pharmaceutical company. Only 4% reported receiving money for consulting work. The team that conducted the study said that receiving drug samples is linked to doctors prescribing more expensive, brand-name drugs rather than cheaper generic drugs. They also noted that compared to a national physician survey conducted in 2009, fewer doctors reported receiving pharmaceutical industry benefits. Posted October 18, 2018. Via Dartmouth Institute for Health Policy and Clinical Practice.

4 Drugs That Interact with Anxiety Meds

If you suffer from anxiety, panic disorder or insomnia, your doctor may have prescribed you a tranquilizer belonging to a class of drugs known as benzodiazepines.

Drugs such as Xanax (alprazolam), Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam) are some of the most-prescribed medicines – more than 133.4 million such prescriptions were filled in the US in 2014. As with any medication, drug interactions can occur if you take a benzo with another medication, and in certain cases, may be life-threatening.

With benzos, there are 2 areas of concern. The first is that interactions might increase the effects of the drug, which can result in oversedation, accidents and/or overdose. The second is that interactions could decrease the amount of a benzo in the bloodstream of a patient who has been on the drug for a long time, which can result in withdrawal symptoms, the most severe being seizures and death. Here are 4 drug classes that can have dangerous interactions with benzodiazepines.

1. Opioids

Opioids such as OxyContin (oxycodone), morphine, and Vicodin (hydrocodone) are painkillers. Katy LaLone, MD, a consulting psychiatrist with A Resilient Space Psychiatry Consultants in Cleveland, says combining benzos with “other sedative medications, especially opioids, can cause cardiorespiratory depression,” putting patients at risk of overdose and death. In fact, 75% of benzodiazepine-related deaths also involve an opioid. This combination is so dangerous that the FDA issued a black box warning in 2016 about prescribing the 2 drug classes together.

Dr. LaLone has even seen overdoses in patients who are on stable doses of the two drugs after developing a “compromised cardiorespiratory status, such as the flu or undiagnosed sleep apnea.” She adds, “overdose is almost always accidental.”

2. Insomnia drugs

Prescription drugs that treat insomnia, known as “Z-drugs” have a mechanism of action similar to benzos. These drugs include Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon). Dr. LaLone sees the combination of benzos and Ambien quite frequently in her clinical practice, usually in patients receiving prescriptions from more than one doctor. Patients are often prescribed benzodiazepines for anxiety and a “Z-drug” for insomnia, not realizing the drugs are similar in action.

She notes this “dangerous combination can cause amnestic episodes (blackout spells),” and she almost never prescribes the 2 drug classes together except in special cases. A 2017 study looking at emergency room visits for adverse events from benzos and/or “Z-drugs” found that the combination of the 2 drug classes led to a 4-fold risk for serious outcomes.

3. Proton Pump Inhibitors (PPIs)

These drugs, such as Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), and Protonix (pantoprazole), are used to treat acid reflux. They can increase blood levels of benzodiazepines by interacting with the same liver enzymes that clear them from the body. This can result in worsening side effects of benzodiazepines including confusion, sedation, dizziness, falls and impaired driving.

The most common offenders are Prilosec and Nexium. Mary Hall, a retiree living in North Carolina, was prescribed Prilosec by her doctor while taking clonazepam. She said, “The clonazepam started to build up, and I started feeling stoned like I was taking more doses of a benzo. I actually had to skip my night dose of the clonazepam and stop taking the Prilosec after three days.” She also developed a “horrible headache” that lasted for several days. She notified her doctor, and he was unaware of the potential interaction.

‘After the first dose of cipro, my heart started beating super fast, I felt really dizzy and had to hold onto the walls for balance. The world was spinning, and I was very shaky’

4. Fluoroquinolone Antibiotics

Fluoroquinolones include Cipro (ciprofloxacin), Levaquin (levofloxacin), and Avelox (moxifloxacin). They compete for the same binding site as benzodiazepines, which means 1 drug blocks the effect of the other. In this case, the fluoroquinolones block the benzodiazepine leading to acute withdrawal in those who are dependent on the benzo. There have been reports in medical literature and online communities of long-term benzodiazepine patients experiencing withdrawal symptoms after taking these antibiotics.

Kristie Walker, a former medical office biller who now lives in Florida, learned about the interaction firsthand after being prescribed ciprofloxacin for a urinary tract infection. She had been taking Xanax for around 15 years. “After the first dose of cipro, my heart started beating super fast, I felt really dizzy and had to hold onto the walls for balance. The world was spinning, and I was very shaky” she says. She informed her doctor of her symptoms and stopped taking the ciprofloxacin after 2 days.

At that point she was profoundly ill. Her heart rate went up to 200 beats per minute just walking from room to room, she was unable to eat due to severe nausea, and she was ultimately hospitalized. Her symptoms were so severe she contemplated suicide. “I thought I was going to die”, she says. After Walker began to research her symptoms online, she found an article on the interaction between benzos and fluoroquinolones and realized the antibiotic had caused her to have acute benzodiazepine withdrawal.

How to Avoid Dangerous Interactions?

