Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency

Vitamin B12 deficiency is more common than most people are aware of, especially in the older adult population. If left untreated, this deficiency may lead to serious complications including anemia, dementia, and other neurologic damage. In this study, researchers studied the effects of proton pump inhibitors and histamine 2 receptor antagonists, two of the most commonly used types of medication used in the United States, and how they are associated with this type of vitamin deficiency.

The study evaluated almost 26,000 patients who were currently diagnosed with vitamin B12 deficiency and compared the evaluation of about 184,000 patients who were not vitamin B12 deficient. Through this study, researchers discovered that both a two-year use of proton pump inhibitors and a two-year use of histamine 2 receptor antagonists lead to a correlation with vitamin B12 deficiency.

This study was important because I feel that vitamin B12 is not as commonly discussed as other vitamins such as vitamin D or vitamin C. It is important to recognize that other vitamins are just as essential to the human body as those. An understanding of potentially dangerous risks associated with proton pump inhibitors and histamine 2 receptor antagonists will allow for prevention of the neurologic damage associated with vitamin B12 deficiency.

 

Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013;310:2435-42.

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Proton Pump Inhibitors May Increase the Risk of Dementia in the Elderly Population

Proton pump inhibitors (PPIs) are a class of medications that are commonly used in the elderly population to remedy gastrointestinal problems. This prospective cohort study in German  looks at the possible association between these medications and dementia. For the study, the inclusion criteria was at least 75 years old and no diagnosis of dementia. They defined the use of a PPI as having one prescription per quarter of the following medications: omeprazole, pantoprazole, lansoprazole, esomeprazole, or rabeprazole. Patients who only used PPIs occasionally were not included in the study.  This study also worked to analyze other factors that could contribute to the risk of dementia. Some of these factors were gender, the use of multiple prescription medications, stroke, and comorbid diagnosis with conditions such as depression, heart disease, or diabetes. The data analyzed was from 2004 – 2011.

A total of 73,679 people who met the inclusion criteria were analyzed in the study. The results of the study shows that the use of PPIs in the elderly is associated with an increased risk of dementia.  77.9% of patients who took PPIs regularly during this study had a “significantly increased risk of incident dementia”.  The study results also show that males had a higher risk of dementia with use of PPIs. The comorbid diagnosis of depression and stroke had a higher risk of dementia with the use of PPIs. Comorbid diagnosis with diabetes and the use of other prescription medication with PPIs showed a very slight increased risk of dementia. Patients using PPIs with heart disease actually had a slight decreased risk in developing dementia.

This study is important because PPIs are such a commonly used medication class, especially in the elderly population. If these medications are contributing to the onset of dementia, consideration should be given to avoid prescribing this medication in the elderly population. Additionally, this study could eventually lead to a clearer understanding of how disease states such as dementia or Alzheimer’s develop in the first place. From there, we could focus on developing medications that could help to prevent and treat these terrible conditions.

Gomm W, von Holt K, Thomé F, et al. Association of Proton Pump Inhibitors With Risk of Dementia. JAMA Neurol. doi:10.1001/jamaneurol.2015.4791. (Published 15 February 2016).

Association of Proton Pump Inhibitors with Risk of Dementia

Proton pump inhibitors, or PPIs, are medications used to treat gastrointestinal diseases such as acid reflux (GERD). These medications are commonly prescribed to patients in the community, and even more take their over-the-counter counterparts. This article describes a study done to measure the correlation of the use of PPIs with cognitive decline in older adults. The study analyzed data from a German health insurer to determine the association between patients 75 years or older who had prescribed PPIs such as omeprazole, pantoprazole, lansoprazole, esomeprazole, and rabeprazole and diagnoses of incident dementia from August to November 2015. The study also adjusted for confounding factors such as age, sex, comorbidities, and prescription of other medications. The study found that patients regularly taking PPIs had a significantly increased risk of incident dementia compared to patients not taking PPIs. The study concluded that not taking PPIs may decrease the risk of dementia onset, possibly because the use of PPIs has been associated with increased beta amyloid levels in the brains of mice (a characteristic of dementia patients), which may translate to having the same effects in humans.

Dementia is a health problem that pharmacists will continue to face with increasing frequency, especially as the baby boomer generation reaches the ages when the onset of dementia normally occurs. Since this disease state is one that also puts an extreme burden on the family and caregivers of dementia patients, it is imperative to identify its causes so that its onset can be prevented. I am very interested in seeing further studies done on the correlation between PPIs and dementia, as well the correlation of its onset with other frequently prescribed medications. What do you think the pharmacist’s role in patient education of this new finding will be, and how do you think it will affect the pharmacist’s job in the future?

Gomm W, von Holt K, Thomé F et al. Association of Proton Pump Inhibitors with Risk of Dementia. JAMA Neurol. doi:10.001/jamaneurol.2015.4791 (published 15 February 2016).

http://archneur.jamanetwork.com/article.aspx?articleid=2487379