Four omeprazole warnings to anyone on heartburn drug longer than six months

A doctor has issued warnings to anyone taking a common medication and the consequences that can arise following long-term use. In the UK, omeprazole, a proton pump inhibitor or PPI, is widely used, available both by prescription and over the counter.

According to the most recent NHS stats, 73 million NHS prescriptions for this category of medications (proton pump inhibitors) were issued in England between 2022 and2023, making omeprazole one of the most frequently prescribed PPIs. It is used to address issues such as heartburn and acid reflux.

The NHS says: "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." Common side effects of omeprazole include, a headache, stomach pain, feeling sick or being sick, constipation or diarrhoea and passing wind more than usual.

• Atorvastatin NHS warning for anyone taking commonly prescribed drug
• People are ditching 10,000 steps for walking trend giving '10 times the benefit'

'Long-term use' of any medication typically refers to taking a drug for three months or longer, although the exact length can differ greatly based on the type of medication and the condition being addressed. Omeprazole's long-term use typically begins after the usual four to eight-week treatment period for indigestion. Some research studies consider six months a standard 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 continued: "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. Heightened risk of gut infections

Long-term use of omeprazole may increase your likelihood of gut infections, including Clostridium difficile (C. diff) and various other enteric infections. This increased risk is linked to prolonged use and is largely caused by omeprazole's capacity to modify the gut microbiome by decreasing beneficial bacteria and lowering the gastric acid barrier, which creates an environment ideal for growing harmful microbes. You can read more about C. diff on the NHS website.

Omeprazole, which is a proton pump inhibitor (PPI), lowers stomach acid levels, resulting in changes to the bacterial population in the gut. This may reduce the number of healthy bacteria and cause an imbalance, increasing the gut's susceptibility to infections. Be mindful of severe diarrhoea or abdominal pain while using omeprazole.

Use omeprazole and other PPIs only when needed and for the briefest time possible. If you are worried about your use of omeprazole and C. diff, talk to your doctor to figure out the best treatment plan for your circumstances.

2. Heightened risk of kidney damage

Prolonged use of omeprazole can elevate the risk of kidney damage, which includes acute interstitial nephritis (AIN) and chronic kidney disease (CKD). Research has shown that there can be a greater likelihood of developing CKD and potentially advancing to end-stage renal disease with extended PPI usage.

It is best to restrict PPI use to the shortest duration necessary. Any patients undergoing long-term treatment should be monitored by their GP for possible kidney issues. Studies have found that omeprazole may cause cell death in kidney tubular cells, which is associated with kidney disease.

Speak to your doctor if you are currently using omeprazole to discuss any of these potential risks. If you notice any changes in urinary function, talk to your doctor straight away. Ask about non-drug approaches or alternative treatments, such as histamine H2 blockers, to alleviate acid reflux symptoms. Without medical guidance, avoid using over-the-counter PPIs for longer than the advised 14-day period.

3. Heightened risk of bone fractures

Omeprazole may increase the risk of bone fractures, especially in older patients, when taken in high doses or for extended periods, particularly after one year. Research indicates a slight increase in the likelihood of hip, wrist, and spine fractures, in particular.

Although the exact mechanism is not completely clear, one hypothesis is that omeprazole could disrupt calcium absorption. Some studies have indicated a link between prolonged use of omeprazole and reduced bone mineral density.

Patients using this medication should consult with their doctor about the associated risks and possible benefits. Evaluate your risk and decide if the advantages of the medication surpass the potential dangers. Your doctor may recommend calcium and vitamin D supplements to support bone density, but this should be done with their supervision.

4. Heightened risk of nutrient absorption issues

Omeprazole can lead to problems with nutrient absorption by lowering stomach acid levels. A sufficiently acidic stomach is essential for the proper absorption of various vital nutrients, such as vitamin B12 and vitamin C.

Long-term omeprazole use is associated with reduced absorption of vitamin B12, vitamin C, and minerals like calcium and magnesium, which could result in deficiencies. Prolonged use of omeprazole heightens the risk of these deficiencies, making it important for patients undergoing long-term treatment to monitor their nutritional intake and consider supplementation.

• Vitamin B12: This is a well-known and documented concern, with research indicating a connection between long-term omeprazole use and vitamin B12 deficiency.
• Vitamin C: Research has demonstrated that omeprazole can lower blood levels of Vitamin C.
• Calcium: Lower stomach acidity can hinder calcium absorption.
• Magnesium: Likewise, magnesium absorption may be reduced due to the acid-suppressing properties of omeprazole.

The likelihood of nutrient deficiencies increases with extended omeprazole use. Anyone taking the medication should recognise the risk of vitamin and mineral deficiencies, and vitamin and mineral supplementation might be advised.