Concurrent use of antacids and proton pump inhibitors
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Patterns of Concurrent Antacid and Proton Pump Inhibitor (PPI) Use
Concurrent use of antacids and PPIs is common in both hospital and community settings. Surveys show that a significant portion of adults use antacids, alginates, and PPIs, with about half of those on therapy for frequent symptoms reporting combination use of antacids/alginate and PPIs. Long-term PPI use is often associated with co-medication and prescription renewals, suggesting that unnecessary or prolonged therapy may be maintained by behavioral patterns rather than clinical need . In hospital settings, especially intensive care units, PPIs are prescribed to the vast majority of inpatients, often alongside multiple other medications, increasing the risk of drug interactions .
Drug Interactions and Clinical Implications
Concurrent administration of PPIs and other antacids can lead to significant drug interactions. Studies have identified major drug interactions when PPIs are used with other medications, highlighting the need for careful monitoring and clinician awareness to avoid serious outcomes . In cancer patients, especially those treated with tyrosine kinase inhibitors (TKIs) or immune checkpoint inhibitors (ICIs), antacid use—including both PPIs and H2 receptor antagonists (H2RAs)—can reduce the efficacy of these cancer therapies, leading to shorter overall survival and progression-free survival Chen2016Rizzo2022Raoul2024. However, some research suggests that when accounting for other medications like corticosteroids and NSAIDs, antacids may not independently affect ICI efficacy, as poor prognosis may be more related to the underlying disease and associated treatments .
Risks Associated with Long-Term and Combined Use
Long-term use of PPIs, especially when combined with other antacids, is linked to several adverse effects. These include increased risks of vitamin and mineral deficiencies, infections (such as enteric, respiratory, and urinary tract infections), and potentially more serious outcomes like gastric polyps, carcinoids, and cancer. The risk of tuberculosis is also higher in patients receiving concurrent antacid therapy, particularly in TB-endemic areas, with the risk being greatest for those using both PPIs and H2RAs Hong2024Koyyada2020. In neonates and infants, while antacids and PPIs increase gastric pH and reduce acid reflux events, they do not consistently improve clinical symptoms and may increase the risk of infections and other complications .
Recommendations for Clinical Practice
Given the potential for adverse effects and drug interactions, clinicians are advised to limit the use of PPIs and other antacids to specific, evidence-based indications. Long-term or unnecessary concurrent use should be avoided, especially in older adults and vulnerable populations. In cancer patients requiring acid suppression, antacids or H2 blockers may be preferred over PPIs to minimize negative impacts on cancer therapy efficacy Koyyada2020Raoul2024. Regular review of ongoing therapy and patient education are essential to prevent unnecessary prolonged use Lødrup2014Razgallah2023.
Conclusion
Concurrent use of antacids and PPIs is widespread but carries risks of drug interactions, reduced efficacy of certain therapies, and increased adverse effects, especially with long-term use. Careful patient selection, regular therapy review, and clinician awareness are crucial to optimize outcomes and minimize harm.
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