More serious risks of Prilosec and similar drugs

New risks of Prilosec (omeprazole), Nexium, and other similar drugs (so-called proton-pump inhibitors, or PPIs) are being highlighted by the FDA. They can increase the risk of Clostridium difficile-associated diarrhea, a serious infection. This probably occurs because lowering stomach’s acidity allows this bacterium grow more easily. In additional to watery diarrhea, this sinfection causes abdominal pain, and fever, especially after recent antibiotic use. This as another reason to try to limit the use of PPIs. Their use is also associated with a small increase in the risk of pneumonia, bone fractures, vitamin B12 deficiency, and magnesium deficiency. Having diarrhea from a bowel infection will worsen these deficiencies. It is not easy to stop a PPI because heartburn and other symptoms will first get worse, due to “rebound” increase in acidity. This is why once you start taking a drug like Prilosec, it is very difficult to stop. The way to do it is to first lower the dose, then extend the dosing interval to every other day, every third day, etc. Temporarily taking an H2-blocker (Zantac, Pepcid) and antacids can also help in getting off PPIs. PPIs include Prilosec, Prevacid, Protonix, Nexium, Dexilant, and Aciphex.
What does this have to do with headaches? PPIs can sometimes cause headaches directly, but more often they worsen migraines by interfering with the absorption of magnesium and other vitamins. This is a class effect, so switching from one drug to another will not help. Taking a magnesium, vitamin B12 and other supplements may help, but many of my patients, especially those who cannot stop the PPI medication require an intravenous infusion of magnesium and an injections of vitamin B12.