It is one of the most popular drugs; one of the best-selling and most consumed medicines in Spain, according to data from the Spanish Pharmacists Business Federation (FEFE). It is common to see him pass from hand to hand before celebrations and copious meals, but the omeprazole it is not as harmless as some think. If it is taken outside of the strict indication of a professional, it can carry significant risks.
“Not a stomach protector”, emphasizes Alicia Lázaro, member of the Viral Hepatopathies Working Group of the Spanish Society of Hospital Pharmacy (SEFH). “In the general population, the fact of calling it that generates an indiscriminate use of the medication, starting to be used ‘if you are going to eat or drink more than necessary or if my stomach hurts a bit, situations that have nothing to do with its indication. and that they must be controlled in another way. That consideration generates a false security in its overuse”.
“Being called a stomach protector has made its consumption is trivialized among the population“, agrees Noelia Fontanillas, coordinator of the Digestive Group of the Spanish Society of Primary Care Physicians (SEMERGEN). “Omeprazole has become part of our personal effects, often ingesting it in the face of any gastric pain or stressful life situation everyday, since we trust its safety when it is not”, he adds.
Omeprazole is a medication that belongs to a group of drugs known as Proton-pump inhibitor, which reduce the secretion of gastric acid and increase the defense barrier of the gastric mucosa. It is used, therefore, to treat pathologies that cause an increase in the secretion of said acid, such as gastric, duodenal or peptic ulcers, reflux esophagitis, gastroesophageal reflux or Zollinger-Ellison syndrome, among others.
“It is also indicated together with gastroerosive drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) or anticoagulants or antiaggregants when the patient has esophageal or gastric digestive pathology or is over 60 years of age”, Fontanillas.
Although proton pump inhibitors, and thus omeprazole, have revolutionized the treatment of gastric acid-related disorders, its possible adverse effects should not be taken lightlypoint out the experts consulted.
The main risks of these medicines derive from a prolonged use (more than three months) or un consumption of high doses. For this reason, “these medications should always be taken under the indication of a professional and when they are prescribed long-term, the prescribed dose must be the minimum effective and it must be reassessed periodically,” they indicate.
Among the potentially serious effects, the alteration of the intestinal microbiome stands out; micronutrient deficiencies, such as magnesium, vitamin B12, iron or calcium; chronic kidney disease; increased risk of gastrointestinal diseases; risk of bone fractures or risk of interaction with other medications, among others.
“He B12 deficit we see it in some patients who take omeprazole continuously”, explains Fontanillas. In these cases, it is necessary perform review analytics since the lack of this vitamin can cause anemia. Without a sufficient dose of vitamin B12, the body cannot adequately generate red blood cells, which initially causes symptoms such as fatigue, paleness, dizziness, or shortness of breath. If not treated, this deficit can affect the functioning of the nervous system and generate neurological alterations.
The development of hypomagnesemia, which can also be a consequence of prolonged use of the drug, “manifests as fatigue, tetany, delirium, seizures, ventricular arrhythmia, dizziness… This is especially worrying in patients who also take other medications such as dignoxin or diuretics. In these cases magnesium levels should be measured regularly,” says Lzaro
“He fracture risk hip, wrist and spine, especially in elderly patients and with added risk of fractures”, it is not negligible either, continues the specialist.
A few weeks ago, the Spanish Agency for Medicines and Health Products (AEMPS) added an adverse effect related to omeprazole, the tubulointersticial nephritisa rare adverse effect (1/10,000 to <1/1,000), "which should not worry patients if the use of this medication is controlled by a health professional," emphasizes Lázaro.
More than risks like this, which are very rare, what should worry the population are the consequences of a indiscriminate use and without professional control of the drug.
“When proton pump inhibitors are prescribed correctly, their benefits greatly outweigh any possible adverse effects,” concludes Fontanillas. Unfortunately, in many cases they are not taken under professional follow-up.
This health professional recently carried out an investigation whose main objective was to check whether the quota patients who were taking proton pump inhibitors were doing so under the correct indication. The results showed that “33% of the patients took it without justified indication and many of them did not know if they took it. In addition, we detected that many institutionalized patients in residences or geriatric patients were also taking it without indication”.
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