There are numerous ways you can protect yourself from dangerous drug interactions involving benzos. Dr. LaLone recommends that you only take medications that are prescribed to you, and take them only as prescribed. Second, obtain your prescriptions from 1 physician and pharmacy, and have regular doctor visits to assess your medication regimen. Third, exercise caution with use of other sedating medications, especially opioids. And finally, inform your doctor of all medications you are taking, including over-the-counter medications and supplements.

It is also important to know that if you are considering stopping a benzo after being on it for a long time, it should be tapered to avoid the risk of severe withdrawal, which can result in seizures and even death.

How Herbs Can Help You Get Off Acid Reflux Drugs

When Rocky Angelucci first went on Prilosec for his acid reflux, he considered it “a miracle drug,” wiping out his sore throat and other symptoms. But over the next decade, whenever he tried to go off the drug, he’d feel even worse than before he started taking it.

“I felt horrible burning, choking reflux,” says Angelucci, 53, a technical writer and author in Texas. “It felt like I had swallowed a potato and it was stuck halfway down, along with burning acidity.”

Angelucci finally was able to quit Prilosec (omeprazole) — one of the most popular over-the-counter (OTC) drugs for acid reflux — for good 8 years ago. What made the difference? First, he radically changed his diet, cutting grains, white sugar and processed foods. Second, to get through the rebound reflux stage, he used herbal remedies, including licorice chews and apple cider vinegar.

Now, he says, reflux is “a distant memory.”

Side Effects Associated With Long-Term PPI Use

Millions of Americans take medications such as Prilosec and Nexium (esomeprazole) – which are proton pump inhibitors (PPIs) that work by suppressing stomach acid. Long-term use of PPIs has been associated in recent years with conditions such as osteoporosisstomach and other infections, kidney problems and heart disease, among others.

Some patients may need to get off PPIs due to having precancerous changes to the esophagus or other serious conditions, experts say. Many who want to try getting off PPIs often find that rebound hyperacidity makes this challenging. A 2006 study showed only 27% of long-term users who tried to stop PPIs were successful.

One way PPI users can more easily wean off the drug is to use herbal medicine, say integrative medicine specialists.

“Herbs and supplements have some mechanisms of action on the esophagus and stomach that’s a little different than pharmaceuticals,” says David Kiefer, MD, a family physician trained in integrative medicine and clinical assistant professor at the University of Wisconsin Department of Family Medicine and Community Health.

Herbs Ease Inflammation, Coat Tissue on GI Tract

Some herbs can ease inflammation on the surface of the gastrointestinal (GI) tract, Kiefer says. These anti-inflammatory herbs include chamomile tea and licorice root (specifically, the deglycyrrhizinated type, also referred to as DGL).

Other herbs work to coat the tissue in the esophagus and stomach, Kiefer says. These include slippery elm root bark and marshmallow root, which come in powdered form that can be mixed with water. “They make kind of a slurry which goes down and coats whatever it touches — the back of your throat, your esophagus, your stomach,” says Kiefer.

Another coating type of herb, says Kiefer, is aloe vera gel — the type formulated for upper GI tract problems, not the kind you get in a bottle in your store’s sunburn section.

Besides these herbs, Kiefer recommends melatonin, which studies have found may be as effective as Prilosec at reducing GERD (gastroesophageal reflux disease) symptoms.

David Rakel, MD, professor and chair in the Department of Family and Community Medicine at the University of New Mexico, adds Iberogast to the list of natural products that can help people get off PPIs. Iberogast is the brand name of a compound comprised of 9 herbs; studies show it’s effective in relieving gastric regurgitation and other symptoms.

How to Use Herbals to Transition Off PPIs?

Rakel says the key is to set expectations. “I say, ‘Hey, this is one of those things where you’re going to get worse before you’ll feel better, but if you can hang in there for 1-1/2 to 2 weeks, that hyperacidity rebound effect should go away.’”

Rakel says it’s important for patients to taper off PPIs slowly, first cutting the dose, if possible, and then taking it every other day. He usually recommends patients stay with one herbal remedy while weaning off PPIs.

Kiefer, on the other hand, says patients can combine herbs. He suggests using anti-inflammatories such as chamomile or DGL plus melatonin during the medication tapering process. Once the PPI is gone, herbs that act to coat the GI tract (such as aloe vera or marshmallow root) can be added, he says. (These can interfere with the absorption of medication, so should be taken at least an hour before or after taking any pills.)

Becky Fishman used a process like this to finally get off PPIs after a dozen years. She says her doctor hadn’t explained how, but her father – also a reflux sufferer — helped her work out a Nexium step-down plan. The 46-year-old North Carolina medical writer used DGL lozenges and aloe vera to help alleviate symptoms during her transition. Some mild reflux symptoms remained, though, which she then mostly eliminated by cutting back on carbs.

Indeed, say Rakel and Kiefer, changing what you eat can also help avoid reflux symptoms, whether it’s avoiding trigger foods or eating less to lose weight. Other non-herbal remedies they advise include acupuncture, stress management (mindfulness and meditation, for instance) and lifestyle changes, such as exercising.

What If Acid Reflux Symptoms Return?

