Long-term effects of omeprazole use
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Hematological and Biochemical Effects of Long-Term Omeprazole Use
Long-term use of omeprazole can lead to significant changes in blood and biochemical parameters. Studies have shown that patients on omeprazole for a year or more may experience a reduction in red blood cell count and indices, which can result in anemia. There are also increases in cholesterol, triglycerides, and low-density lipoprotein (LDL) levels, while high-density lipoprotein (HDL) remains unaffected. Additionally, liver enzymes such as alkaline phosphatase and aspartate aminotransferase may be elevated, and kidney function markers like creatinine and blood urea nitrogen can increase. Omeprazole use is also associated with lower levels of serum ferritin, vitamin D3, and calcium, indicating possible deficiencies in these nutrients and minerals due to impaired absorption 12.
Cognitive and Neuropsychological Impacts of Chronic Omeprazole Therapy
Research indicates that long-term omeprazole use may negatively affect cognitive function. Users have shown impairments in executive functions, memory, attention, and verbal fluency. The degree of cognitive impairment appears to be related to the duration of omeprazole treatment. These cognitive changes are thought to be linked to increased oxidative stress and neurotoxicity, as evidenced by altered antioxidant enzyme levels in omeprazole users 35. Animal studies further support these findings, showing behavioral changes, increased inflammation, and oxidative stress in the brain after prolonged omeprazole administration .
Renal and Electrolyte Disturbances from Extended Omeprazole Use
Long-term omeprazole therapy can adversely affect kidney function. Elevated creatinine and urea levels, as well as histological evidence of kidney injury, have been observed in both human and animal studies. These changes are linked to inflammation, fibrosis, and cellular damage in the kidneys. Some studies suggest that these effects can be mitigated by co-administration of protective agents like ginseng 17. Chronic omeprazole use has also been associated with critical electrolyte imbalances, including hypomagnesemia, hypocalcemia, and hypokalemia, which can be difficult to correct without discontinuing the drug .
Gastrointestinal and Gastric Mucosal Safety in Long-Term Use
For patients with severe acid-related disorders, long-term omeprazole therapy is effective in controlling symptoms and preventing disease relapse. Over periods extending up to 11 years, omeprazole has been shown to be safe for most patients, with rare occurrences of gastric mucosal atrophy or intestinal metaplasia, especially in those without pre-existing gastritis or Helicobacter pylori infection. No cases of dysplasia or neoplasms were reported in these long-term studies 4910.
Vitamin and Mineral Deficiencies Associated with Prolonged Omeprazole Use
Deficiencies in vitamin D, vitamin B12, calcium, and ferritin are commonly reported in individuals using omeprazole for extended periods. These deficiencies are likely due to impaired absorption in the gastrointestinal tract, a known effect of reduced stomach acid production. Vitamin D deficiency, in particular, was found in a significant proportion of long-term users 123.
Conclusion
Long-term omeprazole use is generally effective for managing acid-related gastrointestinal conditions, but it is associated with several potential adverse effects. These include anemia, changes in lipid profiles, liver and kidney function disturbances, electrolyte imbalances, cognitive decline, and deficiencies in key vitamins and minerals. While the risk of serious gastric complications appears low, regular monitoring of blood counts, kidney function, electrolytes, and nutrient levels is recommended for patients on prolonged omeprazole therapy. Where possible, minimizing the duration of use and considering alternative therapies may help reduce these risks.
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