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Antacid Use Linked to B12 Deficiency

Filed December 20th, 2013 Eric

Long-term use of antacids can lead to vitamin B12 deficiency, a new study suggests.

An article published in JAMA: The Journal of the American Medical Association looked into the effects of long-term use of proton pump inhibitors (PPIs) and found that two or more years of treatment with PPIs or histamine 2 receptor antagonists (H2RAs) resulted in an increased risk for vitamin B12 deficiency, reported. Researchers came to this conclusion by comparing rates of vitamin B12 deficiency in patients taking PPIs and H2RAs with those who were not on the medications.

PPIs are a popular group of drugs that include Nexium and Protonix. The drugs work by constraining the production of certain enzymes, which reduces levels of gastric acid, according to Many are available by prescription, but some, including Prilosec and Prevacid, can be purchased over-the-counter at lower doses. PPIs are typically recommended for short-term use, but some people remain on the drugs for years.

H2RAs, which include Pepcid and Axid, inhibit histamine in cells within the stomach. This also leads to a decrease in the amount of of gastric acid produced. These drugs are commonly referred to as antacids, and are available by prescription and over-the-counter.

According to the U.S. Centers for Disease Control and Prevention (CDC), vitamin B12 deficiency can lead to weakness, gait abnormalities, vision loss, anemia, fainting, and palpitations. In severe cases, vitamin B12 deficiency may also lead to nerve damage and dementia. The deficiency can be particularly dangerous for pregnant women as it could result in neural tube and developmental defects, reported.

For the study, the researchers examined records from the Kaiser Permanente Northern California database. They compared nearly 26,000 patients diagnosed with vitamin B12 deficiency to close to 185,000 patients without this diagnosis. The results highlighted that two or more years of treatment with PPIs or H2RAs was linked to an increased risk for vitamin B12 deficiency. The authors noted that the higher doses of the drugs resulted in the greatest link to deficiency. Overall, long-term use of PPIs resulted in a 1.65 times more likely risk of deficiency, while long-term H2RA users were 1.25 times more likely to suffer from the deficiency, reported.

Researchers noted that the association was stronger in women and younger age groups, reported. They also found that   the association decreased once patients stopped using the antacids.

Dr. Douglas Corley, the lead author of the study, told Reuters that the research raises questions about the need for people who are taking the drug to occasionally have their B12 levels checked. Dr. Corley also recommended that health care providers take this information into consideration when prescribing these medications. While many people rely on these drugs, Dr. Corley advises people taking the medications to stay on the the B12 supplements as briefly as possible and to take the lowest dose possible, according to Reuters.

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