If you are off your medication for a few weeks and your reflux symptoms have come burning back, Rakel and Kiefer say patients should be evaluated to see why. Some patients may have hiatal hernias or precancerous changes to the esophagus, for example, which may mean they need to go back on acid-blocking medication or explore other treatments.

What Kiefer and Rakel won’t do is recommend you stay on a regular regimen of herbs to fight reflux. If you have occasional mild heartburn, you can take an herbal remedy, they say, but if your problem is severe and ongoing, you want to find out what the cause is – not just mask its symptoms.

“I would be doing a disservice if I just swapped out a drug for an herb,” says Kiefer.

Angelucci says he decided to go off his PPI because he didn’t want to be on a drug for the rest of his life; he wanted to see if he could address the reason for his symptoms. In his case, it turned out to be his diet, he says.

“Dietary changes were my root cause,” he says. “But the supplements were a dramatic help during that really difficult roller-coaster period.”

Diet Change More Effective Than Meds for Acid Reflux

If you suffer from acid reflux and turn to medication for relief, new research indicates that a change in diet is more effective in reducing that burning sensation than drugs, but without the side effects.

People with laryngopharyngeal reflux – acid that travels up the esophagus to reach the throat – that closely followed a Mediterranean diet saw a better improvement in reflux symptoms than those who were taking proton-pump inhibitors (PPIs), a common class of medication used for acid reflux, according to a new study published in JAMA Otolaryngology-Head & Neck Surgery.

PPIs are available over-the-counter and by prescription, and are also extensively used to treat gastroesophageal reflux disease (GERD). Some of the most popular ones are Nexium (esomeprazole), Prilosec (omeprazole) and Prevacid (lansoprazole).

The Mediterranean diet is plant and whole foods-based, and focuses on eating fruits, vegetables, grains and nuts. Dairy and animal products – such as beef, chicken and pork — are largely cut out. If you have acid reflux, you should also avoid alcohol, coffee, tea, carbonated drinks and greasy, fatty and fried foods.

Researchers enrolled 184 people with laryngopharyngeal reflux. Participants either received a PPI and standard advice to reduce reflux or were treated with a 90% plant-based, Mediterranean diet, alkaline water and standard advice.

About 63% of those on the Mediterranean diet achieved a meaningful reduction in reflux symptoms, compared to 54% who took a PPI, results showed. The average reduction in the Reflux Symptom Index for those who changed their diet was 40%. For those who took a PPI, it was 27%.

The study’s lead author, Craig H. Zalvan, MD, medical director of The Institute for Voice and Swallowing Disorders at Phelps Memorial Hospital in Sleepy Hollow, NY, used to be one of the biggest prescribers of PPIs in the area. But he thought there had to be a better treatment for reflux and through research, developed a plant-based diet for some of his patients.

“Although effective in some patients, I felt medication couldn’t be the only method to treat reflux and recent studies reporting increased rates of stroke and heart attack, dementia and kidney damage from prolonged PPI use made me more certain,” Zalvan said in a statement. “The results we found show we are heading in the right direction to treating reflux without medication.”

A study earlier this year found that people taking PPIs for at least 5 years had a higher risk of developing kidney disease and kidney injury than those taking H2 blockers, such as Pepcid (famotidine) and Zantac (ranitidine). And a study released in 2016 found that those who regularly take PPIs are more likely to see their bones weaken than those who weren’t taking the drugs.

Use of PPIs over long periods of time has also been associated with pneumonia, fractures of the hip, wrist and spine, and iron and vitamin B12 deficiencies, according to the FDA.

Overprescribing: Do You Really Need to Take That Med?

Do you take 4 pills a day? If so, you’re like most Americans. Yet what are we taking all these pills for, and are they improving our lives?

The overuse of prescription drugs has become a serious problem in the US. We hear about this most in the context of opioids — narcotic painkillers whose widespread use and abuse has become a national crisis.

The overuse of antibiotics has also become the focus of an intensive campaign to steer doctors and patients to more judicious use.

The soaring use of prescription drugs has been driven by several factors: A plethora of new drugs coming to the market; a culture that has come to expect a “pill for every ill”; aggressive marketing to both doctors and consumers by the pharmaceutical industry; and treating some “pre-”diseases with pills rather than with lifestyle changes.

Between 1997 and 2016, the number of prescriptions filled in the US increased 85% — from 2.4 billion to 4.5 billion — even though the population increased by just 21%. Nearly half (49%) of adults take at least 1 prescription drug, 23% take 3 or more and about 12% take 5 or more, according to the latest data from the CDC (Centers for Disease Control and Prevention). One in 10 adults takes 10 or more drugs, and the average adult takes 4 prescription medications, according to a Consumer Reports survey of 1,947 adults conducted in April.

What can you do to make sure you’re not getting a drug you don’t need and to avoid harm?

Ten “secret shoppers” were sent to 45 drugstores across the US in a recent Consumer Reports investigative study. The shoppers were testing how well pharmacists identified potential problems with drugs.

