As many as 15 million Americans routinely treat heartburn with prescriptions for popular over-the-counter medications like Prilosec®, Nexium®, and Prevacid®.
The number of Americans who take these over-the-counter drugs without a prescription is even higher, making them some of the best-selling drugs of all time.
These heartburn drugs are known as proton pump inhibitors, or PPIs, for short. They work by reducing the amount of acid that gets “pumped” into the stomach, offering temporary relief for painful gastroesophageal reflux disease (GERD) and common indigestion.
For several years the medical community has been sure of one thing: These medications, in spite of their marketable benefits, do increase one’s risk for harmful conditions — and some may even increase one’s risk of death by as much as 17%.
Adding to the medical consensus that PPIs should never be taken without proper caution are a series of new medical studies that show PPI usage increases the risks of contracting COVID-19 and may even lead to fatal complications associated with the viral disease.
How PPIs May Lead to COVID-19 Complications
In August 2020, The American Journal of Gastroenterology published a study that observed a group of over 35,000 Americans. Of the 35,000, roughly 10% received a positive COVID-19 test result. Analysis showed that those taking PPIs either once or twice daily “had significantly increased odds” of testing positive for COVID-19 compared to those not taking PPIs.
European and Asian studies have identified similar trends. A Korean study found that those taking PPIs regularly were at a 79% increased risk of “severe clinical outcomes of COVID-19,” including the need for supplemental oxygen or a ventilator, increased admission to intensive care units, and increased risk of death.
Gastroenterologist Kyle Staller, MD, MPH, who practices medicine at Massachusetts General Hospital has also studied the side effects of PPIs. To Staller, it’s important for Americans taking PPIs to understand the newly identified risks associated with them, especially as it concerns COVID-19.
According to Staller, by reducing the amount of stomach acid to sometimes dangerously-low levels, PPIs can also lower the chances of a viral infection being eliminated by stomach acid upon entrance into the body. When there is less stomach acid, or less of a “barrier,” the body mounts less of a defense against viruses, such as the coronavirus that leads to COVID-19.
PPIs can lead to low stomach acid, which is a medical condition known as hypochlorhydria. Patients who take PPIs twice daily are likely to have some degree of hypochlorhydria, which, in turn, makes them more susceptible to infections.
According to studies, the brand-name PPIs associated with COVID-19 complications include:
- Nexium® and Nexium® 24HR (esomeprazole magnesium)
- Prevacid® and Prevacid® 24HR (lansoprazole)
- Prilosec® and Prilosec OTC® (omeprazole)
- Protonix® (pantoprazole sodium)
- AcipHex® (rabeprazole sodium)
- Dexilant™ (dexlansoprazole)
- Zegerid® and Zegerid OTC® (omeprazole and Sodium bicarbonate)
Some of the above medications are sold over-the-counter (OTC), while others require a doctor’s prescription.
Other Important Considerations for PPI Users
PPIs have always come with risks. Prior to COVID-19, studies had linked PPIs to side effects such as kidney damage, osteoporosis, lupus, bone damage, and dementia, among others.
More research needs to be conducted in order to further solidify the connections between PPIs and COVID-19 complications. Studies have also pointed out that it is important to consider the overall health of the person taking a PPI. In an interview, Staller noted,
“On average, people who happen to be taking PPIs are likely to be a little bit sicker. It's not that these people are compromised by their heartburn medication; but rather that their heartburn is the result of being overweight, or suffering an ailment associated with an unhealthy lifestyle—something that puts them in a high-risk group. That's probably what's driving the risk for COVID-19.”
While the link between PPIs and COVID-19 continues to sharpen into focus, Staller — along with most other medical experts — advise patients using PPIs to not stop using them before discussing their situation with their doctor.