Doc: Tapering best policy when stopping heartburn meds
Dear Dr. Roach: I am a 61-year-old woman in fairly good health except that I have been taking prescription omeprazole once a day for heartburn for at least 10 years, if not more. I’ve read articles that say this isn’t good to take long term, like I’ve been doing. When I’ve tried to stop by using famotidine instead, I still suffer from heartburn throughout the day. I’ve raised my bed and tried sleeping in an upright position. Your thoughts, please.
Dear O.D.S.: It certainly is a good idea to periodically review with your doctor all the medications you take, to decide whether they are still necessary. It is very often the case that people are taking medications for unclear reasons, and the person who is prescribing it has been doing so without really thinking about whether the benefits still outweigh the risks, especially as people get older and may have acquired new conditions or had medication changes.
Proton pump inhibitors like omeprazole frequently are prescribed for short-term use but end up being continued for years. Except in people who absolutely need it (such as people with Barrett’s esophagus), I agree with a trial of stopping and using H2 blockers like famotidine on an as-needed basis. I recommend a taper, not a sudden stop.
Proton pump inhibitors are likely to increase the risk of infection, such as pneumonia (without acid in the stomach, bacteria are not killed as efficiently) and intestinal infections; may possibly increase the risk of osteoporosis; and probably reduce vitamin B-12 and iron absorption. Although there have been reports of increased risk of kidney disease and dementia, I doubt the actual clinical risk is significant. Still, there are enough possible adverse effects that it is worth balancing the risks against the benefits of reducing symptoms.
I am glad you tried some nondrug therapies, as we doctors often do not emphasize how important they are. In addition to raising the head of the bed (bricks under the feet is traditional, but a foam wedge under the mattress is also effective), losing weight for those who would benefit, avoiding tobacco and alcohol, and not eating three hours before bedtime make drugs unnecessary for many. Some people benefit from eliminating certain foods, especially caffeine, chocolate and fatty or spicy foods.
Dear Dr. Roach: My father, 90, has neuropathy in his feet and legs, and it is very painful. He recently talked to a clinic that is offering stem cell treatment to relieve the pain. The clinic says it helps 85 percent of those who get the treatment; however, because of HIPAA laws, they don’t provide any referrals.
The treatments are very expensive ($16,000), and results are seen in six weeks to six months. Are you familiar with this treatment, and is it effective for 85 percent of the people? Is this something you can recommend?
Dear D.B.: I also have seen advertisements for stem cell treatments for many conditions. For neuropathy in particular, there are no good studies that give an estimate of effectiveness. It may be the case that 85 percent of people treated at the clinic report improvement. But the risk of a placebo effect is very high with this kind of procedure, and I could not recommend stem cell treatments for neuropathy without better information about the risks, the benefits and how long those benefits might last.
Email questions to ToYourGoodHealth@med.cornell.edu.