Of course, it’s your doctor who should be your main consultant on the medicines you take. But bring a big measure of skepticism to your doctor visits: The evidence is now clear that they can be a part of the problem.

Based on the secret shoppers’ findings and more than a decade of Consumer Reports’ grant-funded Best Buy Drugs program, we have compiled a list of drugs that you should use special caution with when prescribed by your healthcare provider.

(For more detailed information, check out Consumer Reports’ September 2017 cover story and the physician-led Choosing Wisely program.

Abilify and Seroquel for Dementia or ADHD

These powerful antipsychotics have potent sedative effects and can be downright dangerous. Studies over the last decade show they have been overprescribed in general and particularly for elderly people with dementia.

The FDA and other healthcare and physician organizations now advise against their use entirely in elderly people. Multiple studies over many years have found an increased risk of death in elderly people prescribed these drugs.

Abilify (aripiprazole) and Seroquel (quetiapine) are also overprescribed to treat children and adults with attention-deficit/hyperactivity disorder (ADHD). The two drugs are not even approved for this condition. Their use to treat ADHD is not advisable unless a person is diagnosed with other psychiatric conditions, such as bipolar disorder. And even then, caution is warranted. Behavioral therapy is a better initial treatment for ADHD.

Advil, Aleve, Celebrex and Any Opioid for Back and/or Joint Pain

The non-steroidal anti-inflammatory drugs (NSAIDs) Advil (ibuprofen), Aleve (naproxen) and Celebrex (celecoxib) are commonly prescribed to treat back and joint pain (and headaches, of course). Short-term use — up to 10 days — is fine at the lowest dose that helps.

But long-term use — which is all too common — is ill-advised because all these drugs can cause bleeding in the intestines and stomach, and increase the risk of heart attack and stroke (especially at higher doses).

Opioids should simply never be a first-line treatment for either chronic back pain or garden-variety periodic back pain (“I threw my back out” kind of pain). The risks are too high. The side effects include drowsiness, sedation, nausea, vomiting, constipation, addiction and overdose. Instead, try yoga, swimming, gentle stretches, tai chi, massage, physical therapy, acupuncture or heat.

For intense pain flare-ups (pain in the range of 8 to 10 on a 10-point scale), an opioid can be useful, but it should be prescribed at the lowest dose that’s effective and for the shortest time possible, like a day or 2. And never more than a week to 10 days.

Celexa, Cymbalta, Lexapro and Prozac for Mild Depression

Antidepressants are overprescribed for people who have mild or so-called “situational” depression — that is, depression triggered by a life event such as a death in the family, job loss, divorce or breakup, accident, trauma or diagnosis with a serious health condition.

You don’t need a pill if these life events befall you. Social support, time and psychotherapy or counseling almost always help. Also, be sure to exercise and perhaps try meditation and/or yoga. For the vast majority of people who have situational depression, the symptoms lift within a few weeks to a couple months.

Nexium, Prevacid and Prilosec for Heartburn

These drugs, called proton-pump inhibitors (PPIs), reduce stomach acid. They were designed to treat a condition called gastroesophageal reflux disease (GERD). But they are greatly overprescribed for common, uncomplicated heartburn, which most of the time can be just as effectively treated with over-the-counter (OTC) products such as Maalox, Pepcid AC, Tums or Zantac 75.

The problem with taking PPIs is that they carry serious risks — a few of which were not fully appreciated until a few years ago. These include a reduction in the body’s ability to absorb certain nutrients and medications, along with an increased risk of gastrointestinal and other infections.

Instead, as a first-line treatment, eat smaller meals, don’t lie down soon after eating, lose excess weight, and avoid acidic or greasy meals that trigger heartburn.

If heartburn occurs twice weekly or more for 4 weeks or longer despite the above diet and lifestyle changes, then you might have damaged your esophagus. Check with your doctor, and if GERD is diagnosed, it would be appropriate to take a PPI for a few months while your esophagus heals.

Ambien, Belsomra and Lunesta for Insomnia

These strong sleeping pills are way overprescribed for people who have insomnia triggered by a life event, as well as for people who have chronic insomnia.

If you find yourself in the first group, try an OTC sleep aid containing an antihistamine, but not for longer than a few days. People with chronic insomnia are not helped in the long term by taking these medicines, recent evidence shows. Instead, try cognitive behavioral therapy (CBT), where a provider teaches you good sleep habits and suggests ways to change your behavior and nighttime habits.

Prescription medicines have significant side effects and risks, including dizziness, next-day drowsiness, impaired driving, dependence, and worsened sleeplessness when you try to stop.

AndroGel, Axiron, Androderm and Aveed for Low Testosterone

Low testosterone (“low T”) is a controversial diagnosis. If you get such a diagnosis and your doctor advises you to take any of these medicines, get a second opinion.

A small percentage of men (usually in their 50s, 60s and 70s) have “low T,” but the manufacturers of these products have sought to create a condition that is not firmly established in medical literature — one marked by low energy and low sex drive due to “low testosterone.”

Don’t buy into it. The drugs can cause blood clots in the legs, sleep apnea, an enlarged prostate and possibly an increased risk of heart attack or stroke.

