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Prilosec weight gain: Omeprazole side effects and how to avoid them

Содержание

Long-term treatment with proton pump inhibitor is associated with undesired weight gain

Abstract

AIM: To examine the effects of long-term proton pump inhibitor (PPI) therapy on body weight (BW) and body mass index (BMI) in patients with gastroesophageal reflux disease (GERD).

METHODS: The subjects were 52 patients with GERD and 58 sex- and age-matched healthy controls. GERD patients were treated with PPI for a mean of 2.2 years (range, 0.8-5.7 years), and also advised on lifestyle modifications (e.g. selective diet, weight management). BW, BMI and other parameters were measured at baseline and end of study.

RESULTS: Twenty-four GERD patients were treated daily with 10 mg omeprazole, 12 with 20 mg omeprazole, 8 with 10 mg rabeprazole, 5 with 15 mg lansoprazole, and 3 patients with 30 mg lansoprazole. At baseline, there were no differences in BW and BMI between reflux patients and controls. Patients with GERD showed increases in BW (baseline: 56.4 ± 10.4 kg, end: 58.6 ± 10.8 kg, mean ± SD, P < 0.0001) and BMI (baseline: 23.1 ± 3.1 kg/m2, end: 24.0 ± 3.1 kg/m2, P < 0.001), but no such changes were noted in the control group. Mean BW increased by 3.5 kg (6.2% of baseline) in 37 (71%) reflux patients but decreased in only 6 (12%) patients during treatment.

CONCLUSION: Long-term PPI treatment was associated with BW gain in patients with GERD. Reflux patients receiving PPI should be encouraged to manage BW through lifestyle modifications.

Keywords: Gastroesophageal reflux disease, Proton pump inhibitor, Body weight

INTRODUCTION

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder, and frequently encountered in the primary care setting. It has been estimated that 15%-25% of persons experience reflux symptoms at least weekly, and 5%-12% suffer on a daily basis[1].

The risk of reflux symptoms, erosive esophagitis, or esophageal adenocarcinoma increases with excessive weight and obesity[2]. Accumulating evidence has confirmed the excellent efficacy and safety of proton pump inhibitor (PPI) therapy in patients with all grades of GERD, making these agents the mainstay of treatment. Consequently, PPIs comprise the largest outpatient pharmacy expenditure in the United States. Body weight loss is commonly recommended as part of a first-line therapeutic measure for GERD, although lifestyle modifications have been relegated to a minor role in the therapeutic regime due to the effectiveness and availability of PPIs as an acid-suppressive therapy[3].

GERD is a chronic condition, necessitating continuous therapy for many patients to control symptoms and prevent complications. Long-term therapeutic options include PPI therapy and surgical or endoscopic procedures[4]. Recently, body weight loss after laparoscopic Nissen fundoplication was reported[5]. There is an extensive literature database that addresses the efficacy and safety of long-term PPI therapy. However, the possible impact of changes in body weight or body mass index (BMI) in reflux patients while on long-term PPI therapy has not been examined. We present herein the first report elucidating the effect on nutritional parameters such as body weight and BMI in patients receiving long-term PPI therapy.

MATERIALS AND METHODS

Subjects

We evaluated 52 adult patients with GERD and 58 healthy controls. We selected patients undergoing daily maintenance therapy of PPI for at least 10 mo at the University Hospital of Occupational and Environmental Health and four Gastroenterology Clinics between June and November 2005. Patients who had prior fundoplication or poor compliance with medication were excluded. Patients with GERD had received advice on lifestyle modifications such as selective diet and weight management to accompany the PPI treatment.

The controls were sex- and age-matched subjects who visited the clinic for a yearly medical examination; they were free of reflux symptoms, and did not take PPIs or histamine receptor antagonists. They did not receive advice on lifestyle modifications. Informed consent was obtained from all subjects and the study was performed in accordance with the Declaration of Helsinki as revised in 1989.

Diagnosis of GERD

The diagnosis of GERD was made based only on the typical symptoms of troublesome heartburn and/or acid regurgitation. Endoscopy at presentation was performed in patients with alarm symptoms such as dysphagia, odynophagia, bleeding, weight loss, and anemia that together suggested a complicated disease.

Treatment of GERD

Initial therapy was a standard dose of PPI (omeprazole 20 mg, rabeprazole 20 mg, or lansoprazole 30 mg) once daily for 8 wk followed by a daily maintenance half-dose therapy. The patients were followed-up at 4-wk intervals in the clinics to assess symptom recurrence. Patients found to have recurring symptoms of heartburn or acid regurgitation were placed back on their initial PPI dose. The patients were educated on lifestyle modifications by their physicians in addition to the PPI treatment. These instructions included avoidance of overeating, decreased fat intake, elevation of the head of the bed, cessation of smoking, avoiding recumbency for postprandial 3 h, and body weight control.

Nutritional parameters and blood pressure

Body weight, height, and blood pressure, as well as fasting serum levels of total protein, total cholesterol, and triglycerides were determined at baseline and at the last visit. The BMI was calculated as body weight (kg)/[height (m)]2. These parameters obtained within four weeks before the commencement of PPI therapy were defined as baseline data.

Statistical analysis

All results were expressed as mean ± SD. Categorical outcome variables were analyzed with Fisher’s exact test. For continuous variables, the Mann-Whitney U-test and Student’s t-test were used where appropriate. A P value less than 0.05 denoted the presence of a statistically significant difference between the groups.

RESULTS

Characteristics and demographics of subjects

Table details the characteristics of the 52 reflux patients and 58 healthy controls. There were no significant differences between the patient and control groups with regard to age, sex, duration of observation, body weight, body height, BMI, blood pressure, and serum values of total protein, total cholesterol, and triglycerides. Helicobacter pylori status, endoscopic findings, and PPI regimens of daily maintenance therapy in reflux patients are listed in Table .

Table 1

Baseline demographics and characteristics of reflux patients treated with long-term daily maintenance proton pump inhibitor therapy and healthy controls (mean ± SD)

Patients Control P
Number of subjects 52 58
Gender (male/female) 36/16 38/20 NS
Age (yr) 68.1 ± 10.4 68.8 ± 1.5 NS
Duration of observation (yr) NS
PPI therapy 2.1 ± 1.1
Medical checkup 2.0 ± 0.4
Body weight (kg) 56.4 ± 10.4 58.6 ± 8.4 NS
Height (cm) 156.0 ± 9.8 156.0 ± 8.9 NS
Body mass index (kg/m2) 23.1 ± 3.1 24.1 ± 2.7 NS
Blood pressure (mmHg)
Systolic 133 ± 17 132 ± 16 NS
Diastolic 75 ± 11 75 ± 9 NS
Serum total protein (g/dL) 7.2 ± 0.3 7.2 ± 0.3 NS
Serum total cholesterol (mg/dL) 210 ± 39 210 ± 25 NS
Serum triglyceride (mg/dL) 121 ± 52 107 ± 43 NS

Table 2

Patients (n = 52)
Helicobacter pylori status
Negative 9
Positive 11
ND 32
Endoscopic findings
Normal 18
LA grade A 6
LA grade B 13
LA grade C 5
LA grade D 3
ND 7
Number of patients according to PPI regimens
Omeprazole 10 mg once daily 24
Omeprazole 20 mg once daily 12
Rabeprazole 10 mg once daily 8
Lansoprazole 15 mg once daily 5
Lansoprazole 30 mg once daily 3

Effect of long-term daily PPI maintenance therapy on nutritional parameters and blood pressure

No significant differences were found between patient and control groups with respect to changes in blood pressure or serum values of total protein, total cholesterol, and triglycerides. In contrast, patients treated with PPI experienced significantly greater increases from the baseline to the last visit in body weight (P < 0.0001) and BMI (P < 0.0005) than controls (Table ).

Table 3

Mean changes in nutritional parameters and blood pressure at the last visit compared to the baseline

Patients (n = 52) Control (n = 58) P
Body weight (kg) +2.2b -0.1a < 0.0001
Body mass index (kg/m2) +0.92b +0.15a 0.0005
Blood pressure (mmHg)
Systolic +2.7 +1.9 NS
Diastolic -0.6 -1.9 NS
Serum total protein (g/dL) +0.014 +0.019 NS
Serum total cholesterol (mg/dL) -9.1 -17.1 NS
Serum Triglyceride (mg/dL) +3.1 +3.8 NS

The differences in body weight and BMI between the baseline and the last visit were analyzed separately for both groups (Table ). Body weight (P < 0.0001) and BMI (P < 0.0001) significantly increased at the last visit in reflux patients. In contrast, there was no significant difference in body weight or BMI at the last visit in controls.

Categorical changes in body weight at the last visit compared to the baseline values are shown in Figure . Most of the control group (91%) remained stable, defined by a change of no more than 5% compared to baseline weight; however, only 60% of the PPI group remained stable. In addition, 36% of these patients had an increase in body weight above baseline of more than 5%, compared with 4% of the control group (P < 0.0001).

Categorical change in body weight at the last visit compared to the baseline reading. Most of the control group (91%) remained stable, within a 5% change, compared to weight at the baseline. However, only 60% of the PPI group remained stable. In addition, compared with 4% of the control group, 36% of patients had a more than 5% increase above the baseline in body weight (P < 0.0001). n: Number of patients or control subjects.

DISCUSSION

This study demonstrated for the first time that long-term PPI treatment is associated with undesirable body weight gain in patients with GERD, despite lifestyle modification recommendations by their physicians. Heartburn is the classical symptom of GERD, with patients generally reporting a burning feeling, rising from the stomach and radiating toward the neck and throat. It usually occurs postprandially, particularly after large meals or the consumption of fats. Untreated patients suffering from reflux symptoms find it difficult to have large meals, because this generally aggravates their symptoms. Untreated patients may therefore reduce their meal sizes and intake of fats intentionally or unintentionally. It is conceivable, therefore, that the resolution of reflux symptoms by PPI treatment leads to a higher food intake resulting in body weight gain.

Laparoscopic Nissen fundoplication has evolved as a gold standard in antireflux surgery. This surgical therapy induces a significant and persistent reduction in body weight, possibly due to postoperative dysphagia or delayed gastric emptying[5]. In contrast, the option of long-term PPI therapy was associated with a significant body weight gain in the present study. Omeprazole and other PPIs delay gastric emptying[6-9], which induces postprandial fullness, dyspeptic symptoms, gastrointestinal bacterial overgrowth, and subsequent weight loss[10,11]. Our results have clearly demonstrated that long-term PPI therapy contributed significantly to body weight changes in patients with GERD by relieving the adverse symptoms rather than altering the state of gastric emptying.

Numerous circulating peptides influence appetite. Ghrelin is produced in the stomach and acts as a meal initiator. A recent report revealed that long-term PPI therapy did not change the serum ghrelin level[12]. Another peptide, leptin, is produced in the stomach and acts as an enteric signal involved in energy homeostasis. Change of this peptide associated with PPI therapy has not been reported.

A practice guideline for patients with GERD recommends the use of lifestyle modifications such as elevation of the bed head, a decreased intake of fat, chocolate, alcohol, peppermint, coffee, onions and garlic, cessation of smoking, and avoiding recumbency for three hours postprandially, in addition to taking antireflux medications[13]. However, the positive advantage of such lifestyle modifications on the patient’s condition is not well substantiated. Among these lifestyle interventions, elevation of the bed head, left lateral decubitus positioning, and weight loss are associated with improvement in reflux symptoms in case-control studies[14,15]. These modifications alone, however, are unlikely to control symptoms in the majority of patients[13]. Our results support the finding that lifestyle modifications are an essential component of the treatment for GERD and the prevention of weight gain during PPI treatment.

There is a growing body of literature regarding the association between BMI and GERD[2,16-24]. A recent large meta-analysis of previous studies demonstrated a strong positive relationship between BMI and reflux symptoms[2]. In addition, moderate weight gains, even among normal-weight persons, resulted in the development or exacerbation of symptoms in GERD patients[16]. In the present study, the patients significantly increased their body weight during PPI therapy. Appropriate management of body weight during PPI treatment should reduce the duration of PPI use or PPI dosage.

Excessive weight is associated with an increased risk of coronary heart disease, hypertension, angina, stroke, and diabetes, and constitutes an important cardiovascular health burden[25]. Body weight gain associated with lifetime GERD treatment may induce further medical costs in addition to the PPI therapy. Unfortunately, potentially effective diet modifications are often underestimated in the presence of various PPI regimens. Healthcare providers still recommend lifestyle changes in a moderate percentage of GERD patients[26], and while PPIs have become of pivotal importance for the initial and maintenance treatment of GERD, repeated lifestyle modification recommendations are required.

