Heartburn and ulcer drugs increase risk of pneumonia, study says

• Widely used heartburn and ulcer drugs such as Nexium, Pepcid and Prilosec can make people more susceptible to pneumonia, probably because they reduce germ-killing stomach acid, Dutch researchers found in a study of more than 300,000 patients.
• The highest risks occurred with more powerful acid-fighting drugs called proton pump inhibitors, which are sold in the United States under such brand names as Nexium, Prevacid and Prilosec.
• Over nearly three years, users of these drugs faced almost double the risk of developing pneumonia compared with former users.
• Users of another class of acid-fighting drugs that includes cimetidine and famotidine --- sold in the United States as Tagamet and Pepcid --- also faced an elevated risk.
• The study was led by researcher Robert J.F. Laheij at University Medical Center St. Radboud in Nijmegen, Netherlands, and appears in Wednesday's Journal of the American Medical Association (news - web sites).
• The acid in normal stomach fluids generally kills harmful bacteria; suppressing it with drugs to treat heartburn and ulcers may make the body more hospitable to such germs, which may then infect the lungs and cause pneumonia, the researchers said.
• These heavily promoted medicines are among the most widely prescribed drugs worldwide, with almost $13 billion in sales in 1998 alone, according to a JAMA editorial.
• The researchers said their findings translate to about one case of pneumonia for 226 patients treated with the more potent acid-fighting drugs and one case per 508 patients treated with the other drugs.
• Patients using the less potent drugs were 63 percent more likely to develop pneumonia than former users of those drugs.
• Nevertheless, the findings are reassuring because the apparent increase in the risk of pneumonia was small, said Dr. James Gregor of the University of Western Ontario.
• Regardless of which medication a patient is taking, heartburn, or acid reflux disease, can cause a person to accidentally inhale regurgitated stomach acid, increasing the risk of pneumonia, he said.