Instead, talk to your doctor about treating common underlying conditions that can decrease testosterone level, such as diabetes, obesity and aging. Also discuss non-drug ways to boost energy and vitality by exercising, getting enough sleep and couples therapy with your partner.

Actonel, Boniva and Fosamax to Treat Osteopenia (Low Bone Density)

These drugs, called bisphosphonates, are widely prescribed to treat a condition dubbed “pre-osteoporosis.” But there’s scientific controversy about the prevalence and impact of mildly or marginally low bone density, and whether it warrants treatment with these strong medicines.

All have side effects and carry risks, which include diarrhea, nausea, vomiting, heartburn, esophageal irritation and bone, joint or muscle pain. Long-term use has also been linked to an increased risk of fractures of the femur (thigh bone).

Before considering one of these medicines, walk more, quit smoking and try eating more foods high in calcium and vitamin D. If bone density tests show you have full-blown osteoporosis, you should consider one of these medicines. But use caution with long-term use.

Detrol and Oxytrol for “Overactive Bladder”

The sudden or frequent need to pee is frustrating and inconvenient. These medicines, called anticholinergics, are often prescribed even to people who have mild symptoms.

The drugs can cause constipation, blurred vision, dizziness and confusion. So before trying one, cut back on caffeine, soft drinks and alcohol, and watch your liquid intake overall. Also, try bladder training (slowly increasing the time between bathroom visits) and Kegel exercises — repeatedly tightening and relaxing the muscles that stop urine flow. These techniques have been proven effective.

If several weeks or months of non-drug strategies don’t provide enough relief, consider an anticholinergic.

Actos and Glucophage for “Pre-diabetes”

Pre-diabetes is a widely accepted condition (unlike “low T”), but there’s no consensus on how aggressively to treat it, or if people with it should take drugs. People with pre-diabetes have blood glucose (sugar) levels at the high end of normal.

Because these diabetes medicines have side effects and carry risks — including dizziness, fatigue, muscle pain and, in rare cases, the dangerous buildup of lactic acid and a vitamin B12 deficiency — talk to your doctor about non-drug options first, such as exercise, a diet rich in unprocessed and non-starchy foods, and weight loss.

If you develop type 2 diabetes, however, you should consider a diabetes drug.

Drugs to treat Pre-hypertension

Like pre-diabetes, pre-hypertension is an accepted condition that warrants monitoring. It’s defined as blood pressure at the high end of normal. But, also like pre-diabetes, there’s no consensus on when to treat it with drugs.

Many classes of medicines are used. They include ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers and diuretics. All are effective at lowering blood pressure but have side effects. Diuretics can cause frequent urination, low potassium levels and erectile dysfunction. ACE inhibitors and ARBs can cause high potassium levels and reduced kidney function. Calcium channel blockers can cause dizziness, an abnormal heartbeat, flushing, headache, swollen gums and, less often, breathing problems.

Unless a patient has other conditions that make the case for starting a drug, non-drug options are a better initial treatment to bring blood pressure into the normal range. Most important among them: Quit smoking, cut back on sodium and alcohol, lose excess weight, and exercise.

Belviq, Contrave, Qsymia and Xenical for Obesity

These weight loss drgs have mixed effectiveness. They work for some people and not at all for others. For patients who are significantly overweight or have diabetes or heart disease, and have been unable to lose weight through exercise and diet, one of these medicines may be worth trying.

But the drugs should not be a first-line treatment for anyone who is just 10 to 20 pounds overweight and hasn’t yet really tried lifestyle and diet changes. All have side effects that are common and can be quite discomforting. Constipation, diarrhea, nausea and vomiting are common.

The drugs also carry rare but dangerous risks, including leaky heart valves with Belviq and liver damage with Xenical.

Americans are all too often pushed — or rushed — into taking drugs too soon. Sure, lifestyle changes can be hard. But they don’t have side effects and the risks are well defined and easily avoidable. And the payoff from adopting a much healthier diet or sticking to an exercise regimen often goes well beyond addressing the medical condition at hand and improves your overall physical and mental health.

Long-Term Heartburn Med Use May Lead to Kidney Damage

Long-term use of proton-pump inhibitors (PPIs), a class of drugs used to relieve heartburn and damage from acid reflux, may lead to kidney damage.

Researchers looked at the medical records of more than 125,000 people who had taken PPIs for 5 years. Although the patients examined used prescription PPIs such as Nexium, Prevacid and Prilosec, those same drugs are widely available over the counter.

Those on PPIs had a higher risk of developing chronic kidney disease and acute kidney injury compared to patients who had taken H2 blockers, another class of heartburn meds, the researchers reported in the journal Kidney International. H2 blockers include Pepcid and Zantac.

OTC heartburn meds aren’t as strong as their prescription counterparts, nor are they typically taken for as long as the prescription meds.

You can minimize the chances of acid reflux by avoiding fatty foods and overeating, and limiting use of alcohol and tobacco products.

A study published last year found that long-term use of OTC heartburn meds like Nexium can lead to weaker bones.