In conclusion, we elucidated in the present study the impact of long-term PPI therapy on body weight. Undesired body weight gain was observed in GERD patients on long-term PPI treatment. Reflux patients treated with a daily maintenance therapy of PPI should be strongly encouraged to manage their body weight through lifestyle modifications such as proper diet and avoidance of overeating. This measure may reduce the overall medical costs associated with obesity-related illness as well as GERD. Lifestyle modification must therefore remain the backbone of treatment for all patients with GERD, even in the PPI era.

Long-term treatment with proton pump inhibitor is associated with undesired weight gain

Abstract

AIM: To examine the effects of long-term proton pump inhibitor (PPI) therapy on body weight (BW) and body mass index (BMI) in patients with gastroesophageal reflux disease (GERD).

METHODS: The subjects were 52 patients with GERD and 58 sex- and age-matched healthy controls. GERD patients were treated with PPI for a mean of 2.2 years (range, 0.8-5.7 years), and also advised on lifestyle modifications (e.g. selective diet, weight management). BW, BMI and other parameters were measured at baseline and end of study.

RESULTS: Twenty-four GERD patients were treated daily with 10 mg omeprazole, 12 with 20 mg omeprazole, 8 with 10 mg rabeprazole, 5 with 15 mg lansoprazole, and 3 patients with 30 mg lansoprazole. At baseline, there were no differences in BW and BMI between reflux patients and controls. Patients with GERD showed increases in BW (baseline: 56.4 ± 10.4 kg, end: 58.6 ± 10.8 kg, mean ± SD, P < 0.0001) and BMI (baseline: 23.1 ± 3.1 kg/m2, end: 24.0 ± 3.1 kg/m2, P < 0.001), but no such changes were noted in the control group. Mean BW increased by 3.5 kg (6.2% of baseline) in 37 (71%) reflux patients but decreased in only 6 (12%) patients during treatment.

CONCLUSION: Long-term PPI treatment was associated with BW gain in patients with GERD. Reflux patients receiving PPI should be encouraged to manage BW through lifestyle modifications.

Keywords: Gastroesophageal reflux disease, Proton pump inhibitor, Body weight

INTRODUCTION

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder, and frequently encountered in the primary care setting. It has been estimated that 15%-25% of persons experience reflux symptoms at least weekly, and 5%-12% suffer on a daily basis[1].

The risk of reflux symptoms, erosive esophagitis, or esophageal adenocarcinoma increases with excessive weight and obesity[2]. Accumulating evidence has confirmed the excellent efficacy and safety of proton pump inhibitor (PPI) therapy in patients with all grades of GERD, making these agents the mainstay of treatment. Consequently, PPIs comprise the largest outpatient pharmacy expenditure in the United States. Body weight loss is commonly recommended as part of a first-line therapeutic measure for GERD, although lifestyle modifications have been relegated to a minor role in the therapeutic regime due to the effectiveness and availability of PPIs as an acid-suppressive therapy[3].

GERD is a chronic condition, necessitating continuous therapy for many patients to control symptoms and prevent complications. Long-term therapeutic options include PPI therapy and surgical or endoscopic procedures[4]. Recently, body weight loss after laparoscopic Nissen fundoplication was reported[5]. There is an extensive literature database that addresses the efficacy and safety of long-term PPI therapy. However, the possible impact of changes in body weight or body mass index (BMI) in reflux patients while on long-term PPI therapy has not been examined. We present herein the first report elucidating the effect on nutritional parameters such as body weight and BMI in patients receiving long-term PPI therapy.

MATERIALS AND METHODS

Subjects

We evaluated 52 adult patients with GERD and 58 healthy controls. We selected patients undergoing daily maintenance therapy of PPI for at least 10 mo at the University Hospital of Occupational and Environmental Health and four Gastroenterology Clinics between June and November 2005. Patients who had prior fundoplication or poor compliance with medication were excluded. Patients with GERD had received advice on lifestyle modifications such as selective diet and weight management to accompany the PPI treatment.

The controls were sex- and age-matched subjects who visited the clinic for a yearly medical examination; they were free of reflux symptoms, and did not take PPIs or histamine receptor antagonists. They did not receive advice on lifestyle modifications. Informed consent was obtained from all subjects and the study was performed in accordance with the Declaration of Helsinki as revised in 1989.

Diagnosis of GERD

The diagnosis of GERD was made based only on the typical symptoms of troublesome heartburn and/or acid regurgitation. Endoscopy at presentation was performed in patients with alarm symptoms such as dysphagia, odynophagia, bleeding, weight loss, and anemia that together suggested a complicated disease.

Treatment of GERD

Initial therapy was a standard dose of PPI (omeprazole 20 mg, rabeprazole 20 mg, or lansoprazole 30 mg) once daily for 8 wk followed by a daily maintenance half-dose therapy. The patients were followed-up at 4-wk intervals in the clinics to assess symptom recurrence. Patients found to have recurring symptoms of heartburn or acid regurgitation were placed back on their initial PPI dose. The patients were educated on lifestyle modifications by their physicians in addition to the PPI treatment. These instructions included avoidance of overeating, decreased fat intake, elevation of the head of the bed, cessation of smoking, avoiding recumbency for postprandial 3 h, and body weight control.

Nutritional parameters and blood pressure

Body weight, height, and blood pressure, as well as fasting serum levels of total protein, total cholesterol, and triglycerides were determined at baseline and at the last visit. The BMI was calculated as body weight (kg)/[height (m)]2. These parameters obtained within four weeks before the commencement of PPI therapy were defined as baseline data.

Statistical analysis

All results were expressed as mean ± SD. Categorical outcome variables were analyzed with Fisher’s exact test. For continuous variables, the Mann-Whitney U-test and Student’s t-test were used where appropriate. A P value less than 0.05 denoted the presence of a statistically significant difference between the groups.

RESULTS

Characteristics and demographics of subjects

Table details the characteristics of the 52 reflux patients and 58 healthy controls. There were no significant differences between the patient and control groups with regard to age, sex, duration of observation, body weight, body height, BMI, blood pressure, and serum values of total protein, total cholesterol, and triglycerides. Helicobacter pylori status, endoscopic findings, and PPI regimens of daily maintenance therapy in reflux patients are listed in Table .

Table 1

Baseline demographics and characteristics of reflux patients treated with long-term daily maintenance proton pump inhibitor therapy and healthy controls (mean ± SD)

Patients Control P
Number of subjects 52 58
Gender (male/female) 36/16 38/20 NS
Age (yr) 68.1 ± 10.4 68.8 ± 1.5 NS
Duration of observation (yr) NS
PPI therapy 2.1 ± 1.1
Medical checkup 2.0 ± 0.4
Body weight (kg) 56.4 ± 10.4 58.6 ± 8.4 NS
Height (cm) 156.0 ± 9.8 156.0 ± 8.9 NS
Body mass index (kg/m2) 23.1 ± 3.1 24.1 ± 2.7 NS
Blood pressure (mmHg)
Systolic 133 ± 17 132 ± 16 NS
Diastolic 75 ± 11 75 ± 9 NS
Serum total protein (g/dL) 7.2 ± 0.3 7.2 ± 0.3 NS
Serum total cholesterol (mg/dL) 210 ± 39 210 ± 25 NS
Serum triglyceride (mg/dL) 121 ± 52 107 ± 43 NS

Table 2

Patients (n = 52)
Helicobacter pylori status
Negative 9
Positive 11
ND 32
Endoscopic findings
Normal 18
LA grade A 6
LA grade B 13
LA grade C 5
LA grade D 3
ND 7
Number of patients according to PPI regimens
Omeprazole 10 mg once daily 24
Omeprazole 20 mg once daily 12
Rabeprazole 10 mg once daily 8
Lansoprazole 15 mg once daily 5
Lansoprazole 30 mg once daily 3

Effect of long-term daily PPI maintenance therapy on nutritional parameters and blood pressure

No significant differences were found between patient and control groups with respect to changes in blood pressure or serum values of total protein, total cholesterol, and triglycerides. In contrast, patients treated with PPI experienced significantly greater increases from the baseline to the last visit in body weight (P < 0.0001) and BMI (P < 0.0005) than controls (Table ).

Table 3

Mean changes in nutritional parameters and blood pressure at the last visit compared to the baseline

Patients (n = 52) Control (n = 58) P
Body weight (kg) +2.2b -0.1a < 0.0001
Body mass index (kg/m2) +0.92b +0.15a 0.0005
Blood pressure (mmHg)
Systolic +2.7 +1.9 NS
Diastolic -0.6 -1.9 NS
Serum total protein (g/dL) +0.014 +0.019 NS
Serum total cholesterol (mg/dL) -9.1 -17.1 NS
Serum Triglyceride (mg/dL) +3.1 +3.8 NS

The differences in body weight and BMI between the baseline and the last visit were analyzed separately for both groups (Table ). Body weight (P < 0.0001) and BMI (P < 0.0001) significantly increased at the last visit in reflux patients. In contrast, there was no significant difference in body weight or BMI at the last visit in controls.

Categorical changes in body weight at the last visit compared to the baseline values are shown in Figure . Most of the control group (91%) remained stable, defined by a change of no more than 5% compared to baseline weight; however, only 60% of the PPI group remained stable. In addition, 36% of these patients had an increase in body weight above baseline of more than 5%, compared with 4% of the control group (P < 0.0001).

Categorical change in body weight at the last visit compared to the baseline reading. Most of the control group (91%) remained stable, within a 5% change, compared to weight at the baseline. However, only 60% of the PPI group remained stable. In addition, compared with 4% of the control group, 36% of patients had a more than 5% increase above the baseline in body weight (P < 0.0001). n: Number of patients or control subjects.

DISCUSSION

This study demonstrated for the first time that long-term PPI treatment is associated with undesirable body weight gain in patients with GERD, despite lifestyle modification recommendations by their physicians. Heartburn is the classical symptom of GERD, with patients generally reporting a burning feeling, rising from the stomach and radiating toward the neck and throat. It usually occurs postprandially, particularly after large meals or the consumption of fats. Untreated patients suffering from reflux symptoms find it difficult to have large meals, because this generally aggravates their symptoms. Untreated patients may therefore reduce their meal sizes and intake of fats intentionally or unintentionally. It is conceivable, therefore, that the resolution of reflux symptoms by PPI treatment leads to a higher food intake resulting in body weight gain.

Laparoscopic Nissen fundoplication has evolved as a gold standard in antireflux surgery. This surgical therapy induces a significant and persistent reduction in body weight, possibly due to postoperative dysphagia or delayed gastric emptying[5]. In contrast, the option of long-term PPI therapy was associated with a significant body weight gain in the present study. Omeprazole and other PPIs delay gastric emptying[6-9], which induces postprandial fullness, dyspeptic symptoms, gastrointestinal bacterial overgrowth, and subsequent weight loss[10,11]. Our results have clearly demonstrated that long-term PPI therapy contributed significantly to body weight changes in patients with GERD by relieving the adverse symptoms rather than altering the state of gastric emptying.

Numerous circulating peptides influence appetite. Ghrelin is produced in the stomach and acts as a meal initiator. A recent report revealed that long-term PPI therapy did not change the serum ghrelin level[12]. Another peptide, leptin, is produced in the stomach and acts as an enteric signal involved in energy homeostasis. Change of this peptide associated with PPI therapy has not been reported.

A practice guideline for patients with GERD recommends the use of lifestyle modifications such as elevation of the bed head, a decreased intake of fat, chocolate, alcohol, peppermint, coffee, onions and garlic, cessation of smoking, and avoiding recumbency for three hours postprandially, in addition to taking antireflux medications[13]. However, the positive advantage of such lifestyle modifications on the patient’s condition is not well substantiated. Among these lifestyle interventions, elevation of the bed head, left lateral decubitus positioning, and weight loss are associated with improvement in reflux symptoms in case-control studies[14,15]. These modifications alone, however, are unlikely to control symptoms in the majority of patients[13]. Our results support the finding that lifestyle modifications are an essential component of the treatment for GERD and the prevention of weight gain during PPI treatment.

There is a growing body of literature regarding the association between BMI and GERD[2,16-24]. A recent large meta-analysis of previous studies demonstrated a strong positive relationship between BMI and reflux symptoms[2]. In addition, moderate weight gains, even among normal-weight persons, resulted in the development or exacerbation of symptoms in GERD patients[16]. In the present study, the patients significantly increased their body weight during PPI therapy. Appropriate management of body weight during PPI treatment should reduce the duration of PPI use or PPI dosage.

