Antiplatelet medication (e.g. aspirin and clopidogrel), NSAIDs (e.g. ibuprofen and naproxen) and gastrointestinal risks.

The above medication can be important to treat or manage health conditions such as heart disease, stroke prevention or chronic pain. However, they increase the risk of developing gastrointestinal adverse effects.

Patients are at higher risk of gastrointestinal adverse events such as stomach ulcers if any of the following risk factors are present:

• Age over 75 years
• History of gastrointestinal bleeding such as stomach ulcer
• Helicobacter pyrlori infection
• Use of 2 or more medications that increase risks including those listed above, anticoagulants and steroids.
• Use of high dose aspirin (usually 300mg daily)

 

Nice guidelines state that a proton pump inhibitor/PPI (usually lower dose lansoprazole 15mg) should be offered to the above patients to protect you from such adverse effects.

 

What are PPIs

PPIs stop some of the acid production from cells in the lining of the stomach. This can help to prevent ulcers from forming or assist the healing process. By decreasing the amount of acid, they can also help to reduce acid reflux-related symptoms such as heartburn.

They are called ‘proton pump inhibitors’ because they work by blocking (inhibiting) a chemical system called the hydrogen-potassium adenosine triphosphatase enzyme system (otherwise known as the ‘proton pump’). This chemical system is found in the cells in the stomach lining that make stomach acid.

Many patients take PPIs,  and although the vast majority of patients will experience no adverse effects, some patient may experience a headache, abdominal pain, nausea, constipation/diarrhoea, increased flatulence. Stopping the medication will halt these side effects.

There are rarer side effects which can be more serious and include:

• C-difficile infection – risk increases 2-3 times compared to background risk, and in some cases may be serious requiring admission to hospital
• Osteoporotic fractures – modest increased risk of low bone density and fractures, which increases the longer it is used. Certain factors increase risk further such as post-menopause and smoking.
• Hypomagnesemia – very rare side effect where magnesium levels drop severely causing symptoms such as nausea, vomiting, lethargy, drowsiness, weakness, tremor, twitching, tetany , agitation, vertigo, confusion, cardiac arrythmia, seizures
• Hyponatraemia – low salt levels causing lack of appetite, headache, nausea, muscle cramps + weakness, confusion, drowsiness and seizures
• Pneumonia – conflicting information but possibly a small increased risk
• Tubulo-interstitial nephritis – a rare association with a condition that causes kidney inflammation

 

What should I do?

There is no fixed rule on how to manage these risks. As a patient, you need to make the right decision to suit your preferences and circumstances. If you feel you need more assistance with this, please let us know.