Natural Ways to Ease Heartburn on Thanksgiving

With its seemingly endless bounty of irresistible dishes, Thanksgiving is undoubtedly one of the tastiest holidays of all. Unfortunately, that can also make it one of the most painful if you overdo it and end up with that dreaded burning sensation in your chest. Heartburn is a symptom of acid reflux, which occurs when the esophagus malfunctions and causes stomach acid to flow into it — and that’s when that fiery feeling sets in. Understandably, the idea of abstaining from all those once-a-year goodies may sound like a form of torture, so how can you have your cake and eat it too?

Though there are several types of medications on the market to treat the condition, some have been linked with serious negative health effects. For example, a study just released this month found that people taking a type of heartburn medication called a proton pump inhibitor – specifically ones with the brand names Prilosec, Protonix, Nexium and Prevacid – had a 21% increase in the risk of suffering a stroke. And this summer, the FDA issued a warning about antacid heartburn meds that contain aspirin, like Alka-Seltzer Original, after receiving numerous reports of consumers being hospitalized with stomach bleeding after taking them.

But don’t let these warnings spook you into doing nothing. Even if you can stand the discomfort, it’s best to seek relief because unchecked heartburn can damage your esophagus. With Turkey Day – and all the yummy treats that come along with it – rapidly approaching, we called on experts to bring you some simple, natural fixes to keep in mind during the holidays or any time. However, if you experience heartburn more than twice a week, you could have GERD (gastroesophageal reflux disease) and should see your doc to be safe.

Prevention first. Before planning for remedies, remember that common saying: Prevention is better than a cure. Fortunately, there are some super-simple steps you can take to help prevent heartburn in the first place.

“First and foremost, not eating late at night is key to decreasing nighttime heartburn symptoms. People should try to not eat within 3 hours of going to sleep,” advises Philip O. Katz, MD, FACG, a clinical professor of medicine at the Sidney Kimmel School of Medicine at Thomas Jefferson University, and chief of gastroenterology and nutrition at Einstein Medical Center in Philadelphia. Other tips: Try to avoid lying down right after eating, eat smaller meals, and eat and drink more slowly. Take closer to 30 minutes to finish your meal rather than 5 or 10 minutes.

Keep your head up. “Some people find a benefit to elevating the head of the bed either by using a 6-inch bed block or a commercial wedge” that goes under the mattress, says Dr. Katz. “It is important to create a 30-degree angle so the shoulders and head are elevated above the waist to allow gravity to aid in the clearance of refluxed acid.”

A study published in 2012 in the Journal of Gastroenterology and Hepatology showed that elevating the head in this way reduced symptoms and improved sleep in patients with acid reflux. There is no need to sleep in a chair or recliner to achieve this, and sleeping on extra pillows typically does not have the same effect. “In fact, it causes a posture change that might increase pressure on the stomach and work against you,” notes Dr. Katz.

Drink up. Let your beverage pull double duty. Dr. Katz suggests drinking a glass of room-temperature water to help clear reflux from the esophagus: “Tepid or warm water tends to relax the esophagus and may increase the speed of symptom relief,” he says. If you want to jazz it up a bit, chamomile tea can help too, particularly in the evening. It may relieve stress, which can lead to improved sleep and decreased nighttime heartburn.

Ginger tea also helps to ease inflammation and improve digestion, according to Taz Bhatia, MD, an integrative health expert and medical director at the Atlanta Center for Holistic and Integrative Medicine. She suggests cutting up a teaspoon of fresh ginger and boiling it in a cup of water. You can add honey to taste if desired. Calcium eases heartburn, too, she says, so another option is a 4-ounce glass of warm milk with a teaspoon of coconut oil, which also aids digestion and calms inflammation.

Pop a piece of gum. “Chewing gum increases the amount of saliva produced, which may neutralize the acidic material refluxed into the esophagus,” explains Dr. Katz. It can also cause more frequent swallowing and clear out the acid from the esophagus more quickly. In a study published in the Journal of Dental Research, scientists at King’s College London found that chewing gum for 30 minutes after a meal reduced reflux in participants who typically suffered from it after eating.

But be aware that “many of the sugar-free products contain sorbitol, which may increase gas and perhaps cause diarrhea if used in excess,” Dr. Katz cautions. If you think this might be an issue for you, be sure to check labels and avoid brands of chewing gum –- and other products, like sugar-free drinks –- that contain sorbitol.

Do be bitter. Substances with a bitter taste are known to ease digestion, and apple cider vinegar fits the bill. “This is a time-tested heartburn remedy that naturally provides lots of great bacteria and enzymes that break down and digest foods,” says Dr. Bhatia. Dr. Katz adds that many patients find that apple cider vinegar improves their digestion by helping to maintain an appropriate acidic pH level in the stomach.

Dr. Bhatia recommends diluting a tablespoon of the sour-bitter brew in 3 to 4 tablespoons of water after eating. “Aloe vera juice also helps heal an irritated gut lining, so this a holiday must to ease heartburn and an overworked digestive system.” She advises taking an ounce of the soothing stuff once or twice daily with meals during the holiday season to prevent heartburn. Baking soda also neutralizes excess stomach acid, she notes, so stir a teaspoon into a glass of warm water and drink a few times daily.