Excessive weight is associated with an increased risk of coronary heart disease, hypertension, angina, stroke, and diabetes, and constitutes an important cardiovascular health burden[25]. Body weight gain associated with lifetime GERD treatment may induce further medical costs in addition to the PPI therapy. Unfortunately, potentially effective diet modifications are often underestimated in the presence of various PPI regimens. Healthcare providers still recommend lifestyle changes in a moderate percentage of GERD patients[26], and while PPIs have become of pivotal importance for the initial and maintenance treatment of GERD, repeated lifestyle modification recommendations are required.

In conclusion, we elucidated in the present study the impact of long-term PPI therapy on body weight. Undesired body weight gain was observed in GERD patients on long-term PPI treatment. Reflux patients treated with a daily maintenance therapy of PPI should be strongly encouraged to manage their body weight through lifestyle modifications such as proper diet and avoidance of overeating. This measure may reduce the overall medical costs associated with obesity-related illness as well as GERD. Lifestyle modification must therefore remain the backbone of treatment for all patients with GERD, even in the PPI era.

Long-term treatment with proton pump inhibitor is associated with undesired weight gain

Abstract

AIM: To examine the effects of long-term proton pump inhibitor (PPI) therapy on body weight (BW) and body mass index (BMI) in patients with gastroesophageal reflux disease (GERD).

METHODS: The subjects were 52 patients with GERD and 58 sex- and age-matched healthy controls. GERD patients were treated with PPI for a mean of 2.2 years (range, 0.8-5.7 years), and also advised on lifestyle modifications (e.g. selective diet, weight management). BW, BMI and other parameters were measured at baseline and end of study.

RESULTS: Twenty-four GERD patients were treated daily with 10 mg omeprazole, 12 with 20 mg omeprazole, 8 with 10 mg rabeprazole, 5 with 15 mg lansoprazole, and 3 patients with 30 mg lansoprazole. At baseline, there were no differences in BW and BMI between reflux patients and controls. Patients with GERD showed increases in BW (baseline: 56.4 ± 10.4 kg, end: 58.6 ± 10.8 kg, mean ± SD, P < 0.0001) and BMI (baseline: 23.1 ± 3.1 kg/m2, end: 24.0 ± 3.1 kg/m2, P < 0.001), but no such changes were noted in the control group. Mean BW increased by 3.5 kg (6.2% of baseline) in 37 (71%) reflux patients but decreased in only 6 (12%) patients during treatment.

CONCLUSION: Long-term PPI treatment was associated with BW gain in patients with GERD. Reflux patients receiving PPI should be encouraged to manage BW through lifestyle modifications.

Keywords: Gastroesophageal reflux disease, Proton pump inhibitor, Body weight

INTRODUCTION

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder, and frequently encountered in the primary care setting. It has been estimated that 15%-25% of persons experience reflux symptoms at least weekly, and 5%-12% suffer on a daily basis[1].

The risk of reflux symptoms, erosive esophagitis, or esophageal adenocarcinoma increases with excessive weight and obesity[2]. Accumulating evidence has confirmed the excellent efficacy and safety of proton pump inhibitor (PPI) therapy in patients with all grades of GERD, making these agents the mainstay of treatment. Consequently, PPIs comprise the largest outpatient pharmacy expenditure in the United States. Body weight loss is commonly recommended as part of a first-line therapeutic measure for GERD, although lifestyle modifications have been relegated to a minor role in the therapeutic regime due to the effectiveness and availability of PPIs as an acid-suppressive therapy[3].

GERD is a chronic condition, necessitating continuous therapy for many patients to control symptoms and prevent complications. Long-term therapeutic options include PPI therapy and surgical or endoscopic procedures[4]. Recently, body weight loss after laparoscopic Nissen fundoplication was reported[5]. There is an extensive literature database that addresses the efficacy and safety of long-term PPI therapy. However, the possible impact of changes in body weight or body mass index (BMI) in reflux patients while on long-term PPI therapy has not been examined. We present herein the first report elucidating the effect on nutritional parameters such as body weight and BMI in patients receiving long-term PPI therapy.

MATERIALS AND METHODS

Subjects

We evaluated 52 adult patients with GERD and 58 healthy controls. We selected patients undergoing daily maintenance therapy of PPI for at least 10 mo at the University Hospital of Occupational and Environmental Health and four Gastroenterology Clinics between June and November 2005. Patients who had prior fundoplication or poor compliance with medication were excluded. Patients with GERD had received advice on lifestyle modifications such as selective diet and weight management to accompany the PPI treatment.

The controls were sex- and age-matched subjects who visited the clinic for a yearly medical examination; they were free of reflux symptoms, and did not take PPIs or histamine receptor antagonists. They did not receive advice on lifestyle modifications. Informed consent was obtained from all subjects and the study was performed in accordance with the Declaration of Helsinki as revised in 1989.

Diagnosis of GERD

The diagnosis of GERD was made based only on the typical symptoms of troublesome heartburn and/or acid regurgitation. Endoscopy at presentation was performed in patients with alarm symptoms such as dysphagia, odynophagia, bleeding, weight loss, and anemia that together suggested a complicated disease.

Treatment of GERD

Initial therapy was a standard dose of PPI (omeprazole 20 mg, rabeprazole 20 mg, or lansoprazole 30 mg) once daily for 8 wk followed by a daily maintenance half-dose therapy. The patients were followed-up at 4-wk intervals in the clinics to assess symptom recurrence. Patients found to have recurring symptoms of heartburn or acid regurgitation were placed back on their initial PPI dose. The patients were educated on lifestyle modifications by their physicians in addition to the PPI treatment. These instructions included avoidance of overeating, decreased fat intake, elevation of the head of the bed, cessation of smoking, avoiding recumbency for postprandial 3 h, and body weight control.

Nutritional parameters and blood pressure

Body weight, height, and blood pressure, as well as fasting serum levels of total protein, total cholesterol, and triglycerides were determined at baseline and at the last visit. The BMI was calculated as body weight (kg)/[height (m)]2. These parameters obtained within four weeks before the commencement of PPI therapy were defined as baseline data.

Statistical analysis

All results were expressed as mean ± SD. Categorical outcome variables were analyzed with Fisher’s exact test. For continuous variables, the Mann-Whitney U-test and Student’s t-test were used where appropriate. A P value less than 0.05 denoted the presence of a statistically significant difference between the groups.

RESULTS

Characteristics and demographics of subjects

Table details the characteristics of the 52 reflux patients and 58 healthy controls. There were no significant differences between the patient and control groups with regard to age, sex, duration of observation, body weight, body height, BMI, blood pressure, and serum values of total protein, total cholesterol, and triglycerides. Helicobacter pylori status, endoscopic findings, and PPI regimens of daily maintenance therapy in reflux patients are listed in Table .

Table 1

Baseline demographics and characteristics of reflux patients treated with long-term daily maintenance proton pump inhibitor therapy and healthy controls (mean ± SD)

Patients Control P
Number of subjects 52 58
Gender (male/female) 36/16 38/20 NS
Age (yr) 68.1 ± 10.4 68.8 ± 1.5 NS
Duration of observation (yr) NS
PPI therapy 2.1 ± 1.1
Medical checkup 2.0 ± 0.4
Body weight (kg) 56.4 ± 10.4 58.6 ± 8.4 NS
Height (cm) 156.0 ± 9.8 156.0 ± 8.9 NS
Body mass index (kg/m2) 23.1 ± 3.1 24.1 ± 2.7 NS
Blood pressure (mmHg)
Systolic 133 ± 17 132 ± 16 NS
Diastolic 75 ± 11 75 ± 9 NS
Serum total protein (g/dL) 7.2 ± 0.3 7.2 ± 0.3 NS
Serum total cholesterol (mg/dL) 210 ± 39 210 ± 25 NS
Serum triglyceride (mg/dL) 121 ± 52 107 ± 43 NS

Table 2

Patients (n = 52)
Helicobacter pylori status
Negative 9
Positive 11
ND 32
Endoscopic findings
Normal 18
LA grade A 6
LA grade B 13
LA grade C 5
LA grade D 3
ND 7
Number of patients according to PPI regimens
Omeprazole 10 mg once daily 24
Omeprazole 20 mg once daily 12
Rabeprazole 10 mg once daily 8
Lansoprazole 15 mg once daily 5
Lansoprazole 30 mg once daily 3

Effect of long-term daily PPI maintenance therapy on nutritional parameters and blood pressure

No significant differences were found between patient and control groups with respect to changes in blood pressure or serum values of total protein, total cholesterol, and triglycerides. In contrast, patients treated with PPI experienced significantly greater increases from the baseline to the last visit in body weight (P < 0.0001) and BMI (P < 0.0005) than controls (Table ).

Table 3

Mean changes in nutritional parameters and blood pressure at the last visit compared to the baseline

Patients (n = 52) Control (n = 58) P
Body weight (kg) +2.2b -0.1a < 0.0001
Body mass index (kg/m2) +0.92b +0.15a 0.0005
Blood pressure (mmHg)
Systolic +2.7 +1.9 NS
Diastolic -0.6 -1.9 NS
Serum total protein (g/dL) +0.014 +0.019 NS
Serum total cholesterol (mg/dL) -9.1 -17.1 NS
Serum Triglyceride (mg/dL) +3.1 +3.8 NS

The differences in body weight and BMI between the baseline and the last visit were analyzed separately for both groups (Table ). Body weight (P < 0.0001) and BMI (P < 0.0001) significantly increased at the last visit in reflux patients. In contrast, there was no significant difference in body weight or BMI at the last visit in controls.

Categorical changes in body weight at the last visit compared to the baseline values are shown in Figure . Most of the control group (91%) remained stable, defined by a change of no more than 5% compared to baseline weight; however, only 60% of the PPI group remained stable. In addition, 36% of these patients had an increase in body weight above baseline of more than 5%, compared with 4% of the control group (P < 0.0001).

Categorical change in body weight at the last visit compared to the baseline reading. Most of the control group (91%) remained stable, within a 5% change, compared to weight at the baseline. However, only 60% of the PPI group remained stable. In addition, compared with 4% of the control group, 36% of patients had a more than 5% increase above the baseline in body weight (P < 0.0001). n: Number of patients or control subjects.

DISCUSSION

This study demonstrated for the first time that long-term PPI treatment is associated with undesirable body weight gain in patients with GERD, despite lifestyle modification recommendations by their physicians. Heartburn is the classical symptom of GERD, with patients generally reporting a burning feeling, rising from the stomach and radiating toward the neck and throat. It usually occurs postprandially, particularly after large meals or the consumption of fats. Untreated patients suffering from reflux symptoms find it difficult to have large meals, because this generally aggravates their symptoms. Untreated patients may therefore reduce their meal sizes and intake of fats intentionally or unintentionally. It is conceivable, therefore, that the resolution of reflux symptoms by PPI treatment leads to a higher food intake resulting in body weight gain.

Laparoscopic Nissen fundoplication has evolved as a gold standard in antireflux surgery. This surgical therapy induces a significant and persistent reduction in body weight, possibly due to postoperative dysphagia or delayed gastric emptying[5]. In contrast, the option of long-term PPI therapy was associated with a significant body weight gain in the present study. Omeprazole and other PPIs delay gastric emptying[6-9], which induces postprandial fullness, dyspeptic symptoms, gastrointestinal bacterial overgrowth, and subsequent weight loss[10,11]. Our results have clearly demonstrated that long-term PPI therapy contributed significantly to body weight changes in patients with GERD by relieving the adverse symptoms rather than altering the state of gastric emptying.

Numerous circulating peptides influence appetite. Ghrelin is produced in the stomach and acts as a meal initiator. A recent report revealed that long-term PPI therapy did not change the serum ghrelin level[12]. Another peptide, leptin, is produced in the stomach and acts as an enteric signal involved in energy homeostasis. Change of this peptide associated with PPI therapy has not been reported.

A practice guideline for patients with GERD recommends the use of lifestyle modifications such as elevation of the bed head, a decreased intake of fat, chocolate, alcohol, peppermint, coffee, onions and garlic, cessation of smoking, and avoiding recumbency for three hours postprandially, in addition to taking antireflux medications[13]. However, the positive advantage of such lifestyle modifications on the patient’s condition is not well substantiated. Among these lifestyle interventions, elevation of the bed head, left lateral decubitus positioning, and weight loss are associated with improvement in reflux symptoms in case-control studies[14,15]. These modifications alone, however, are unlikely to control symptoms in the majority of patients[13]. Our results support the finding that lifestyle modifications are an essential component of the treatment for GERD and the prevention of weight gain during PPI treatment.

