Heartburn Drugs Linked to Pneumonia

The longer you use them, the greater the risk, study finds

TUESDAY, Oct. 26, 2004 (HealthDayNews) -- Taking heartburn drugs for prolonged periods increases the risk of developing pneumonia, claims a new report by Dutch researchers.

The finding is particularly timely because the United States is facing a significant shortage of flu vaccine, and flu can lead to pneumonia in vulnerable individuals.

The study of more than 364,000 participants in the Netherlands national health insurance program found the risk of pneumonia was nearly doubled for people taking heartburn drugs called proton-pump inhibitors for prolonged periods. And the risk was almost two-thirds higher for those taking histamine antagonists, compared to people not taking such drugs.

Both kinds of drugs fight heartburn by reducing production of stomach acid. Histamine inhibitors, as the name implies, block histamine from stimulating cells from producing acid. They include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac). Proton pump inhibitors act against a different mechanism of acid production. They include Nexium, Prevacid, Prevpac, Prilosec, Protonix and Aciphex.

Because some prescription drugs are available in inexpensive generic form and others are sold without prescription, they are taken by a large number of people, accounting for more than an estimated $20 billion in annual sales.

One reason long-term use of the drugs can increase the risk of infection is that acid kills bacteria in the stomach, said study author Robert J. F. Laheij, an epidemiologist at the University Medical Center in Nijmegen. Lowering stomach acid lets more bacteria survive, he explained.

"There can be some kind of aspiration of bacteria into the airway," Laheij said. And while the study looked specifically at pneumonia, "pneumonia is not the whole story," he added. He and his colleagues have done other studies showing an increase in other respiratory infections such as influenza and bronchitis associated with use of the drugs.

The new study appears in the Oct. 27 issue of the Journal of the American Medical Association.

The finding is important, given the current flu vaccine shortage in the United States, because "a major impetus toward pneumonia is influenza," said Dr. George Pankey, head of infectious disease research at the Ochsner Clinic Foundation in New Orleans. Influenza can be a relatively mild disease, but in vulnerable people -- particularly the elderly -- it can lead to pneumonia, which can be life-threatening.

Both Pankey and Laheij said anyone taking a heartburn drug for a prolonged period should consult a doctor, especially now, because the onset of colder weather increases the risk of respiratory infections.

"I don't think these drugs should be used indiscriminately, and I think they are," Pankey said.

The easy availability of the acid-suppressing medications is a big part of the problem, Laheij said. In most cases, two or three weeks of medication is enough for most people, he said, but some "continue to take the medicine for a very long period. My advice would be to use them as long as necessary and then stop them."

Pankey added: "Your doctor needs to know what you are taking. In this country, perhaps more than over there [Europe], physicians do not know everything that a patient is taking, especially over-the-counter medications. If you are taking a lot of medications, tell your doctor."

More information

To learn more about proton pump inhibitors, check with Drug Digest.

SOURCES: Robert J. F. Laheij, Ph.D, epidemiologist, University Medical Center, Nijmegen, Netherlands; George Pankey, M.D., head, infectious disease research, Ochsner Clinic Foundation, New Orleans; Oct. 27, 2004, Journal of the American Medical Association
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