Health
Can I take PPI forever?
Dear Dr. Roach: You’re writing about PPIs like Prilosec, which I’ve been successful in fighting severe cases of GERD with small hiatal hernias for over a decade.
But what is your opinion about my long-term use (which was a true lifesaver) and keeping it essentially forever? My stomach specialist seems to be “keeping it” for its success, but are there any potential drawbacks, especially in renal function? Is it easy for the kidneys to switch to H2 blockers like Pepcid or Tagamet?
— — KJ
Dear KJ: All drugs have side effects, and it is worth regularly examining the risks and benefits of taking them for long periods of time. You already know its benefits: a significant improvement in your quality of life. The balance, on the other hand, is some potential risk.
The most obvious risk is probably an infection. Failure to make stomach acid carries the risk of Clostridium difficile infection (severe diarrhea) and possibly other infections, including pneumonia. Malabsorption of nutrients, especially magnesium and vitamin B12, is so frequent that tests may be appropriate for people taking PPI for long periods of time. Calcium can also be affected, which can increase the risk of osteoporosis. It also deserves screening for the appropriate people at risk.
The link between chronic kidney disease and long-term PPI use is controversial and probably small. Still, regular checks of kidney function are wise. There is weak evidence that the risk of dementia is slightly increased.
Given all these risks, my preference for patients with long-term PPIs is to take the drug slowly and replace it with an H2 blocker, as you suggest. It works for many, but some really need daily PPI to avoid serious daily symptoms. It depends on the person, but the risk of serious side effects is small enough that in most cases the benefits outweigh it.
Dear Dr. Roach: Can my wife and I resume Jim’s class and return to the restaurant after receiving both shots of the COVID-19 vaccine? We are both in good health. She is 68 years old and I am 70 years old.
— — GG
Dear GG: Not immediately. The vaccine is given twice at intervals of 3 to 4 weeks, and the maximum preventive effect is not obtained for about 2 weeks after the second vaccination. Still, the protection is not perfect. According to the best studies of vaccines currently available, it is 94% to 95%. It is safest for you and your wife to stay socially distant and continue to wear masks, as the prevailing infection remains in all parts of the country. This is especially important for people at high risk of complications.
Second, vaccines are good at reducing the risk of developing symptomatic COVID-19 infections, but it is not clear whether they will stop asymptomatic infections. Vaccinated people can become temporarily infected after exposure without knowing that they may have spread the virus. It is safer for others if you, your wife, and all of us vaccinated are wearing masks and socially distant until you know for sure that this is not the case.
It’s a pity that we can’t get back to our lives right away before the pandemic begins, but vaccines are only part of the solution. You can’t give up the rest of the action needed to keep the pandemic in check.
Readers can email their questions to [email protected].
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