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  • Dr Stephanie Matinpour, PharmD, CGP, FASCP

Do heartburn Meds cause Dementia?


The report that was just published in JAMA Neurology suggests that there is a weak association between PPI use and dementia.They didn't adjust for some very important risk factors for dementia, including alcohol use, family history of dementia, and high blood pressure. These are well-known risk factors for dementia, and for some reason, these weren't included in the analysis. Thus, we're missing a tremendous amount of potential risk factors that might account for the imbalance of incident dementia between PPI users and nonusers. Certainly, there are benefits of PPIs, including treatment of severe reflux disease and prevention of bleeding from some pain medications. All of these benefits need to be kept in perspective, but if you don't need the medication we suggest saving PPIs for when they're really needed and if possible, use them short-term. Ask your Pharmacist if you’re unsure about your PPI use.

What are proton pump inhibitors?

Proton pump inhibitors (PPIs) work by lowering the amount of acid in the stomach. PPIs treat conditions caused by too much stomach acid. Some of these conditions are heartburn or gastroesophageal reflux disease (GERD) and ulcers. Here are some current PPIs available over the counter and by prescription: omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix).

How should I take a PPI?

If you take a PPI once a day, take it 30 to 60 minutes before breakfast. If you take it twice a day, take the second dose 30 to 60 minutes before dinner. Your stomach makes acid when you eat. Taking the PPI before you eat stops extra acid from being made. Some people also take an antacid or an H2-blocker. H2-blockers are medicines like famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac), or nizatidine (Axid). If you take a PPI and one of these medicines, take the PPI 30 to 60 minutes before a meal. Take the other medicine at a different time of the day. They don’t work as well when taken at the same time. Take the H2-blocker at bedtime if you have symptoms at night.

Can I take a PPI with other medicines?

PPIs may reduce the amount of calcium you absorb. There’s a very small chance this could weaken your bones and cause them to break more easily. This is more likely if you are over 50, take a high dose, or use a PPI for a year or more. To be safe, make sure you get enough calcium and vitamin D in your diet and from supplements. Calcium citrate is the best supplement for people taking PPIs. Some drugs need acid in the stomach to work. Ask your pharmacist if your PPI affects other medicines you are taking.

How often should I take a PPI?

You might be able to take your PPI only when you have symptoms of heartburn or mild GERD. Check with your prescriber to see if this is an option for you. For ulcers and other serious conditions, you must take your PPI as prescribed.

How do I stop taking a PPI?

Your prescriber will tell you when to stop your PPI. If you stop your PPI all at once, you might have heartburn symptoms. To avoid this, your prescriber may have you slowly decrease your PPI use over a week or more. During this time, an H2-blocker or antacid can be used if you have symptoms.

What else can I do to help prevent heartburn?

  • Don’t eat two to three hours before bedtime

  • Raise the head of your bed four to six inches

  • Stay at a normal weight

  • Avoid foods that seem to make it worse


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