Acid Reducing Medications

What are acid reducing medications?

Acid reducing drugs are generally safe medications used to treat heartburn, gastroesophageal reflux disease (GERD), and gastric ulcers. These medications are broken down into two categories: proton pump inhibitors (PPI) and H2 blockers. PPIs would include medications such as omeprazole (Prilosec, Losec), rabeprazole (Aciphex, Pariet), omeprazole/sodium bicarbonate (Zegerid), dexlansoprazole (Dexilant), lansoprazole (Prevacid), esomeprazole (Nexium), pantoprazole (Protonix, Pantoloc, Tecta), and esomeprazole/Naproxen (Vimovo). H2 blockers would include medications such as cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). Many of these medications require a prescription, but some may be bought over the counter.

What nutrients can be depleted with acid reducing medications?

PPI                                                      H2 Blockers

Magnesium                                         Vitamin B12

Vitamin B12

What can happen if these nutrients are depleted?

Magnesium:  Magnesium is the fourth most abundant nutrient in the body and is involved in over 300 biochemical reactions.   A significant reduction in magnesium is often seen in patients taking PPIs long term ( greater than 1 year) or who are also taking medications known to reduce magnesium (digoxin, certain diuretics). Common signs of low magnesium levels can include loss of appetite, nausea, vomiting, fatigue, cramping, and weakness. Serious side effects of untreated magnesium depletion can cause seizures, osteoporosis, personality changes, abnormal heart rhythms, and coronary spasms. If any serious symptoms occur, discontinue the medication and call your physician immediately.

Vitamin B12:  Vitamin B12 is a nutrient that helps keep the body's nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Reduced vitamin B12 levels occur with acid reducing agents because dietary vitamin B12 relies on gastric acid to be absorbed into the body.  A moderate depletion occurs most often in patients taking acid reducing agents long term. Depletion is more common in patients on PPIs than H2 blockers. Low vitamin B12 levels can causes anemia. Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Most patients with mild anemia will have no symptoms or the symptoms will be very mild. Common signs of anemia can include diarrhea, constipation, loss of appetite, pale skin, problems concentrating, and bleeding gums. Rare, but serious side effects can include signs of nerve damage such as confusion, depression, loss balance, and numbness or tingling in the hands and feet. If any serious symptoms occur, discontinue the medication and call your physician immediately.

What can you do?

If you suspect your magnesium or vitamin B12 levels is low, contact your physician or local pharmacist. A magnesium or vitamin B12 supplement may be suggested to help replenish low nutrient levels.

Magnesium :  Different magnesium supplement preparations are available over the counter These preparation can include magnesium salts such as: magnesium oxide, magnesium aspartate, magnesium citrate, magnesium sulfate, magnesium chloride, and magnesium glycinate . The recommended daily allowance for elemental magnesium is between 310- 400 mg/day for ages 19-30 years old and between 320- 420 mg/day for ages greater than 31 years old. Side effects with supplemental magnesium can include gastrointestinal upset and diarrhea.  Magnesium oxide tends to firm stools (leading to constipation), whereas the citrate, sulfate and chloride forms tend to loosen the stools (diarrhea).  Magnesium glycinate preparations are least likely to disrupt the bowel and they are highly absorbable. Magnesium glycinate is absorbed 5 times better than magnesium oxide.

Vitamin B12:  Vitamin B12 supplements preparations are available over the counter as an activated B12 (methylcobalamin),