Episode 10: Disease Mongering

This week, Su Robotti and Jonathan Block discuss Disease Mongering. That’s when pharmaceutical companies take an everyday discomfort and promote it to a disease — and then seel meds to cure the disease.

Su Robotti: Hi. I’m Su Robotti and this is Jonathan Block. We’re both from MedShadow. I’m the founder and Jonathan is the content manager.

Today, we’re going to talk to you about conditions of life that somehow are becoming elevated into diseases. When I was a kid, watching TV, there was this terrible disease that was going through a scourge of the nation. It was halitosis. And everybody had to use Listerine to get rid of it. When my vocabulary expanded, I found out it was bad breath and that good dental care and brushing your teeth and not eating onions would take care of most cases, most times, of bad breath. So it wasn’t really necessary to take medicine or anything.

But that was the beginning of a wave of products that pharmaceutical companies had developed, to take everyday aging or life occurrences and are turning them into diseases. And were very concerned about this, aren’t we?

Jonathan Block: Yeah. What you’re talking about is something called disease mongering, which is taking conditions that are just common, everyday occurrences — sometimes they’re just the consequence of aging — and turning it into something where you think it’s a serious medical condition that if you don’t have it treated, it’s going to significantly impact your health or well-being. You were just talking about restless leg syndrome.

There’s a drug out there called Requip and that was originally developed for Parkinson’s disease and it got a secondary indication for restless leg syndrome. And in most cases, most people that have been diagnosed with restless leg syndrome really don’t have that condition. A very small percentage of people actually have it. Most of the time, if you have restless legs, it might be because you don’t have enough sleep, you’re suffering from stress or anxiety, or you’re maybe drinking or smoking too much.

SR: You mean too much coffee?

JB: Exactly, so put that cup down.

SR: Sorry. You’re right. What about esophageal reflux disease?

JB: AKA acid reflux?

SR: You mean gas?

JB: Exactly.

SR: And do you have to take a medicine for that?

JB: No, that could be a consequence of eating spicy foods. Some people are just more sensitive to eating certain foods. There’s a very easy way to take care of that.

SR: Do you imagine there are 5 jalapeno poppers?

JB: Probably not because not only would that affect your stomach it will probably raise your cholesterol a great deal.

SR: Thank you for taking care of me. What else is a made-up disease or an exaggerated symptom into a disease?

JB: A good one is the drug called Addyi which is for something called, I have to look at this, hypoactive sexual desire disorder. This made the news last year when the drug was approved. It called the “female Viagra.” The drug company decided that since men had Viagra and other similar drugs for erectile dysfunction, that there should be a similar drug for women. It had very tenuous–

SR: Research.

JB: Research, thank you, conducted for it. And the good news with this one is that since it’s been on the market, the drug has kind of bombed. It hasn’t really been selling very much as doctors realized that it’s not a real condition and the drug itself doesn’t work at all.

SR: The issue with a lot of these diseases are that once you start with the cure, with the medicine, even sleeping aids, there’s a rebound effect that will keep you from not using it. If you quite often, if you use a sleeping aid, and by then the other kind of ones or the prescription ones, the next night, you will have more trouble getting to sleep, and therefore, need it again, and the following night, and so forth, because you’ve interrupted your natural sleep pattern.

What about overactive bladder?

JB: Well, that’s another condition that is a consequence of getting older. There were pharmaceutical companies that decided to elevate that from just kind of an inconvenience or annoyance to, again, something more serious that required medical attention and necessitate taking a prescription drug.

One thing that we haven’t addressed with all of these drugs for questionable conditions is that many of them have side effects. Another class of drugs that has come on the market recently are so-called Low T or low testosterone drugs, which is really more of a “lifestyle drug” but doctors have said that Low T isn’t even a real condition. And taking one of these gels which you would actually just put on, rub on your skin, it gets absorbed that way, actually doesn’t do much in terms of increasing your sexual health. And they do come with several risks, most seriously is the risk of coronary artery disease. So it’s important that for some of these conditions that are very, very questionable, that there are serious side effects with the drug associated with them.

SR: If you like to learn more about the side effects associated with the drugs that you’re discussing with your doctor or that you’re seeing on TV, please go to www.medshadow.org, and just search for the drug. It’s very likely, we have something to say about it.

In the meantime, taking a drug for a condition that is not serious and not life threatening or that can be treated in a lower tech way, is just plain dangerous. So please, think carefully and balance the risks and the benefits of every drug you take. Thank you.

Need to Know: Corticosteroids

Corticosteroids are often used in the treatment of joint pain or inflammation (arthritis), as well as irritable bowel disease (ulcerative colitis and Crohn’s disease), skin diseases, allergies, asthma and even brain tumors. However, this class of drugs can cause many complications. Knowing and understanding the facts can improve corticosteroid use.

