Still On That Heartburn Medication?

You or someone you love is probably taking a proton pump inhibitor (PPI)—like omeprazole or pantoprazole—for heartburn, reflux, or stomach issues. These medications are helpful and often necessary, but many Canadians are staying on them far longer than they need to, sometimes for years without review. That can come with hidden risks. In this issue, we break down what PPIs are, when they’re needed, and when it might be time to reassess. If you’re on one—or know someone who is—this is a must-read. Feel free to forward it to a friend or loved one who might benefit.

Proton pump inhibitors (PPIs) like omeprazole, pantoprazole, lansoprazole, dexlansoprazole, rabeprazole and esomeprazole are among the most prescribed medications in Canada. These acid-reducing medications are often used to treat symptoms like heartburn, acid reflux, and stomach ulcers—and for many, they work incredibly well.

But are we relying on them more than we should?

What Are PPIs—and Why Are They Prescribed?

PPIs are medications that reduce the amount of acid your stomach produces. They’re commonly used to treat:

GERD (gastroesophageal reflux disease)
Stomach and duodenal ulcers
Indigestion and heartburn
Damage from NSAIDs
Helicobacter pylori infections (part of combination therapy)

They help relieve symptoms, heal the lining of the stomach and esophagus, and prevent recurrence of damage.

The Situation in Canada: Growing Use, Growing Questions

Over the last 15 years, PPI prescriptions in Canada have more than doubled.

Nearly 1 in 3 seniors in Canada is on a PPI. Studies estimate that 25–50% of these prescriptions may not be clinically necessary long-term. That means many patients are continuing to take PPIs for months—or years—without a clear reason.

How Does PPI Overuse Happen?

Here’s what we often see:

A PPI is started in hospital and never stopped
It’s prescribed for general “heartburn” without further investigation
Refills continue automatically without re-evaluation
There’s hesitation to discontinue it—even when symptoms are gone
Sometimes, patients also purchase over-the-counter PPIs and continue using them long-term without supervision.

Why It Matters: Potential Risks of Long-Term PPI Use

PPIs are safe and effective for short-term use and for clearly diagnosed long-term conditions. But extended use—especially without clear medical need—has been linked to several health risks:

Vitamin and mineral deficiencies (especially B12, magnesium, and iron)
Increased risk of bone fractures, particularly in older adults
Chronic kidney disease and acute kidney injury
C. difficile infections and other gut infections
Rebound acid hypersecretion when PPIs are stopped abruptly

These risks are low for most people, but they add up when millions are exposed to these drugs for longer than needed.

A Quick Note: Don’t Panic—PPIs Are Still Important

PPIs remain essential medications when used appropriately. They are the gold standard for:

Healing stomach and duodenal ulcers
Treating serious or frequent GERD symptoms
Preventing gastrointestinal bleeding in high-risk patients (e.g., those on NSAIDs)
Long-term use can be appropriate—it just needs to be monitored. The issue isn’t that PPIs are bad—it’s that many people are using them longer than they need to, without review.

What You Can Do (With Our Help)

If you’ve been on a PPI for longer than 8–12 weeks, ask yourself—or your pharmacist—these questions:

Do I still have symptoms that need this treatment?
Was I ever diagnosed with GERD or ulcers?
Could I step down to a lower dose or try a taper?
Are there lifestyle changes I could make to reduce symptoms naturally?

Never stop a PPI suddenly—this can trigger acid rebound. But we can help you taper safely or assess whether continuing makes sense.

We’re Here to Help You Make Informed Choices

At Opal Wellness Pharmacy, we regularly work with patients and healthcare providers to:

Review long-term prescriptions

Identify medications that may no longer be needed

Create tapering or transition plans

Support lifestyle-based digestive care

Whether you’re managing GERD, healing from ulcers, or just unsure if you need your current therapy—we’re here to provide science-backed support.

We believe your treatment plan should evolve with you.

Book a MedsCheck (medication review) with us.

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Your Guide to a Pharmacy Medication Review

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