What are the effects of long-term omeprazole (Proton Pump Inhibitor) use?

From the Guidelines

Long-term omeprazole use can lead to several concerning side effects, and its use should be carefully considered and monitored, particularly in patients with a history of severe erosive esophagitis or GERD-related complications, as discontinuation may lead to recurrence of symptoms or complications 1.

Effects of Long-term Omeprazole Use

The effects of long-term omeprazole use are multifaceted and can impact various aspects of a patient's health. Some of the key concerns include:

• Nutrient deficiencies: Prolonged use of omeprazole can lead to deficiencies in vitamin B12, magnesium, calcium, and iron, as stomach acid is necessary for proper nutrient absorption 1.
• Kidney disease: Chronic omeprazole use is associated with an increased risk of kidney disease, including acute interstitial nephritis and chronic kidney disease 1.
• Infections: Reduced stomach acid can allow more bacteria to survive, increasing susceptibility to certain infections like Clostridium difficile and pneumonia 1.
• Rebound acid hypersecretion: Long-term users may experience rebound acid hypersecretion when stopping the medication, making discontinuation difficult 1.

Recommendations for Long-term Omeprazole Use

For patients requiring extended acid suppression therapy, the following recommendations can be made:

• Use the lowest effective dose of omeprazole to minimize the risk of side effects 1.
• Periodically attempt to discontinue or reduce the dosage of omeprazole under medical supervision to assess the need for ongoing therapy 1.
• Regularly monitor nutrient levels and kidney function in long-term users, and consider supplementation to prevent deficiencies 1.
• Carefully weigh the benefits and harms of discontinuing omeprazole in patients with a history of severe erosive esophagitis or GERD-related complications, and quickly re-initiate therapy if symptoms or signs of complicated GERD emerge 1.

From the FDA Drug Label

You should take omeprazole delayed-release capsules exactly as prescribed, at the lowest dose possible and for the shortest time needed. Omeprazole delayed-release capsules can cause serious side effects, including: • A type of kidney problem (tubulointerstitial nephritis). • Diarrhea. • Bone fractures. • Certain types of lupus erythematosus. People who take multiple daily doses of PPI medicines for a long period of time (a year or longer) may have an increased risk of fractures of the hip, wrist, or spine.

The effects of long-term omeprazole use include:

• Increased risk of bone fractures: People who take multiple daily doses of PPI medicines for a long period of time (a year or longer) may have an increased risk of fractures of the hip, wrist, or spine.
• Kidney problems: Long-term use of omeprazole may cause a type of kidney problem called tubulointerstitial nephritis.
• Diarrhea: Omeprazole may increase the risk of getting severe diarrhea, which may be caused by an infection (Clostridium difficile) in the intestines.
• Lupus erythematosus: Long-term use of omeprazole may cause certain types of lupus erythematosus or have worsening of the lupus that already exists. It is recommended to take omeprazole delayed-release capsules exactly as prescribed, at the lowest dose possible and for the shortest time needed 2.

From the Research

Effects of Long-Term Omeprazole Use

• Long-term omeprazole therapy is effective for controlling reflux esophagitis, with a low relapse rate of 1 per 9.4 years 3.
• The treatment is accompanied by a persistent increase in serum gastrin levels, which can lead to micronodular hyperplasia and subatrophic or atrophic gastritis 4.
• Elevated serum gastrin levels can be reduced by using an alternate-day treatment regimen instead of daily treatment 5.
• Long-term use of omeprazole may result in adverse effects on hematological and biochemical parameters, including:
  • Reduced red blood cell count and indices 6
  • Elevated cholesterol, triglyceride, and low-density lipoprotein levels 6
  • Increased alkaline phosphatase and aspartate aminotransferase levels 6
  • Elevated creatinine and nitrogen blood urea levels 6
  • Decreased serum ferritin, vitamin D3, and calcium levels 6
• The American Gastroenterological Association recommends that patients with gastroesophageal reflux disease (GERD) and acid-related complications take a proton pump inhibitor (PPI) for short-term healing, maintenance of healing, and long-term symptom control 7.
• Patients with uncomplicated GERD who respond to short-term PPIs should attempt to stop or reduce them, and those who cannot reduce PPIs should consider ambulatory esophageal pH/impedance monitoring before committing to lifelong PPIs 7.