Common Names

Celestone (betamethasone), Cortone (Cortisone acetate), Decadron (dexamethasone), Cortef (hydrocortisone), Aristocort (hydrocortisone), Medrol (methylprednisolone), Prelone (prednisolone), Deltasone (prednisone)

Side Effects and What to Do About Them

Corticosteroids can be taken in tablet form or through inhalation, and the side effects will differ based on what form of medication is used.

The most common side effects of inhaled corticosteroids include a sore mouth, hoarse voice, and infections in the throat and mouth. To avoid or reduce these side effects, it’s highly recommended to rinse the mouth out with water after taking the medication.

The most common side effects of corticosteroids in tablet form include bruising of the skin, weight gain, weakening of the bones, high blood sugar levels, cataracts, and swelling of the feet or ankles. Side effects can lessen during treatment as your body adjusts to the medicine, but if these side effects continue or are bothersome, you may want to check with your doctor to discuss alternative medications.

Diet is very important if you take a corticosteroid for a long time. Doctors might want you to follow a low-sodium or a potassium-rich diet.

Before giving corticosteroids to children or teenagers, doctors should discuss the possible side effects. They may cause infections like chickenpox or measles, or slow growth in children and teenagers.

According to a Cochrane review, clinical trials cannot prove that inhaled corticosteroids reduce inflammation in the lungs of cystic fibrosis patients. However, one trial reveals that inhaled corticosteroids can inhibit a child’s growth when used in high doses.

Older patients who take corticosteroids may be at risk of high blood pressure or osteoporosis. Women, in particular, are at risk of developing bone disease. Because of this, women should ensure they are getting enough calcium and vitamin D in their diet. If not, they should consider taking supplements. In severe cases, bisphosphonates may be prescribed to treat the osteoporosis.

In another Cochrane review, there is convincing evidence that corticosteroids can reduce the rate of erosion progression in rheumatoid arthritis. Unfortunately, there is some concern that the long-term effects of corticosteroids, such as increased cardiovascular risk and osteoporosis, may outweigh the benefits.

Drug Interactions

Other medicines can interact with corticosteroids, and as a result the side effects of either medicine can be altered.

Mixing corticosteroids and anticoagulant medicines (such as heparin, warfarin, dabigatran, apixaban, and rivaroxaban) can make anticoagulants less effective. Additionally, it can cause bleeding inside the digestive system.

If you need to take both corticosteroids and a diabetes medication, then your blood glucose levels should be checked regularly and your dose of diabetes medication might need to be adjusted.

Combining NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, Voltaren (diclofenac), naproxen and corticosteroids increases your risk of developing stomach ulcers and internal bleeding. If you need to take both medications, you may be given a proton pump inhibitor (PPI) to minimize the risk of stomach ulcers.

Effectiveness & Considerations

Corticosteroids are intended to provide relief for inflamed areas of the body. They are used to lessen swelling, redness, itching, and allergic reactions. Typically, corticosteroids are used to treat severe allergies or skin problems, asthma, and arthritis.

The body naturally produces cortisone-like hormones to maintain good health, but if your body doesn’t produce enough cortisol, then your doctor might suggest corticosteroids to help make up the difference. This type of medicine is available by prescription only. The duration of corticosteroid treatment depends on the condition being treated.

Alternatives to Corticosteroids

Corticosteroids are the most popular therapy to treat inflammation, but patients should consider the safety concerns. Herbs and dietary supplements might offer just as effective results as prescribed corticosteroids. Natural anti-inflammatory treatments include omega-3 fatty acids (fish oil), white willow bark, curcimin (turmeric), and green tea. Always make sure your health care providers know all the medicines, herbs and supplements you are taking or considering taking. Every product you put in your body can cause interactions you may not know to expect.

Since the late 18th century, fish oil has been used to treat muscular, skeletal, and discogenic diseases. The therapeutic benefits of fish oil have shown to be an effective, natural anti-inflammatory agent. The active ingredients in fish oil can directly reduce inflammation in cartilage. There have been positive clinical studies that show the efficacy of fish oil in treating arthritis.

One of the oldest herbal remedies for pain and inflammation is bark from a white willow tree.  White willow bark works similarly to aspirin by blocking swelling. Usually, the dose of white willow bark is 240 mg/day. White willow bark is available as a supplement in a pill form, as well as a liquid extract.

Curcumin is yellow in pigment and derived from turmeric, a plant of the ginger family. Curcumin is considered to inhibit inflammation by suppressing NF-kB, a protein complex that controls transcription of DNA. Clinical studies have shown that curcumin has anti-inflammatory effects. It’s possible to be a viable natural alternative to nonsteroidal agents.

Green tea is used in the treatment of arthritic disease as an anti-inflammatory agent. The constituents of green tea have shown to inhibit aggrecanases, enzymes found in cartilage, which degrade cartilage. Research on green tea demonstrates anti-inflammatory effects.

How They Work (Method of Action)

Corticosteroids imitate the effects of cortisol, a natural hormone in your body, to suppress inflammation. They also lower the activity of your immune system by reducing white blood cells, which help to prevent damage to body tissue.

What Worked for You?

Share your experience with bisphosphonates in the Disqus box below.

MedShadow Coverage on Corticosteroids

Further Reading

Corticosteroids Method of Action