Common OTC acid blockers may worsen cognitive impairment in the elderly

Adverse drug reactions are ranked as the fifth leading cause of death causing more than 100,000 deaths/year, account for seven percent of all hospitalizations and costs over $100 billion annually in the United States. While within the elderly population (age 65 and above), adverse drug reactions are even more widespread with some studies showing the elderly are two to four times more likely to be hospitalized for adverse drug events than non-elderly. In addition, some estimates show up to 30 percent of all hospital admissions involving the elderly are due to some sort of drug-related problem (especially if they are in poor health and are taking multiple medications).

Age-related changes in elderly often can lead to adverse drug reactions

As we get older, our body composition changes which essentially reduces our body's size (due to less body water, less body weight, more body fat, fewer protein stores, etc.) which in effect increases the amount of drug exposure per body weight. The elderly also have less ability to clear drugs via the liver and the kidneys which may lead to drug accumulation. In addition, the elderly compared to non-elderly also have less ability to compensate and tolerate drug side effects. Thus, all these factors may contribute to causing adverse drug reactions in the elderly.

All OTC H2 acid blockers can exacerbate mental confusion in the elderly

In most cases, OTC antacids like Alka-Seltzer, Tums, Maalox, Rolaids, etc. often suffice to reduce occasional heartburn symptoms. However, for more frequent and severe heartburn symptoms, H2 Blockers (OTC Versions: Pepcid AC, Tagamet HR, Axid AR, Zantac 75) are often recommended by healthcare practitioners. However, according to the leading consensus database (known as the "Beers Criteria") that identifies "potentially inappropriate medications" for patients 65 and older, all drugs in this class can worsen mental decline in the elderly (especially in those with a pre-existing cognitive impairment). Also, a study involving a large group of elderly African Americans, showed that elderly patients had a 2.4 times higher risk of developing cognitive impairment when H2 Blockers were taken continuously.

Though the exact cause of the cognitive impairment in the elderly from H2 Acid Blockers is unknown, it may be related to added inhibition of a neurotransmitter known as acetylcholine that plays a critical role in sustaining cognitive function (which may occur due to drug accumulation). In addition, H2 Acid Blockers may reduce vitamin B12 levels which may also contribute to cognitive decline. Therefore, caution must be taken in any person over the age of 65 who contemplates taking this class of drug and safer alternatives should be recommended.

Unfortunately, these guidelines are often difficult to enforce in non-institutionalized settings involving over-the-counter (OTC) medications for self-treatment. Furthermore, some of the so-called "safer alternatives" suggested by the "Beers Criteria" like proton pump inhibitors (OTC Versions: Prilosec OTC, Zegerid OTC, Prevacid OTC, Nexium OTC etc.) have potentially devastating side effects of their own like C. Difficile diarrhea, pneumonia and increased risk for bone fractures. Hence, more emphasis should be placed on suggesting safer, natural or non-pharmacologic alternatives.