There is a growing body of literature regarding the association between BMI and GERD[2,16-24]. A recent large meta-analysis of previous studies demonstrated a strong positive relationship between BMI and reflux symptoms[2]. In addition, moderate weight gains, even among normal-weight persons, resulted in the development or exacerbation of symptoms in GERD patients[16]. In the present study, the patients significantly increased their body weight during PPI therapy. Appropriate management of body weight during PPI treatment should reduce the duration of PPI use or PPI dosage.

Excessive weight is associated with an increased risk of coronary heart disease, hypertension, angina, stroke, and diabetes, and constitutes an important cardiovascular health burden[25]. Body weight gain associated with lifetime GERD treatment may induce further medical costs in addition to the PPI therapy. Unfortunately, potentially effective diet modifications are often underestimated in the presence of various PPI regimens. Healthcare providers still recommend lifestyle changes in a moderate percentage of GERD patients[26], and while PPIs have become of pivotal importance for the initial and maintenance treatment of GERD, repeated lifestyle modification recommendations are required.

In conclusion, we elucidated in the present study the impact of long-term PPI therapy on body weight. Undesired body weight gain was observed in GERD patients on long-term PPI treatment. Reflux patients treated with a daily maintenance therapy of PPI should be strongly encouraged to manage their body weight through lifestyle modifications such as proper diet and avoidance of overeating. This measure may reduce the overall medical costs associated with obesity-related illness as well as GERD. Lifestyle modification must therefore remain the backbone of treatment for all patients with GERD, even in the PPI era.

Long-term treatment with proton pump inhibitor is associated with undesired weight gain

Abstract

AIM: To examine the effects of long-term proton pump inhibitor (PPI) therapy on body weight (BW) and body mass index (BMI) in patients with gastroesophageal reflux disease (GERD).

METHODS: The subjects were 52 patients with GERD and 58 sex- and age-matched healthy controls. GERD patients were treated with PPI for a mean of 2.2 years (range, 0.8-5.7 years), and also advised on lifestyle modifications (e.g. selective diet, weight management). BW, BMI and other parameters were measured at baseline and end of study.

RESULTS: Twenty-four GERD patients were treated daily with 10 mg omeprazole, 12 with 20 mg omeprazole, 8 with 10 mg rabeprazole, 5 with 15 mg lansoprazole, and 3 patients with 30 mg lansoprazole. At baseline, there were no differences in BW and BMI between reflux patients and controls. Patients with GERD showed increases in BW (baseline: 56.4 ± 10.4 kg, end: 58.6 ± 10.8 kg, mean ± SD, P < 0.0001) and BMI (baseline: 23.1 ± 3.1 kg/m2, end: 24.0 ± 3.1 kg/m2, P < 0.001), but no such changes were noted in the control group. Mean BW increased by 3.5 kg (6.2% of baseline) in 37 (71%) reflux patients but decreased in only 6 (12%) patients during treatment.

CONCLUSION: Long-term PPI treatment was associated with BW gain in patients with GERD. Reflux patients receiving PPI should be encouraged to manage BW through lifestyle modifications.

Keywords: Gastroesophageal reflux disease, Proton pump inhibitor, Body weight

INTRODUCTION

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder, and frequently encountered in the primary care setting. It has been estimated that 15%-25% of persons experience reflux symptoms at least weekly, and 5%-12% suffer on a daily basis[1].

The risk of reflux symptoms, erosive esophagitis, or esophageal adenocarcinoma increases with excessive weight and obesity[2]. Accumulating evidence has confirmed the excellent efficacy and safety of proton pump inhibitor (PPI) therapy in patients with all grades of GERD, making these agents the mainstay of treatment. Consequently, PPIs comprise the largest outpatient pharmacy expenditure in the United States. Body weight loss is commonly recommended as part of a first-line therapeutic measure for GERD, although lifestyle modifications have been relegated to a minor role in the therapeutic regime due to the effectiveness and availability of PPIs as an acid-suppressive therapy[3].

GERD is a chronic condition, necessitating continuous therapy for many patients to control symptoms and prevent complications. Long-term therapeutic options include PPI therapy and surgical or endoscopic procedures[4]. Recently, body weight loss after laparoscopic Nissen fundoplication was reported[5]. There is an extensive literature database that addresses the efficacy and safety of long-term PPI therapy. However, the possible impact of changes in body weight or body mass index (BMI) in reflux patients while on long-term PPI therapy has not been examined. We present herein the first report elucidating the effect on nutritional parameters such as body weight and BMI in patients receiving long-term PPI therapy.

MATERIALS AND METHODS

Subjects

We evaluated 52 adult patients with GERD and 58 healthy controls. We selected patients undergoing daily maintenance therapy of PPI for at least 10 mo at the University Hospital of Occupational and Environmental Health and four Gastroenterology Clinics between June and November 2005. Patients who had prior fundoplication or poor compliance with medication were excluded. Patients with GERD had received advice on lifestyle modifications such as selective diet and weight management to accompany the PPI treatment.

The controls were sex- and age-matched subjects who visited the clinic for a yearly medical examination; they were free of reflux symptoms, and did not take PPIs or histamine receptor antagonists. They did not receive advice on lifestyle modifications. Informed consent was obtained from all subjects and the study was performed in accordance with the Declaration of Helsinki as revised in 1989.

Diagnosis of GERD

The diagnosis of GERD was made based only on the typical symptoms of troublesome heartburn and/or acid regurgitation. Endoscopy at presentation was performed in patients with alarm symptoms such as dysphagia, odynophagia, bleeding, weight loss, and anemia that together suggested a complicated disease.

Treatment of GERD

Initial therapy was a standard dose of PPI (omeprazole 20 mg, rabeprazole 20 mg, or lansoprazole 30 mg) once daily for 8 wk followed by a daily maintenance half-dose therapy. The patients were followed-up at 4-wk intervals in the clinics to assess symptom recurrence. Patients found to have recurring symptoms of heartburn or acid regurgitation were placed back on their initial PPI dose. The patients were educated on lifestyle modifications by their physicians in addition to the PPI treatment. These instructions included avoidance of overeating, decreased fat intake, elevation of the head of the bed, cessation of smoking, avoiding recumbency for postprandial 3 h, and body weight control.

Nutritional parameters and blood pressure

Body weight, height, and blood pressure, as well as fasting serum levels of total protein, total cholesterol, and triglycerides were determined at baseline and at the last visit. The BMI was calculated as body weight (kg)/[height (m)]2. These parameters obtained within four weeks before the commencement of PPI therapy were defined as baseline data.

Statistical analysis

All results were expressed as mean ± SD. Categorical outcome variables were analyzed with Fisher’s exact test. For continuous variables, the Mann-Whitney U-test and Student’s t-test were used where appropriate. A P value less than 0.05 denoted the presence of a statistically significant difference between the groups.

RESULTS

Characteristics and demographics of subjects

Table details the characteristics of the 52 reflux patients and 58 healthy controls. There were no significant differences between the patient and control groups with regard to age, sex, duration of observation, body weight, body height, BMI, blood pressure, and serum values of total protein, total cholesterol, and triglycerides. Helicobacter pylori status, endoscopic findings, and PPI regimens of daily maintenance therapy in reflux patients are listed in Table .

Table 1

Baseline demographics and characteristics of reflux patients treated with long-term daily maintenance proton pump inhibitor therapy and healthy controls (mean ± SD)

Patients Control P
Number of subjects 52 58
Gender (male/female) 36/16 38/20 NS
Age (yr) 68.1 ± 10.4 68.8 ± 1.5 NS
Duration of observation (yr) NS
PPI therapy 2.1 ± 1.1
Medical checkup 2.0 ± 0.4
Body weight (kg) 56.4 ± 10.4 58.6 ± 8.4 NS
Height (cm) 156.0 ± 9.8 156.0 ± 8.9 NS
Body mass index (kg/m2) 23.1 ± 3.1 24.1 ± 2.7 NS
Blood pressure (mmHg)
Systolic 133 ± 17 132 ± 16 NS
Diastolic 75 ± 11 75 ± 9 NS
Serum total protein (g/dL) 7.2 ± 0.3 7.2 ± 0.3 NS
Serum total cholesterol (mg/dL) 210 ± 39 210 ± 25 NS
Serum triglyceride (mg/dL) 121 ± 52 107 ± 43 NS

Table 2

Patients (n = 52)
Helicobacter pylori status
Negative 9
Positive 11
ND 32
Endoscopic findings
Normal 18
LA grade A 6
LA grade B 13
LA grade C 5
LA grade D 3
ND 7
Number of patients according to PPI regimens
Omeprazole 10 mg once daily 24
Omeprazole 20 mg once daily 12
Rabeprazole 10 mg once daily 8
Lansoprazole 15 mg once daily 5
Lansoprazole 30 mg once daily 3

Effect of long-term daily PPI maintenance therapy on nutritional parameters and blood pressure

No significant differences were found between patient and control groups with respect to changes in blood pressure or serum values of total protein, total cholesterol, and triglycerides. In contrast, patients treated with PPI experienced significantly greater increases from the baseline to the last visit in body weight (P < 0.0001) and BMI (P < 0.0005) than controls (Table ).

Table 3

Mean changes in nutritional parameters and blood pressure at the last visit compared to the baseline

Patients (n = 52) Control (n = 58) P
Body weight (kg) +2.2b -0.1a < 0.0001
Body mass index (kg/m2) +0.92b +0.15a 0.0005
Blood pressure (mmHg)
Systolic +2.7 +1.9 NS
Diastolic -0.6 -1.9 NS
Serum total protein (g/dL) +0.014 +0.019 NS
Serum total cholesterol (mg/dL) -9.1 -17.1 NS
Serum Triglyceride (mg/dL) +3.1 +3.8 NS

The differences in body weight and BMI between the baseline and the last visit were analyzed separately for both groups (Table ). Body weight (P < 0.0001) and BMI (P < 0.0001) significantly increased at the last visit in reflux patients. In contrast, there was no significant difference in body weight or BMI at the last visit in controls.

Categorical changes in body weight at the last visit compared to the baseline values are shown in Figure . Most of the control group (91%) remained stable, defined by a change of no more than 5% compared to baseline weight; however, only 60% of the PPI group remained stable. In addition, 36% of these patients had an increase in body weight above baseline of more than 5%, compared with 4% of the control group (P < 0.0001).

Categorical change in body weight at the last visit compared to the baseline reading. Most of the control group (91%) remained stable, within a 5% change, compared to weight at the baseline. However, only 60% of the PPI group remained stable. In addition, compared with 4% of the control group, 36% of patients had a more than 5% increase above the baseline in body weight (P < 0.0001). n: Number of patients or control subjects.

DISCUSSION

This study demonstrated for the first time that long-term PPI treatment is associated with undesirable body weight gain in patients with GERD, despite lifestyle modification recommendations by their physicians. Heartburn is the classical symptom of GERD, with patients generally reporting a burning feeling, rising from the stomach and radiating toward the neck and throat. It usually occurs postprandially, particularly after large meals or the consumption of fats. Untreated patients suffering from reflux symptoms find it difficult to have large meals, because this generally aggravates their symptoms. Untreated patients may therefore reduce their meal sizes and intake of fats intentionally or unintentionally. It is conceivable, therefore, that the resolution of reflux symptoms by PPI treatment leads to a higher food intake resulting in body weight gain.

Laparoscopic Nissen fundoplication has evolved as a gold standard in antireflux surgery. This surgical therapy induces a significant and persistent reduction in body weight, possibly due to postoperative dysphagia or delayed gastric emptying[5]. In contrast, the option of long-term PPI therapy was associated with a significant body weight gain in the present study. Omeprazole and other PPIs delay gastric emptying[6-9], which induces postprandial fullness, dyspeptic symptoms, gastrointestinal bacterial overgrowth, and subsequent weight loss[10,11]. Our results have clearly demonstrated that long-term PPI therapy contributed significantly to body weight changes in patients with GERD by relieving the adverse symptoms rather than altering the state of gastric emptying.

