Covid-19 Alert: Talk to Your Doctor if You’re Taking This Heartburn Drug
New research suggests that popular heartburn drugs may be linked to a higher risk of Covid-19. But if you're taking a proton pump inhibitor, don't stop just yet.
The threat of Covid-19 continues unabated. In the United States, cases have surpassed three million, representing a quarter of all cases globally. The pandemic caught the world largely by surprise and experts have been scrambling to learn all they can in as short a time as possible. New—often unwelcome—information arrives every day. (Learn about 11 troubling new symptoms and complications of Covid-19.)
The list of risk factors for contracting the virus and for complications is a long one and scientists may have uncovered a new one—certain heartburn drugs seem to be associated with a higher risk of infection.
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Why experts are concerned
A new study—still under review—in the American Journal of Gastroenterology suggests that regular use of the popular heartburn medications known as proton pump inhibitors or PPIs may be associated with a higher risk of getting infected with SARS-CoV-2, the virus that causes Covid-19. (Here are factors that increase your risk of dying from Covid-19.)
In an online health survey of more than 86,000 people, 6.4 percent said they tested positive for Covid-19. About 61 percent, or 53,130 people, reported having acid reflux, heartburn, regurgitation, or minor abdominal pain, and the researchers asked this subgroup about their use of PPIs.
The authors, led by Christopher V. Almario, MD, at Cedars-Sinai Medical Center in Los Angeles, found that people who took PPIs twice a day were about 3.7 times as likely to say they had tested positive for the virus as people who didn’t take any. Those taking the drugs once a day were at twice the risk, although the overall risk of a Covid-19 positive test was still low. The authors found no association between PPIs and gastrointestinal symptoms of Covid-19.
Waiting on confirmation
Even though the research did show an association between PPIs and Covid infection, it’s a far cry from proving that PPI use can actually raise the risk of Covid-19 infection. “Although the findings in this study are compelling and definitely illustrate a correlation between PPI and Covid, there is no clear scientific evidence (as yet) of causation,” says Danny Branstetter, MD, medical director of infection prevention at Wellstar Health System in Atlanta, Georgia. “It will be interesting to see how the research progresses under peer review.”
In other words, the study needs to be checked by outside experts and confirmed with additional research; this will likely be the next step. “Until the final reviewed manuscript is published, we need to be very careful in our application of the findings to routine patient care,” says Travis T. King, a clinical pharmacy specialist at Ochsner Health in New Orleans.
In addition, studies based on surveys can be prone to bias because not everyone responds to the survey. (In this case, about half of people invited to take the survey actually completed it.) In addition, surveys rely on people’s memory and ability to accurately communicate their medication and test results, which is not considered as reliable as some other types of research.
PPIs and infections
Millions of people in the United States take PPIs such as Prevacid (lansoprazole), Prilosec (omeprazole), and Nexium (esomeprazole), which are available both by prescription and over-the-counter. The drugs cut down on the amount of acid your stomach produces. This can relieve acid reflux-related symptoms such as inflammation, precancerous changes in your esophagus (like Barrett’s esophagus—damage to the tube that feeds into your stomach) and scars that get in the way of swallowing, says Gulchin Ergun, MD, a gastroenterologist and professor of medicine in digestive disorders at Houston Methodist.
Previous studies have linked PPIs with an increased risk of some intestinal infections, including Clostridium difficile, the theory being that less stomach acid makes it easier for infections to take hold.
The importance of a healthy gut
“Stomach acid serves many purposes, not the least of which is helping to maintain a healthy gut flora,” explains King. “When the acidity of the stomach is decreased with the use of acid-suppressing medicines like PPIs and histamine-2 receptor antagonists (H2RAs), organisms that ordinarily are kept in check begin to overgrow other, healthy organisms.” An acidic stomach also helps protect against organisms that may not be part of a healthy bowel, like Covid-19. “In the presence of a PPI, it may be possible that this virus is able to survive better,” he says.
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Don’t stop your PPIs on your own
The study is too preliminary to warrant stopping PPIs if you’re already using them. “This is just too premature to hang your hat on,” says Dr. Ergun. “If someone thinks that they should begin to discontinue PPI use in patients who really need this medication … then our patients would be in a world of hurt.”
Instead, talk to your doctor about whether you’re taking PPIs for the right reason and at the right dose, she recommends. But there is a way to cut any potential risk by half: The study authors point out that taking PPIs twice a day doesn’t provide any significant improvement over once a day.
You may be able to eliminate the as-yet theoretical risk by switching to an H2 blocking medicine such as Pepcid (famotidine) or Tagamet (cimetidine), recommends Dr. Branstetter. The study did not find any increased risk of Covid-19 among people taking H2 blockers, but you’ll want to discuss this move with your doctor before making any changes.
Consider lifestyle solutions for heartburn
In addition to lowering the dose of PPIs or switching to H2 blockers, you can also reduce heartburn by avoiding spicy foods, fatty foods, and citrus, says Dr. Branstetter. Obesity and smoking have been shown to increase the risk of getting Covid-19, he adds, so losing weight and quitting smoking (or vaping) would help.
“This would be the time to reassess all the other things people can do to improve their health and lifestyle that doesn’t involve medications,” says Dr. Ergun. “The pandemic has been stressful for everyone and a lot of people have gained weight at home and stress eating,” she adds. “This would be an opportunity to avoid that.”
Make sure you know the subtle signs of heartburn.
- Johns Hopkins: "Coronavirus COVID-19 Global Cases."
- American Journal of Gastroenterology: "Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors."
- Danny Branstetter, MD, director of infection prevention, WellStar Health System, Georgia.
- Travis T. King, PharmD, clinical pharmacy specialist, Ochsner Health, New Orleans.
- National Library of Medicine: "Proton pump inhibitors."
- Gulchin Ergun, MD, gastroenterologist and professor of medicine in digestive disorders, Houston Methodist.
- Gastroenterology: "Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin."