A recently released series of studies suggest proton pump inhibitors (PPIs), the most powerful class of antacid drugs, including AstraZeneca’s Nexium and Prilosec, Aciphex, Dexilant, Prevacid and Protonix, medication often used to treat common indigestion should be used with caution, as they can cause serious side effects.

Every year, doctors write 113.4 million prescriptions for what are the third highest-selling class of drugs in the US. However, Prilosec and Prevacid, medicines in the same class Prevacid and Prilosec, are available without prescription and now sold over-the-counter for treating frequent heartburn.

PPIs do a great job of reducing stomach acid, and are not only more powerful than simple antacids like Maalox, Rolaids, and Tums, they also reduce stomach acid more than the H2RA drugs Axid, Pepcid, Tagamet, and Zantac. Though, they should only be used for serious conditions, often they are taken for even the simplest of heartburns. Moreover, doctors seeing no harm in it, tend to over prescribe PPIs for hospitalized patients.

Perhaps, the worst PPI risk is serious infection with C. difficile bacteria, a hard-to-cure infection that causes severe diarrhoea. Stomach acid does a wonderful job in keeping C. diff down. However, PPIs keep stomach acid below protective levels.

According to a special report in the Archives of Internal Medicine, while they seem to greatly help certain patients, they are also known to raise the risk of fractures in post-menopausal women, including causing bacterial infections in many patients.

One study looking at 161,806 women aged between 50 to 79 years, after eight years of follow-up found women who were taking these drugs seemed at greater risk for fractures overall, especially those of the spine and wrist.

Over prescribed, the benefits of PPIs may not justify their risks, and it is recommended that doctors offer other treatments for heartburn, including non-drug treatments like stress reduction, weight loss, and smoking cessation, including using shorter courses and lower doses, whenever possible when using PPIs.