Numerous circulating peptides influence appetite. Ghrelin is produced in the stomach and acts as a meal initiator. A recent report revealed that long-term PPI therapy did not change the serum ghrelin level[12]. Another peptide, leptin, is produced in the stomach and acts as an enteric signal involved in energy homeostasis. Change of this peptide associated with PPI therapy has not been reported.

A practice guideline for patients with GERD recommends the use of lifestyle modifications such as elevation of the bed head, a decreased intake of fat, chocolate, alcohol, peppermint, coffee, onions and garlic, cessation of smoking, and avoiding recumbency for three hours postprandially, in addition to taking antireflux medications[13]. However, the positive advantage of such lifestyle modifications on the patient’s condition is not well substantiated. Among these lifestyle interventions, elevation of the bed head, left lateral decubitus positioning, and weight loss are associated with improvement in reflux symptoms in case-control studies[14,15]. These modifications alone, however, are unlikely to control symptoms in the majority of patients[13]. Our results support the finding that lifestyle modifications are an essential component of the treatment for GERD and the prevention of weight gain during PPI treatment.

There is a growing body of literature regarding the association between BMI and GERD[2,16-24]. A recent large meta-analysis of previous studies demonstrated a strong positive relationship between BMI and reflux symptoms[2]. In addition, moderate weight gains, even among normal-weight persons, resulted in the development or exacerbation of symptoms in GERD patients[16]. In the present study, the patients significantly increased their body weight during PPI therapy. Appropriate management of body weight during PPI treatment should reduce the duration of PPI use or PPI dosage.

Excessive weight is associated with an increased risk of coronary heart disease, hypertension, angina, stroke, and diabetes, and constitutes an important cardiovascular health burden[25]. Body weight gain associated with lifetime GERD treatment may induce further medical costs in addition to the PPI therapy. Unfortunately, potentially effective diet modifications are often underestimated in the presence of various PPI regimens. Healthcare providers still recommend lifestyle changes in a moderate percentage of GERD patients[26], and while PPIs have become of pivotal importance for the initial and maintenance treatment of GERD, repeated lifestyle modification recommendations are required.

In conclusion, we elucidated in the present study the impact of long-term PPI therapy on body weight. Undesired body weight gain was observed in GERD patients on long-term PPI treatment. Reflux patients treated with a daily maintenance therapy of PPI should be strongly encouraged to manage their body weight through lifestyle modifications such as proper diet and avoidance of overeating. This measure may reduce the overall medical costs associated with obesity-related illness as well as GERD. Lifestyle modification must therefore remain the backbone of treatment for all patients with GERD, even in the PPI era.

Long-term treatment with proton pump inhibitor is associated with undesired weight gain

Abstract

AIM: To examine the effects of long-term proton pump inhibitor (PPI) therapy on body weight (BW) and body mass index (BMI) in patients with gastroesophageal reflux disease (GERD).

METHODS: The subjects were 52 patients with GERD and 58 sex- and age-matched healthy controls. GERD patients were treated with PPI for a mean of 2.2 years (range, 0.8-5.7 years), and also advised on lifestyle modifications (e.g. selective diet, weight management). BW, BMI and other parameters were measured at baseline and end of study.

RESULTS: Twenty-four GERD patients were treated daily with 10 mg omeprazole, 12 with 20 mg omeprazole, 8 with 10 mg rabeprazole, 5 with 15 mg lansoprazole, and 3 patients with 30 mg lansoprazole. At baseline, there were no differences in BW and BMI between reflux patients and controls. Patients with GERD showed increases in BW (baseline: 56.4 ± 10.4 kg, end: 58.6 ± 10.8 kg, mean ± SD, P < 0.0001) and BMI (baseline: 23.1 ± 3.1 kg/m2, end: 24.0 ± 3.1 kg/m2, P < 0.001), but no such changes were noted in the control group. Mean BW increased by 3.5 kg (6.2% of baseline) in 37 (71%) reflux patients but decreased in only 6 (12%) patients during treatment.

CONCLUSION: Long-term PPI treatment was associated with BW gain in patients with GERD. Reflux patients receiving PPI should be encouraged to manage BW through lifestyle modifications.

Keywords: Gastroesophageal reflux disease, Proton pump inhibitor, Body weight

INTRODUCTION

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder, and frequently encountered in the primary care setting. It has been estimated that 15%-25% of persons experience reflux symptoms at least weekly, and 5%-12% suffer on a daily basis[1].

The risk of reflux symptoms, erosive esophagitis, or esophageal adenocarcinoma increases with excessive weight and obesity[2]. Accumulating evidence has confirmed the excellent efficacy and safety of proton pump inhibitor (PPI) therapy in patients with all grades of GERD, making these agents the mainstay of treatment. Consequently, PPIs comprise the largest outpatient pharmacy expenditure in the United States. Body weight loss is commonly recommended as part of a first-line therapeutic measure for GERD, although lifestyle modifications have been relegated to a minor role in the therapeutic regime due to the effectiveness and availability of PPIs as an acid-suppressive therapy[3].

GERD is a chronic condition, necessitating continuous therapy for many patients to control symptoms and prevent complications. Long-term therapeutic options include PPI therapy and surgical or endoscopic procedures[4]. Recently, body weight loss after laparoscopic Nissen fundoplication was reported[5]. There is an extensive literature database that addresses the efficacy and safety of long-term PPI therapy. However, the possible impact of changes in body weight or body mass index (BMI) in reflux patients while on long-term PPI therapy has not been examined. We present herein the first report elucidating the effect on nutritional parameters such as body weight and BMI in patients receiving long-term PPI therapy.

MATERIALS AND METHODS

Subjects

We evaluated 52 adult patients with GERD and 58 healthy controls. We selected patients undergoing daily maintenance therapy of PPI for at least 10 mo at the University Hospital of Occupational and Environmental Health and four Gastroenterology Clinics between June and November 2005. Patients who had prior fundoplication or poor compliance with medication were excluded. Patients with GERD had received advice on lifestyle modifications such as selective diet and weight management to accompany the PPI treatment.

The controls were sex- and age-matched subjects who visited the clinic for a yearly medical examination; they were free of reflux symptoms, and did not take PPIs or histamine receptor antagonists. They did not receive advice on lifestyle modifications. Informed consent was obtained from all subjects and the study was performed in accordance with the Declaration of Helsinki as revised in 1989.

Diagnosis of GERD

The diagnosis of GERD was made based only on the typical symptoms of troublesome heartburn and/or acid regurgitation. Endoscopy at presentation was performed in patients with alarm symptoms such as dysphagia, odynophagia, bleeding, weight loss, and anemia that together suggested a complicated disease.

Treatment of GERD

Initial therapy was a standard dose of PPI (omeprazole 20 mg, rabeprazole 20 mg, or lansoprazole 30 mg) once daily for 8 wk followed by a daily maintenance half-dose therapy. The patients were followed-up at 4-wk intervals in the clinics to assess symptom recurrence. Patients found to have recurring symptoms of heartburn or acid regurgitation were placed back on their initial PPI dose. The patients were educated on lifestyle modifications by their physicians in addition to the PPI treatment. These instructions included avoidance of overeating, decreased fat intake, elevation of the head of the bed, cessation of smoking, avoiding recumbency for postprandial 3 h, and body weight control.

Nutritional parameters and blood pressure

Body weight, height, and blood pressure, as well as fasting serum levels of total protein, total cholesterol, and triglycerides were determined at baseline and at the last visit. The BMI was calculated as body weight (kg)/[height (m)]2. These parameters obtained within four weeks before the commencement of PPI therapy were defined as baseline data.

Statistical analysis

All results were expressed as mean ± SD. Categorical outcome variables were analyzed with Fisher’s exact test. For continuous variables, the Mann-Whitney U-test and Student’s t-test were used where appropriate. A P value less than 0.05 denoted the presence of a statistically significant difference between the groups.

RESULTS

Characteristics and demographics of subjects

Table details the characteristics of the 52 reflux patients and 58 healthy controls. There were no significant differences between the patient and control groups with regard to age, sex, duration of observation, body weight, body height, BMI, blood pressure, and serum values of total protein, total cholesterol, and triglycerides. Helicobacter pylori status, endoscopic findings, and PPI regimens of daily maintenance therapy in reflux patients are listed in Table .

Table 1

Baseline demographics and characteristics of reflux patients treated with long-term daily maintenance proton pump inhibitor therapy and healthy controls (mean ± SD)

Patients Control P
Number of subjects 52 58
Gender (male/female) 36/16 38/20 NS
Age (yr) 68.1 ± 10.4 68.8 ± 1.5 NS
Duration of observation (yr) NS
PPI therapy 2.1 ± 1.1
Medical checkup 2.0 ± 0.4
Body weight (kg) 56.4 ± 10.4 58.6 ± 8.4 NS
Height (cm) 156.0 ± 9.8 156.0 ± 8.9 NS
Body mass index (kg/m2) 23.1 ± 3.1 24.1 ± 2.7 NS
Blood pressure (mmHg)
Systolic 133 ± 17 132 ± 16 NS
Diastolic 75 ± 11 75 ± 9 NS
Serum total protein (g/dL) 7.2 ± 0.3 7.2 ± 0.3 NS
Serum total cholesterol (mg/dL) 210 ± 39 210 ± 25 NS
Serum triglyceride (mg/dL) 121 ± 52 107 ± 43 NS

Table 2

Patients (n = 52)
Helicobacter pylori status
Negative 9
Positive 11
ND 32
Endoscopic findings
Normal 18
LA grade A 6
LA grade B 13
LA grade C 5
LA grade D 3
ND 7
Number of patients according to PPI regimens
Omeprazole 10 mg once daily 24
Omeprazole 20 mg once daily 12
Rabeprazole 10 mg once daily 8
Lansoprazole 15 mg once daily 5
Lansoprazole 30 mg once daily 3

Effect of long-term daily PPI maintenance therapy on nutritional parameters and blood pressure

No significant differences were found between patient and control groups with respect to changes in blood pressure or serum values of total protein, total cholesterol, and triglycerides. In contrast, patients treated with PPI experienced significantly greater increases from the baseline to the last visit in body weight (P < 0.0001) and BMI (P < 0.0005) than controls (Table ).

Table 3

Mean changes in nutritional parameters and blood pressure at the last visit compared to the baseline

Patients (n = 52) Control (n = 58) P
Body weight (kg) +2.2b -0.1a < 0.0001
Body mass index (kg/m2) +0.92b +0.15a 0.0005
Blood pressure (mmHg)
Systolic +2.7 +1.9 NS
Diastolic -0.6 -1.9 NS
Serum total protein (g/dL) +0.014 +0.019 NS
Serum total cholesterol (mg/dL) -9.1 -17.1 NS
Serum Triglyceride (mg/dL) +3.1 +3.8 NS

The differences in body weight and BMI between the baseline and the last visit were analyzed separately for both groups (Table ). Body weight (P < 0.0001) and BMI (P < 0.0001) significantly increased at the last visit in reflux patients. In contrast, there was no significant difference in body weight or BMI at the last visit in controls.

Categorical changes in body weight at the last visit compared to the baseline values are shown in Figure . Most of the control group (91%) remained stable, defined by a change of no more than 5% compared to baseline weight; however, only 60% of the PPI group remained stable. In addition, 36% of these patients had an increase in body weight above baseline of more than 5%, compared with 4% of the control group (P < 0.0001).

Categorical change in body weight at the last visit compared to the baseline reading. Most of the control group (91%) remained stable, within a 5% change, compared to weight at the baseline. However, only 60% of the PPI group remained stable. In addition, compared with 4% of the control group, 36% of patients had a more than 5% increase above the baseline in body weight (P < 0.0001). n: Number of patients or control subjects.

DISCUSSION

This study demonstrated for the first time that long-term PPI treatment is associated with undesirable body weight gain in patients with GERD, despite lifestyle modification recommendations by their physicians. Heartburn is the classical symptom of GERD, with patients generally reporting a burning feeling, rising from the stomach and radiating toward the neck and throat. It usually occurs postprandially, particularly after large meals or the consumption of fats. Untreated patients suffering from reflux symptoms find it difficult to have large meals, because this generally aggravates their symptoms. Untreated patients may therefore reduce their meal sizes and intake of fats intentionally or unintentionally. It is conceivable, therefore, that the resolution of reflux symptoms by PPI treatment leads to a higher food intake resulting in body weight gain.

