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.

  1. Debbie says: 03/28/20123:08 pm

    I have chronic migraine and can’t take NSAIDS because I have gastritis. I take Prevacid daily and i didn’t know that it could make migraines worse! I have found that it’s difficult to discontinue Prevacid and I’m glad to know about using the H-2 blocker. However, even if I want to, I may not be able to discontinue Prevacid if my stomach pain is unbearable without it. How would I know if I need a magnesium infusion and/or injection of vitamin B-12? I take 800 mg of magnesium daily and get 50mcg of B12 in my multi-vitamin.

  2. Dr. Mauskop says: 03/28/201211:33 pm

    You can ask your doctor to check your vitamin B12 and homocysteine level (high homocysteine indicates B12 deficiency, even if B12 itself is normal), as well as RBC magnesium, which is more accurate that the regular, serum level. A recent study showed that if you have high homocysteine and take vitamins B6, B12, and folic acid, your migraine headaches may improve. This seems to apply mostly to those who have migraine with aura.

  3. Dr. Mauskop says: 04/06/20128:10 am

    You can ask your doctor to check your RBC magnesium and vitamin B12 levels, although neither test is very accurate. For B12, we also check a related test – homocysteine level – if homocysteine is high, then you need not only vitamin B12, but also folic acid (500 mg) and vitamin B6 or pyridoxine (25 mg) and this combination can help migraine headaches. 50 mcg of vitamin B12 in a multivitamin may not be enough. Taking 1,000 mg sublingually (under your tongue) may be enough, but in severe deficiency, injections are necessary. 800 mg of magnesium is usually sufficient.

  4. Danielle says: 09/07/201411:18 am

    I stopped my PPIs a month ago and soon after I stopped them I started waking up every day (for a month now) with a dull and constant headache throughout the day. The headaches range from a 1-4 on the pain scale and they feel like they are occurring in the front of my head throughout the forehead and temples. They are not migraines though.

    Once I realized going off the PPIs was the cause of my headaches I started taking them again in hopes of stopping the headaches but it has not helped. I am wondering what I should do now to try to make the headaches stop?

    I have experienced chronic headaches once before when I tried to stop taking my PPIs but I didn’t realize the headaches were caused by stopping my PPIs so I went to the doctor and he said maybe the headaches were caused by allergies so he put me on a daily dose of Flounase and Zyrtec and surprisingly this solved the problem and I no longer had headaches…..that is until recently stopped my PPIs and now I am still taking the allergy meds but they are not helping with my headaches.

  5. andy says: 09/22/20141:06 am

    Currently,Im on omeprazole and domperidone for my GERD.I stopped taking domperidone as there are few articles written on it about cardiac,whenever I take omeprazole,i have this anxiety attack,my chest feels it one of the side effects?

  6. joseph says: 10/01/20149:47 am

    Danielle, I have exactly the same problem! I took them for a couple of months when I did the PREVpac and now I have the headaches just as you describe. I’m frustrated! I have seen a nurologist and she has booked me in for an MRI. I have Done a CAT scan, but they found nothing with that. I have been taking Hawthorn tea which has mitigated the headaches a lot. I think the heahaches are something to do with nurtients, the vascular system, or toxins.

  7. Dr. Mauskop says: 10/01/201410:16 am

    Yes, it is possible that omeprazole causes anxiety and it is possible that domperidone is a safer choice – ask your doctor about it.

  8. Dr. Mauskop says: 10/01/201410:19 am

    It is possible that you and Danielle are having headaches due to reflux. This is relatively uncommon without obvious reflux symptoms, but irritation of the nasal passages by acid at night could be contributing to the headaches. To avoid having to take PPIs such as Prevacid, Prilosec (omeprazole) and other you can try different probiotics and a reflux diet, particularly avoiding caffeine.

  9. Cindy says: 12/05/20147:49 pm

    I am curious about the association with omeprazole and migraines.

    I am 62 years old and have had migraines of all types – with/without aura, aura alone, numbness, aphasia, etc. – since I was a pre-teen. I rarely have a bad migraine now, although a few times a year a have visual/aura migraines without headache. I have taken magnesium daily for years, as it helped me noticeably when I used to have monthly (at least) headaches.

    Recently, I went on a course of omeprazole for 3 months. During that time, I noticed an increase in confusion, and difficulty finding words. I was worried that I was beginning to become senile. Then I read the side effects more carefully, and realized that “confusion” and “magnesium deficiency” were listed, and I thought two things: 1st, that the symptoms had begun at around the same time as the medication, and 2nd, that the confusion “felt” very similar to the kind of aphasic episodes I had had when I was younger – though much milder, thankfully. (Difficulty finding words and concentrating, vs. sounding like a drunk crazy person).

    I stopped taking the omeprazole, and the symptoms disappeared within 2 days. It’s been several weeks and I have not noticed any search for words, any difficulty remembering words, or any saying of the wrong words. That had been happening multiple times a day.

    I asked my GP about this – haven’t had a headache doctor in years as I haven’t had many problems since menopause. She was not aware of any link. But I kept thinking – it FELT like the blurry, stupid, word loss episodes, I know magnesium helped me, and if this lowered my magnesium…..?

    Have you heard of anything like this?

  10. Dr. Mauskop says: 12/06/20144:40 pm

    Yes, your experience is not at all unusual. Fortunately for you, the side effects appeared quickly and you were able to make the association with omeprazole. In many patients the deficiency in magnesium and other vitamins and minerals happens over time and they do not realize that it is due to omeprazole or a similar drug (PPI – Nexium, Protonix, etc).

  11. Amy says: 05/06/201511:53 pm

    I know this is an old post so I may not get a response, but I recently started taking Omeprazole to treat a relatively minor case of gastritis. I’m only 18 and went to the gastroenterologist a couple weeks ago for the first time due to back pain when I ate. To begin with, my doctor really wasn’t really sure what could be the cause, because it’s such an atypical symptom and the only one I have ever experienced. I remember first having this back pain, where it feels like whatever I swallow is traveling down my spine, in late elementary school. It’s extremely uncomfortable but does not happen every time I eat, or with certain foods. To find the cause, I got an endoscopy and found that I have gastritis. I was told the main cause for people my age is taking too many medications with aspirin in them, and although I have always been relatively susceptible to headaches, I usually try to stay away from headache medications. Personally, I feel that it is more due to high stress levels. My blood pressure is usually normal, but the last time I took it my systolic (?) number was 134. Anyway, I started taking 40 mg of Omeprazole twice daily two weeks ago, and have had a headache everyday since. To make matters worse, I am slightly anemic and a vegetarian. This post was kind of all over the place, but if you have any advice for me whatsoever I would very much appreciate it!

  12. Dr. Mauskop says: 05/08/20154:25 pm

    Yes, omeprazole can cause headaches, as can other drugs in this category (PPIs – proton pump inhibitors). Zantac with antacids, such as Tums, Maalox, or Gaviscon can help relieve gastritis without causing a headache. Vegetarians are more likely to have vitamin B12 deficiency, which can contribute to anemia, headaches, and other neurological symptoms. So, it is very important to have your vitamin B12 level checked (and it should be above 400, not 200 as laboratories indicate) along with vitamin D and RBC magnesium. Taking oral vitamin B12 may not be enough – some people need regular injections. The same applies to magnesium.

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