What Are Proton Pump Inhibitors (PPIs)?

These drugs treat heartburn by limiting acid production in the stomach.

Proton pump inhibitors, or PPIs, are a class of drugs used to help relieve heartburn caused by acid reflux and stomach ulcers.

Decreasing stomach acid can help ulcers heal or prevent them from forming.

Many people with heartburn experience discomfort because a special valve that's meant to keep stomach acid and food particles from flowing back up into the esophagus (food pipe) doesn't close completely.

As a result, the acid produced by your stomach irritates the lining of the food pipe, causing symptoms like heartburn, irritation, chest pain, and coughing.

PPIs work by preventing acid pumps (proton pumps) in the stomach from releasing hydrochloric acid, so that even if the valve above the stomach doesn't close properly, less acid flows into your food pipe and irritates its lining.

Less acid also means a decreased likelihood of an ulcer.

Proton pump inhibitors include the following drugs:

• Aciphex (rabeprazole)
• Omeprazole, found in Prilosec, Prilosec OTC, and Zegerid (in combination with sodium bicarbonate)
• Nexium (esomeprazole)
• Protonix (pantoprazole)
• Dexilant (deslansoprazole)
• Prevacid (lansoprazole)

Warnings and Precautions

Many people fail to follow drug label instructions and take PPIs at the onset of symptoms, which may occur after finishing a meal. Taking them in this manner is usually ineffective.

This is because if you take a PPI at the start of a meal or after eating, by the time it starts working, your stomach has already released most of its acid.

For best results, take a PPI 30 minutes before you eat a heavy meal, or on an empty stomach at the time of the day when you've noticed you have the most discomfort.

This gives the medication enough time to shut down the acid pumps that cause your heartburn.

Don't take PPIs if you're allergic to the active or inactive ingredients found in the medication.

Also, ask your doctor about whether PPIs are right for you if you:

• Have been using PPIs for a year or more already
• Are taking high doses of PPIs
• Have liver problems
• Have low magnesium levels in your blood
• Are over age 50

Common Side Effects

You may experience some of the following side effects when taking a PPI:

• Headache
• Nausea, stomach pain, or gas
• Constipation
• Diarrhea
• Rash
• Low vitamin B12 levels (with long-term use of drug)

Less common but more concerning side effects include:

• Increased risk of bone fracture in patients with osteoporosis
• Increased risk of the bowel infection Clostridium difficile (C. diff)
• Increased risk of heart attack

Drug Interactions

Don't take PPIs if you're taking:

• Viracept (nelfinavir)
• Drugs that contain rilpivirine, like Complera and Edurant

Also, ask your doctor about PPIs if you're already taking certain blood thinners like Plavix (clopidogrel) or Brilinta (ticagrelor).

Dosages may need to be adjusted when you take PPIs along with:

• Antifungal agents, such as ketoconazole
• Digoxin
• Dizepam (valium)
• Warfarin (Coumadin)
• Phenytoin (Dilantin)