Laparoscopic Nissen fundoplication has evolved as a gold standard in antireflux surgery. This surgical therapy induces a significant and persistent reduction in body weight, possibly due to postoperative dysphagia or delayed gastric emptying[5]. In contrast, the option of long-term PPI therapy was associated with a significant body weight gain in the present study. Omeprazole and other PPIs delay gastric emptying[6-9], which induces postprandial fullness, dyspeptic symptoms, gastrointestinal bacterial overgrowth, and subsequent weight loss[10,11]. Our results have clearly demonstrated that long-term PPI therapy contributed significantly to body weight changes in patients with GERD by relieving the adverse symptoms rather than altering the state of gastric emptying.

Numerous circulating peptides influence appetite. Ghrelin is produced in the stomach and acts as a meal initiator. A recent report revealed that long-term PPI therapy did not change the serum ghrelin level[12]. Another peptide, leptin, is produced in the stomach and acts as an enteric signal involved in energy homeostasis. Change of this peptide associated with PPI therapy has not been reported.

A practice guideline for patients with GERD recommends the use of lifestyle modifications such as elevation of the bed head, a decreased intake of fat, chocolate, alcohol, peppermint, coffee, onions and garlic, cessation of smoking, and avoiding recumbency for three hours postprandially, in addition to taking antireflux medications[13]. However, the positive advantage of such lifestyle modifications on the patient’s condition is not well substantiated. Among these lifestyle interventions, elevation of the bed head, left lateral decubitus positioning, and weight loss are associated with improvement in reflux symptoms in case-control studies[14,15]. These modifications alone, however, are unlikely to control symptoms in the majority of patients[13]. Our results support the finding that lifestyle modifications are an essential component of the treatment for GERD and the prevention of weight gain during PPI treatment.

There is a growing body of literature regarding the association between BMI and GERD[2,16-24]. A recent large meta-analysis of previous studies demonstrated a strong positive relationship between BMI and reflux symptoms[2]. In addition, moderate weight gains, even among normal-weight persons, resulted in the development or exacerbation of symptoms in GERD patients[16]. In the present study, the patients significantly increased their body weight during PPI therapy. Appropriate management of body weight during PPI treatment should reduce the duration of PPI use or PPI dosage.

Excessive weight is associated with an increased risk of coronary heart disease, hypertension, angina, stroke, and diabetes, and constitutes an important cardiovascular health burden[25]. Body weight gain associated with lifetime GERD treatment may induce further medical costs in addition to the PPI therapy. Unfortunately, potentially effective diet modifications are often underestimated in the presence of various PPI regimens. Healthcare providers still recommend lifestyle changes in a moderate percentage of GERD patients[26], and while PPIs have become of pivotal importance for the initial and maintenance treatment of GERD, repeated lifestyle modification recommendations are required.

In conclusion, we elucidated in the present study the impact of long-term PPI therapy on body weight. Undesired body weight gain was observed in GERD patients on long-term PPI treatment. Reflux patients treated with a daily maintenance therapy of PPI should be strongly encouraged to manage their body weight through lifestyle modifications such as proper diet and avoidance of overeating. This measure may reduce the overall medical costs associated with obesity-related illness as well as GERD. Lifestyle modification must therefore remain the backbone of treatment for all patients with GERD, even in the PPI era.

Omeprazole and Weight Gain (Prilosec, Zegerid)

Research shows that less than 1% of omeprazole users may experience weight gain as a side effect. The type of weight gain is dependent on the patient and varies from moderate to severe. It may or may not necessitate medical attention. Where medical attention is not warranted, there are several steps the patient themselves can take to combat the weight gain.

In cases where this drug causes weight gain, it’s usually because the patient is allergic or particularly sensitive to the medication. Alternatively the side effect could reflect a separate, serious issue.

Omeprazole (Prilosec, Zegerid) is sometimes used to treat gout and as an acute gout attack can lead to sudden weight gain, gout sufferers should pay particular attention to their weight whilst taking this medication. Pregnant women who take omeprazole may experience increased bloating, swelling or other weight gain. In the cases of swelling and bloating, this is not actual fat gain but water weight gain and does not require medical attention or drastic lifestyle changes.

Sudden Weight Gain

Cases of sudden weight gain are not very common and should be reported to your health care provider immediately if it does occur.   Such rapid weight gain may indicate a very serious underlying problem.

How to Combat Weight Gain from Omeprazole

Patients who do experience genuine fat gain through using omeprazole may want to consider implementing certain lifestyle changes to combat the increase in weight. Exercising at least 3 times a week for 20 minutes per session and switching to a healthier diet can help reverse weight gain. Weight-loss diets should not only limit the amount of calories consumed but should also include plenty of fruit, vegetables, lean protein and unrefined carbohydrates. In cases where the increase in body fat is very sudden or where the patient is unable to shift the weight despite changes in diet and exercise, he or she should consult their healthcare provider.

Weight gain in omeprazole users is very rare but patients should still be aware that it can happen. Individuals using the medication should drink plenty of water and avoid excessive salt to prevent water retention. They should also live as healthily as possible to prevent an increase in body fat. This is especially the case if the patient is prone to bloating or other types of weight gain.

omeprazole and sodium bicarbonate | Michigan Medicine

What is the most important information I should know about omeprazole and sodium bicarbonate?

Omeprazole can cause kidney problems. Tell your doctor if you are urinating less than usual, or if you have blood in your urine.

Diarrhea may be a sign of a new infection. Call your doctor if you have diarrhea that is watery or has blood in it.

Omeprazole may cause new or worsening symptoms of lupus. Tell your doctor if you have joint pain and a skin rash on your cheeks or arms that worsens in sunlight.

You may be more likely to have a broken bone while taking this medicine long term or more than once per day.

This medicine contains sodium bicarbonate, a form of salt. Tell your doctor if you have Bartter’s syndrome (a rare kidney disorder), or if you are on a low-salt diet.

What is omeprazole and sodium bicarbonate?

Omeprazole and sodium bicarbonate is a combination medicine used to treat heartburn and other symptoms of gastroesophageal reflux disease (GERD).

This medicine is also used to treat certain type of ulcers, or to promote healing of erosive esophagitis (damage to your esophagus caused by stomach acid).

Omeprazole and sodium bicarbonate may also be used for purposes not listed in this medication guide.

What should I discuss with my health care provider before taking omeprazole and sodium bicarbonate?

Heartburn can mimic early symptoms of a heart attack. Get emergency medical help if you have chest pain that spreads to your jaw or shoulder and you feel anxious or light-headed.

You should not take this medicine if you are allergic to omeprazole or sodium bicarbonate, or if you are also taking any medication that contains rilpivirine (Edurant, Juluca, Complera, Odefsey).

This medicine contains sodium bicarbonate, a form of salt. Each capsule contains the equivalent of 300 mg of sodium. Each packet of powder contains the equivalent of 460 mg of sodium. If you are on a low-salt diet, you may not be able to use omeprazole and sodium bicarbonate. Talk with your doctor.

Ask a doctor or pharmacist if this medicine is safe to use if you have:

  • a rare kidney disorder called Bartter’s syndrome;
  • liver disease;
  • any allergies;
  • heart failure;
  • problems with acid-base (pH) balance in your body;
  • low levels of calcium, magnesium, or potassium levels in your blood;
  • if you are of Asian descent.

You may be more likely to have a broken bone in your hip, wrist, or spine while taking a proton pump inhibitor long-term or more than once per day. Talk with your doctor about ways to keep your bones healthy.

Ask a doctor before using this medicine if you are pregnant or breastfeeding.

Omeprazole and sodium bicarbonate is not approved for use by anyone younger than 18 years old.

How should I take omeprazole and sodium bicarbonate?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Omeprazole and sodium bicarbonate is for short-term use only, usually 4 to 8 weeks. Erosive esophagitis may take longer to heal. Follow your doctor’s dosing instructions very carefully.

Take this medicine on an empty stomach, at least 1 hour before eating a meal.

Take the omeprazole and sodium bicarbonate capsule with a full glass of water. Do not use any other type of liquid or food. Swallow the capsule whole and do not crush, chew, break, or open it.

To use the powder form, open a packet and pour all of the powder into a small cup with 1 or 2 tablespoons of water. Do not use any other type of liquid. Stir and drink this mixture right away. Add a little more water to the glass, swirl gently and drink right away.

Do not use two 20-mg capsules to equal one 40-mg capsule. Do not use two 20-mg powder packets to equal one 40-mg powder packet. If you do not use the exact capsule or powder packet your doctor has prescribed, you may receive too much sodium bicarbonate.

Read and carefully follow any Instructions for Use if you are giving this medicine to a person who is fed through a nasogastric (NG) tube. Ask your doctor or pharmacist if you do not understand these instructions.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Use the medicine as soon as you can, but skip the missed dose if your next dose is due in less than 12 hours. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include confusion, headache, drowsiness, blurred vision, fast heartbeats, sweating, vomiting, dry mouth, and warmth or tingling.

What should I avoid while taking omeprazole and sodium bicarbonate?

This medicine can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.

If you take this medicine long-term, ask your doctor if you should also use calcium supplements. Also ask your doctor about sources of calcium in your diet from milk or other dairy products. Getting too much calcium while taking omeprazole and sodium bicarbonate may be harmful to your kidneys.

What are the possible side effects of omeprazole and sodium bicarbonate?

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • severe stomach pain, diarrhea that is watery or bloody;
  • new or unusual pain in your wrist, back, hip, or thigh;
  • muscle twitching or tremor;
  • numbness or tingling in your face, arms, or legs;
  • confusion, dizziness;
  • a seizure;
  • low magnesium –dizziness, irregular heartbeats, feeling jittery, muscle cramps, muscle spasms, cough or choking feeling;
  • kidney problems –little or no urination, blood in your urine, swelling, rapid weight gain;
  • new or worsening symptoms of lupus –joint pain, and a skin rash on your cheeks or arms that worsens in sunlight; or
  • vitamin B12 deficiency –shortness of breath, feeling lightheaded, irregular heartbeats, muscle weakness, pale skin, tiredness, mood changes.

Taking this medicine long-term may cause you to develop stomach growths called fundic gland polyps. Talk with your doctor about this risk.

If you use omeprazole and sodium bicarbonate for longer than 3 years, you could develop a vitamin B-12 deficiency. Talk to your doctor about how to manage this condition if you develop it.

Common side effects may include:

  • headache;
  • nausea, vomiting, stomach pain, gas; or
  • diarrhea.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect omeprazole and sodium bicarbonate?

Tell your doctor about all your current medicines. Many drugs can affect omeprazole and sodium bicarbonate, especially:

  • clopidogrel;
  • cyclosporine;
  • digoxin;
  • methotrexate;
  • rifampin; or
  • St. John’s wort.

This list is not complete and many other drugs may affect omeprazole and sodium bicarbonate. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Where can I get more information?

Your pharmacist can provide more information about omeprazole and sodium bicarbonate.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2021 Cerner Multum, Inc. Version: 15.01. Revision date: 11/18/2019.

Omeprazole and Sodium Bicarbonate | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

OmePPi; Zegerid; Zegerid OTC [OTC] [DSC]

What is this drug used for?

