Reducing Reliance on Nexium, Prilosec, Similar Drugs Not Only Saves Money, But Study Indicates It Will Do No Harm

A new study finds that programs used to reduce prescriptions for common heartburn drugs like Nexium, Prilosec and Prevacid were successful in reducing healthcare costs, without actually causing any negative harm to patients.

Researchers from the University of Michigan conducted one of the largest studies ever that focused on reducing reliance on popular heartburn medications. In findings published last week in the medical journal The BMJ, they report that use of a medication overuse program resulted in fewer patients taking proton pump inhibitor (PPI) drugs, without any increase in intestinal bleeding incidents.

Proton pump inhibitors are designed to help reduce stomach acid production. They include brands like Prilosec, Prevacid, Nexium, and Protonic, which are among the most widely recognized and used medications in the U.S.

Although there are widespread beliefs that the drugs carry few, if any, serious side effects, prior research has identified potentially serious health risks, including an increased risk of dementia among older patients and serious infections among children, as well as kidney and liver damage.

In 2023, AstraZeneca, the maker of Nexium and Prilosec, agreed to a $425 million settlement to resolve more than 11,000 PPI kidney injury lawsuits filed by individuals who alleged that the drug maker withheld known information about side effects of the drugs for years.

In this latest study, researchers looked at data on more than 4.3 million patients from one regional network of the U.S. Veterans Affairs Healthcare System. The researchers implemented a medication overuse intervention program from 2009 to 2019, which limited PPI prescription size and refills for patients without a documented reason for the medication, discontinued old prescriptions, and provided information to patients and doctors on drug alternatives.

A total of 26% of patients were receiving PPI medications like Prilosec before the intervention. According to the data, the intervention program helped to reduce PPI prescription use by 30%.

The findings indicate that reducing Nexium prescriptions did not lead to more primary care doctor visits for stomach problems or hospital admissions for intestinal diseases among older patients. It also did not lead to an increase in intestinal or stomach bleeds for high-risk patients, which researchers initially feared.

Instead, the main benefits of reducing PPI use was cost savings for patients and less hassle of having to take fewer pills.

No Increase or Decrease in PPI Side Effect Risks

Researchers did note that reducing PPI prescriptions led to a decrease in PPI use among veteran patients who actually needed the medications because alternatives were too risky for them.

Additionally, the number of negative side effects of PPIs, like kidney disease, stroke, heart attack, or pneumonia, did not decrease, they determined. Researchers said this may indicate the PPIs are not causing the side effects; instead, many patients on PPIs may be at risk for other health problems.

“A pharmacy based, multicomponent PPI overuse intervention was associated with reduced use in patients for whom PPIs were appropriate and those for whom they were inappropriate but without evidence of clinically significant harms or benefits. Thus, the primary benefits are likely to be reduced pill burden for patients and reduced drug costs for health systems,” the researchers concluded. “Ensuring that PPI de-implementation efforts are both highly effective but also focused on the right patients will be important to their long term success.”