  • Used to treat gastroesophageal reflux disease (GERD; acid reflux).
  • Used to treat heartburn.
  • It is used to treat gastrointestinal ulcers.
  • It is used for the treatment and prevention of esophageal ulcers.
  • Used in some patients to prevent gastrointestinal bleeding.
  • This medicinal product may be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

  • If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
  • If you have any of the following health conditions: Bartter’s syndrome, decreased levels of calcium or potassium, an acid-base balance in the blood.
  • If you have had a history of kidney problems with this drug.
  • If you are taking any of these medicines: atazanavir, clopidogrel, nelfinavir, rifampin, rilpivirine, or St. John’s wort.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical condition and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

  • Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
  • If you have high blood sugar (diabetes), your blood sugar should be checked regularly.
  • Contact to the doctor.These could be signs of a serious health problem.
  • Do not use this drug for longer than your doctor prescribed.
  • In people with fragile bones (osteoporosis), this drug increases the chance of fractures of the hip, spine, and wrist. This chance may be higher if you take the drug at high doses or for more than one year, or if you are over 50 years old.
  • Be careful if you are at risk of developing a condition in which bones become fragile and soft (osteoporosis).These risks may include drinking alcoholic beverages, smoking, taking steroids, anticonvulsants, or having osteoporosis in a family member. Talk to your doctor about the risks of developing osteoporosis.
  • In rare cases, people who have taken drugs like this have decreased magnesium levels for 3 months or more. In most cases, this effect developed after 1 year of treatment. If you will be taking this drug for a long time or in combination with certain other drugs, you will need to have a blood test.
  • Lupus and lupus that has worsened have been reported with this drug. If you have lupus, tell your doctor. Call your doctor right away if you have symptoms of lupus, such as a rash on your cheeks or other parts of your body, rapid sunburn, muscle or joint pain, chest pain or shortness of breath, or swelling in your arms or legs.
  • Very bad pancreas, liver, and white blood cells have happened with this drug.On rare occasions, they were life-threatening. If you have any questions, please consult your doctor.
  • This drug may increase the risk of a severe form of diarrhea, diarrhea caused by the bacteria Clostridium difficile (C. diff.) [CDAD]. If you have abdominal pain or cramps or very thin, watery, or bloody stool, see your doctor right away. Do not try to treat diarrhea on your own without first consulting your doctor.
  • Possible severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis).This can lead to serious and permanent health problems and sometimes death. Get immediate medical attention if you experience symptoms such as redness, skin swelling with blistering or scaling (with or without a high fever), eye redness or irritation, or ulceration in the mouth, throat, nose, or eyes.
  • If you are a native of Asia, take this medicine with caution. You may have more side effects.
  • Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding.The benefits and risks for you and your child will need to be discussed.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your doctor right away or get medical help if you have any of the following signs or symptoms, which may be associated with serious side effects:

  • Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
  • Signs of low magnesium, such as sudden changes in mood, muscle pain or weakness, muscle cramps or spasms, seizures, unsteadiness, lack of appetite, severe stomach upset or vomiting, and a feeling of disturbed heartbeat.
  • Signs of low potassium, such as muscle pain or weakness, muscle cramps, or a feeling of an irregular heartbeat.
  • Signs of kidney problems, including lack of urination, change in urine volume, blood in the urine, or rapid weight gain.
  • Signs of high blood sugar, such as confusion, drowsiness, increased thirst and hunger, increased urination, facial flushing, rapid breathing, and fruity breath.
  • Signs of a problem with the pancreas (pancreatitis) such as severe abdominal pain, severe back pain, severe stomach upset and vomiting.
  • Signs of liver problems such as dark urine, feeling tired, lack of appetite, nausea or abdominal pain, light stools, vomiting, yellowing of the skin and eyes.
  • Signs of high or low blood pressure, such as very severe headache or dizziness, fainting, or vision changes.
  • Confusion of consciousness.
  • Shiver.
  • Twitching.
  • Unusual burning, numbness, or tingling sensations.
  • Bone pain.
  • Fever, chills, sore throat; the appearance of bruising and bleeding for unexplained reasons; a pronounced feeling of tiredness or weakness.
  • Inflammation.
  • Weight gain.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

  • Headache.
  • Abdominal pain or diarrhea.
  • Gas.
  • Nausea or vomiting.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https: // www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

All forms of issue:

  • Take this medication 1 hour before meals.
  • Talk to your doctor before using antacids with this drug.
  • Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.
  • It may take several days for the full effect to develop.
  • Long-term treatment (for example, longer than 3 years) with drugs such as this, in rare cases, caused a decrease in the content of vitamin B-12. Please consult your doctor.
  • This drug may interfere with some laboratory tests. Tell all healthcare providers and laboratory staff that you are taking this drug.
  • If you are on a low sodium or salt-free diet, tell your doctor.Some of these preparations contain sodium.

Capsules:

  • Take this medicine with water only; do not take it with other drinks.
  • Swallow whole. Do not chew, break, or crush.
  • Do not open capsules.

Powder:

  • Mix powder in a cup with 1 or 2 teaspoons (5 or 10 ml) of water and drink the resulting solution. Do not mix with other liquids.Rinse the cup with extra water and drink.
  • Take the dose immediately after mixing. Do not store for future use.
  • Patients with feeding tubes can also use powder. Feed within 3 hours or one hour after the introduction of the liquid prepared from the powder. Flush the feeding tube before and after taking the medication.

What should I do if a dose of a drug is missed?

  • Take the missed dose as soon as you can.
  • If it’s time to take your next dose, do not take the missed dose and then return to your normal drug schedule.
  • Do not take 2 doses at the same time or an additional dose.

How do I store and / or discard this drug?

  • Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
  • The lid must be tightly closed.
  • Store all medicines in a safe place.Keep all medicines out of the reach of children and pets.
  • Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

  • If your health does not improve or even worsens, see your doctor.
  • You should not give your medicine to anyone or take someone else’s medicine.
  • Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
  • A separate patient instruction sheet is attached to the product. Please read this information carefully. Reread it every time you replenish your supply.If you have questions about this drug, talk with your doctor, pharmacist, or other healthcare professional.
  • If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug.Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug.This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

© UpToDate, Inc.and its affiliates and / or licensors, 2021. All rights reserved.

Omeprazole and Sodium Bicarbonate: Pediatric Medication

This document, provided by Lexicomp ® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

OmePPi; Zegerid; Zegerid OTC [OTC] [DSC]

What is this drug used for?

  • Used to treat gastroesophageal reflux disease (GERD; acid reflux).
  • It is used for the treatment and prevention of esophageal ulcers.
  • This drug can be given to children for other indications. Consult your doctor.

What should I tell my doctor BEFORE my child takes this drug?

  • If your child is allergic to this drug, any of its ingredients, other drugs, foods, or substances. Tell your doctor about the allergy and how your child has it.
  • If you have any of the following health conditions: Bartter’s syndrome, decreased levels of calcium or potassium, an acid-base balance in the blood.
  • If your child has a history of kidney problems with this or a similar drug.
  • If your child is taking any of these drugs: atazanavir, clopidogrel, nelfinavir, rifampin, rilpivirine, or St. John’s wort.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Talk to your doctor or pharmacist about all medications your child is taking (prescription and over-the-counter, natural products, and vitamins) and any health concerns.You need to make sure that this drug is safe for your child’s illness and in combination with other drugs that he or she is already taking. You should not start, stop, or change the dosage of any drug your child is taking without talking to the doctor.

What do I need to know or do while my child is taking this drug?

  • Tell all health care providers for your child that your child is taking this drug.These are your child’s doctors, nurses, pharmacists and dentists.
  • If your child has high blood glucose (diabetes), the child’s blood glucose should be checked regularly.
  • This drug may interfere with some laboratory tests. Tell all healthcare professionals and laboratory staff providing your child’s healthcare that your child is taking this drug.
  • See your doctor if your child has sore throat, chest pains, very severe abdominal pain, difficulty swallowing, or signs of bleeding ulcers such as black, tarry or bloody stools, vomit that is bloody, or has type of coffee grounds.These could be signs of a serious health problem.
  • Do not use on a child for longer than prescribed by your child’s healthcare provider.
  • In people with fragile bones (osteoporosis), this drug increases the chance of fractures of the hip, spine, and wrist. This risk increases with high doses of the drug or duration of administration for more than a year.
  • Be careful if your child is at risk of developing a condition in which bones become fragile and soft (osteoporosis).These risks may include drinking alcoholic beverages, smoking, taking steroids, anticonvulsants, or having osteoporosis in a family member. Talk to your doctor about the risks of your child developing osteoporosis.
  • In rare cases, people who have taken drugs like this have decreased magnesium levels for 3 months or more. In most cases, this effect developed after 1 year of treatment. If your child will take this drug for a long time or in combination with other drugs, they will need to have a blood test.
  • Long-term treatment (for example, longer than 3 years) with drugs such as this, in rare cases, caused a decrease in the content of vitamin B-12. Please consult your doctor.
  • Lupus and lupus that has worsened have been reported with this drug. If your child has lupus, tell your child’s doctor. Call your child’s doctor right away if your child develops symptoms of lupus, such as a rash on the cheeks or other parts of the body, rapid sunburn, muscle or joint pain, chest pain or shortness of breath, or swelling in the arms or legs.
  • Very bad pancreas, liver, and white blood cells have happened with this drug. On rare occasions, they were life-threatening. If you have any questions, please consult your doctor.
  • If your child is on a low sodium or salt free diet, consult a doctor. Some of these preparations contain sodium.
  • If your child is Asian, use this drug with caution.Your child may have more side effects.

If your daughter is pregnant or breastfeeding:

  • Consult a doctor if your daughter is pregnant, pregnant, or breastfeeding. The benefits and risks for your daughter and her child will need to be discussed.

What side effects should I report to my child’s healthcare provider right away?

WARNING / CAUTION: Although rare, this drug can cause very serious and sometimes deadly side effects in some people.Call your child’s doctor right away or get medical attention if your child has any of the following signs or symptoms that could be associated with a very bad side effect:

  • Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
  • Signs of low magnesium, such as sudden changes in mood, muscle pain or weakness, muscle cramps or spasms, seizures, unsteadiness, lack of appetite, severe stomach upset or vomiting, and a feeling of disturbed heartbeat.
  • Signs of low potassium, such as muscle pain or weakness, muscle cramps, or a feeling of an irregular heartbeat.
  • Signs of high blood sugar, such as confusion, drowsiness, increased thirst and hunger, increased urination, facial flushing, rapid breathing, and fruity breath.
  • Signs of kidney problems, including lack of urination, change in urine volume, blood in the urine, or rapid weight gain.
  • Signs of liver problems such as dark urine, feeling tired, lack of appetite, nausea or abdominal pain, light stools, vomiting, yellowing of the skin and eyes.
  • Signs of a problem with the pancreas (pancreatitis) such as severe abdominal pain, severe back pain, severe stomach upset and vomiting.
  • Signs of high or low blood pressure, such as very severe headache or dizziness, fainting, or vision changes.
  • Confusion of consciousness.
  • Shiver.
  • Twitching.
  • Unusual burning, numbness, or tingling sensations.
  • Bone pain.
  • Fever, chills, sore throat; the appearance of bruising and bleeding for unexplained reasons; a pronounced feeling of tiredness or weakness.
  • Inflammation.
  • Weight gain.
  • This drug may increase the risk of a severe form of diarrhea, diarrhea caused by the bacteria Clostridium difficile (C.diff.) [CDAD]. Call your doctor right away if your child has abdominal pain or cramps or loose, watery, or bloody stools. Do not try to treat diarrhea on your own without first talking to your child’s healthcare provider.
  • Possible severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis). This can lead to serious and permanent health problems and sometimes death. Get medical help right away if your child has symptoms such as redness, skin swelling with blistering or scaling (with or without a high fever), redness or irritation of the eyes, painful sores on the lining of the mouth, throat, nose, or eyes …

What are some other side effects of this drug?

Any drug can have side effects. However, many people have little or no side effects. Call your child’s doctor or get medical help if any of these or other side effects bothers your child or does not go away:

  • Headache.
  • Abdominal pain or diarrhea.
  • Gas.
  • Nausea or vomiting.

This list of potential side effects is not exhaustive. If you have any questions about side effects, talk to your child’s doctor. Talk to your child’s doctor about side effects.

You can report side effects to the National Health Office.

What is the best way to give this drug?

Give this drug to your child as directed by the doctor.Read all the information provided to you. Follow all instructions strictly.

All forms of issue:

  • Give this medicine 1 hour before meals.
  • Talk to your doctor before giving antacids with this drug to your child.
  • Continue giving this drug as directed by your child’s doctor or other healthcare professional, even if your child is well.
  • It may take several days for the full effect to develop.

Capsules:

  • Give this medicine with water only; do not mix it with other drinks.
  • Have your child swallow whole. Tell your child not to chew, crush, or crush the tablet.
  • Do not open capsules.

Powder:

  • Mix powder in a cup with 1 or 2 tablespoons (15 or 30 ml) of water and give your child a drink.Do not mix with other liquids. Rinse the cup with extra water and let your child drink.
  • Take the mixture immediately. Do not store for future use.
  • Patients with feeding tubes can also use powder. Feed within 3 hours or one hour after the introduction of the liquid prepared from the powder. Flush the feeding tube before and after taking the medication.

What if my child misses a dose of a drug?

  • Give the missed dose as soon as possible.
  • If it is time for your child to take the next dose, do not take the missed dose and then return to your child’s normal schedule.
  • Do not give a double dose at the same time or additional doses.

How do I store and / or discard this drug?

  • Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
  • The lid must be tightly closed.
  • Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
  • Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

  • If your child’s symptoms or health problems do not improve, or if they get worse, see your child’s doctor.
  • Do not share your child’s medication with others or give anyone else’s medication to your child.
  • Some medicines may have different patient information sheets. If you have questions about this drug, talk with your child’s doctor, nurse, pharmacist, or other healthcare professional.
  • If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient.This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional.Check with your doctor for complete information on the possible risks and benefits of taking this drug. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

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© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

90,000 Is there a link between omeprazole and weight gain?

There may be a link between omeprazole and weight gain, but it is very rare if it exists.Weight gain is a listed potential side effect of treatment, but is only reported in less than 1% of people taking the drug. Studies have examined the effects of omeprazole and found that people taking the drug are more likely to gain weight than those taking a placebo. Despite these results, especially sudden or unexpected weight gain is still a serious and unusual side effect of treatment.

Most drugs cause some side effects in patients, which are classified according to the likelihood of their occurrence.Sudden or severe weight gain is listed as a possible side effect of omeprazole, but this occurs in only a very small number of patients. It can be assumed that the intended effect of the drug – a decrease in stomach acid for patients suffering from gastroesophageal reflux disease (GERD) or ulcers – calms the stomach and increases the likelihood of food intake in the patient. However, any patient experiencing unusually sudden or severe weight gain should see a healthcare professional as this could be a sign of a serious adverse reaction to treatment.

Studies have been conducted on the relationship between proton pump inhibitors such as omeprazole and weight gain. In particular, studies have examined this effect in patients with GERD. It was found that weight gain over a two-year period occurs in more than 70% of patients taking this or similar drugs. However, the weight gain was minimal, about 6% more than baseline body weight. This slight increase in body weight should be controlled with diet and exercise, if possible.

Any patient experiencing a link between omeprazole and weight gain should try to cope with the problem through lifestyle changes. Eating a diet rich in vegetables, fruits, and lean meats is one way to deal with this problem. Patients with weight gain issues should also use fat-free or non-fat milk alternatives and avoid saturated and trans fats. Regular exercise can also prevent weight gain.

Although unlikely, patients taking all these precautions may still experience weight gain problems. In less than 1% of people, diet and exercise can make little difference. Patients experiencing rapid or unusual weight gain should see a doctor immediately. This side effect may cause you to stop taking the drug.

OTHER LANGUAGES

90,000 “Unexpected side effects of drugs” – Yandex.Kew

Upset stomach, nausea, pain in muscles and joints, headaches are common side effects when taking medications. But sometimes the body reacts so strangely to an allergy remedy, an antibiotic or a sleeping pill that it is just right to be frightened. What if you suddenly felt weakness, you suddenly wanted to sleep, there was a fog in your eyes, or hallucinations began? Of course, contact your doctor as soon as possible. Here are the strangest side effects of common medications you may encounter.

Hallucinations

What is not really there can be seen, heard or felt by taking the ordinary sleeping pill Lunesta (eszopiclone).

Medicine

for depression Lexapro (escitalopram), unfortunately, can cause the same side effect.

Discoloration of urine

The urine can turn pink due to the fact that you have eaten beets, orange, if you overdo it with vitamins.This is not dangerous and has happened to you at least once. But what if the urine turns green or blue? This is most likely a side effect of antidepressant Elavil (amitriptyline) or pain reliever Indocin (indomethacin) .

Antibiotic Flagil

(metronidazole) may turn your urine black.

Vivid dreams, blackouts

If you decide to quit smoking with Chantix (varenicline), dreams can become very vivid and exciting.Do you need to see a doctor, even if in a dream you lead a more interesting life than in reality? Of course. Sleeping pills Ambien (zolpidem) may cause sleepwalking symptoms. A person can get up at night, drive a car, talk on the phone and even have sex, and in the morning he does not remember anything about it.

Bloating

Anti-constipation preparations containing lactulose or sorbitol and antacids containing calcium carbonate can cause bloating (flatulence).The problem is unpleasant, especially when it manifests itself not at home, but in the office or in a public place. For example, Prilosec (omeprazole), a drug used to treat heartburn or GERD, causes bloating.

Weight gain

You can add 10 kg in just 3 months by taking antipsychotic Zyprex (olanzapine), aimed at treating bipolar disorder. Antidepressants , such as Paxil (paroxetine), can cause the same side effect.Other medicines that can affect weight: steroids, birth control pills, hormone replacement therapy, diabetes medications.

Decreased libido

Basically, a decrease in sexual desire is caused by antidepressants – selective serotonin reuptake inhibitors: Prozac (fluoxetine), Celexa (citalopram), Zoloft (sertraline). Another side effect of these drugs can be priapism, a painful erection that lasts more than 4 hours and is not associated with sexual arousal.An example is the antidepressant Desyrel (trazodone).

Visual impairment

Distortions of visual perception (fog, halos, bifurcation of objects) can cause antihistamines , drugs for lowering blood pressure , drugs against malaria and tuberculosis . You can also see everything through blue or green “glasses” – by taking Viagra (sildenafil). But better not.

Hair loss / abnormal hair growth

Hair loss can be caused by cancer treatment , but there are several common medications that can cause this side effect.These include blood thinners , birth control pills , antidepressants and gout drugs . Sometimes medications provoke excessive hair growth in the most unexpected places. It can be steroid drugs or a drug for treatment of endometriosis in women – Danocrin (danazol).

Tendon rupture

Fluoroquinolone antibiotics *** may damage the Achilles tendon.If you have been prescribed fluoroquinolone Cipro (ciprofloxacin) or levaquin (levofloxacin), keep this in mind.

If strange symptoms appear that do not cause discomfort, but are still frightening, discuss this with your doctor. In any case, even if treatment or drug withdrawal is not required, it will not hurt to know what is happening to your body.

*** US Food and Drug Administration (FDA)

issued

side effects bulletin of fluoroquinolone antibiotics for the treatment of infections of the genitourinary system, intestines, nasopharynx, eyes, ears, lungs and bronchi.It is reported that fluoroquinolones can cause a significant decrease in blood sugar levels, as well as adversely affect the functioning of the central nervous system (CNS). The bulletin clarifies that a sudden drop in blood sugar (hypoglycemia) can cause 90,465 coma 90,466. And violations of the central nervous system can manifest itself in the form of decreased attention and memory, disorientation, excitability, nervousness, confusion.

If the attending physician has prescribed a fluoroquinolone antibiotic , the patient with diabetes must inform him about his illness and list the medications he is taking.If the appointment remains in effect for one reason or another, it is necessary to carefully monitor the blood sugar level and know the symptoms of hypoglycemia. Early signs include: confusion, rapid heart rate, heart palpitations, dizziness, pale skin, sweating, unusual hunger, tremors, headache, irritability.

When prescribing fluoroquinolones, physicians should take into account the increased risk of hypoglycemia (and coma) in elderly diabetic patients and in diabetic patients who are prescribed oral hypoglycemic (antidiabetic) drugs or insulin.If the patient reports the appearance of side effects associated with a dysfunction of the central nervous system or characteristic of hypoglycemia, it is advisable to change the treatment regimen for the infection.

Physicians should not prescribe fluoroquinolones to patients for whom other treatment options are available for acute bacterial sinusitis, acute bacterial exacerbation, chronic bronchitis, and uncomplicated urinary tract infections because the risks outweigh the benefits of .

Fluoroquinolones are broad-spectrum antibiotics capable of suppressing the activity of gram-positive (staphylococci, streptococci, clostridia, corynebacteria, listeria; diseases of the nasopharynx, eyes, ears, lungs, bronchi) and gram-negative bacteria (Escherichia coli, Salmonella, Shigabella, Moraine ; diseases of the intestines and genitourinary system).

Broad-spectrum antibiotics are prescribed when the causative agent of the infection cannot be identified as a result of tests or it is impossible to analyze for bacterial culture.

Fluoroquinolones banned during pregnancy and breastfeeding. In young children, fluoroquinolones slow bone growth and are therefore prescribed only if the benefits of antibiotic therapy outweigh the harm. Oxolinic and nalidixic acids are toxic to the kidneys and are therefore not recommended for patients with kidney disease.

Material provided

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Medicines that make you fat. How to be treated without harm to the figure? | Healthy life | Health

On the one hand, this may be true. If the potential damage from drugs was greater than the guaranteed benefits, doctors would not prescribe them to patients, and moreover, they would not be sold at all. In addition, taking care of us and their reputation, pharmaceutical manufacturers indicate absolutely ALL possible side effects, even if their probability tends to zero, which is why the list of these very actions is usually large and very scary.It can include anything from mild malaise to internal organ dysfunction; so why scare yourself once again and give povd to refuse the necessary medication?

But there is another side to this issue. The most serious side effects do occur 1 time in a million packs of the drug sold, but what appears first on the list can befall one in 10. And this, among other things, is such a nuisance as being overweight.

What drugs can contribute to the appearance of extra pounds? And what should those who need these drugs do? Do not give up treatment for the sake of a slim figure! It is better to try to minimize the harmful effect.

Steroids

When they are prescribed. For allergies, asthma, rheumatoid arthritis.

How they work. Steroids mimic the action of hormones that normally regulate metabolism and the immune system. These diseases, in turn, are associated with excessive or unmotivated immune responses, therefore steroids are designed to suppress immunity and reduce inflammation.

Why they get fat. Steroids can affect levels of the “stress hormone” cortisol.In a stressful situation, our body prepares to “fight or run”, therefore it stores up a lot of energy, that is, fat, which mainly accumulates in the abdomen and on the neck. In addition, under the influence of steroids, more sugars enter the bloodstream, and they are also processed and converted into fat.

How much you can get fat. On average, patients who are permanently living on steroids gain about 7% overweight. Fortunately, doctors try to prescribe these drugs in the minimum effective doses and for a very short time.

What to do. Talk to the doctor who prescribes these medicines. Perhaps the treatment regimen can be changed so as to reduce the course or take steroids not daily. In the case of allergies, these drugs can be substituted for aspirin or ibuprofen, which also fight inflammation.

Antiallergenic drugs

How they work. Not all, but most contain the substance diphenhydramine, which blocks the brain receptors responsible for the production of histamine.In turn, this hormone causes everything that is called an allergic reaction – swelling, itching, runny nose, and so on.

Why they get fat. Along with histamine, diphenhydramine “blocks” the production of other important hormones in the brain. For example, those that regulate our appetite, drown out the feeling of hunger and prevent overeating. And another side effect of this substance is lethargy and loss of strength; that is, we not only eat a lot, but also hardly move, which is why we get fat.

How much you can get fat. With long-term use – 1-3% of the original weight.

What to do. Ask the doctor to change the medication. Fortunately, the modern pharmaceutical market offers a wide range of anti-allergenic drugs that have a more delicate effect on hormones.

Medicines for hypertension (beta-blockers)

When they are prescribed. In addition to high blood pressure, indications for use are excitability and cardiac arrhythmias.

How they work. Beta-blockers neutralize the irritating effect of adrenaline on the nervous system, which ultimately leads to a decrease in heart rate and a drop in blood pressure.

Why they get fat. Together with the slowing down of our heartbeat, our metabolism also becomes slower. The body spends fewer calories, and all that is left is stored in fat.

How much you can get fat. Many hypertensive patients have to take these drugs for several years.During this time, weight gain can be from 5 to 10 kilograms or more.

What to do. Unfortunately, in some cases, beta blockers are no substitute. But sometimes the doctor can prescribe another type of “heart” pills – ACF inhibitors, which also lower blood pressure, but do not threaten to be overweight.

Antidepressants

When they are prescribed. In a variety of cases, depending on what symptoms triggered the depression. Sometimes antidepressants are used to treat insomnia, hyperactivity, lethargy, persistent fatigue, and bowel disorders.

How they work. Depending on the principle of action, antidepressants are divided into many different classes and groups, but they are based on the same effect of preserving monoamines. Simply put, these drugs interfere with the breakdown or neutralization of the joy hormone serotonin, as well as other chemicals, without which depression occurs.

Why they get fat. In terms of excess weight, tricyclic antidepressants are the most dangerous.They dull the sensitivity of receptors that respond to signals of satiety and prevent us from overeating.

How much you can get fat. Such drugs are usually prescribed for a long period (3 months or more), and the longer you drink them, the more extra pounds you can gain. A year or two on tricyclics threatens on average five to ten, and sometimes twenty kilograms, and antidepressants such as SSRIs (selective serotonin reuptake inhibitors) can add 8-10% of your initial body weight.

What to do. In some patients, SSRIs or tricyclics can be substituted for other types of drugs, some of which do not increase, but, on the contrary, reduce appetite. In addition, studies have shown that the first kilograms begin to “build up” usually after six months of taking antidepressants, and after this period you may no longer need a high dose or you can take a break from treatment.