Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching, 2020, Lee et al

Open access, https://gut.bmj.com/content/early/2020/07/30/gutjnl-2020-322248

 

I suspect that a significant number of our members take PPIs, which is why I thought it was worth posting this as a separate thread, rather than on the Covid19 research mega-thread, so that more see it.

 

I recall an early article about Chinese covid patients taking older H2 blockers for reducing stomach acid were experiencing better outcomes than other covid patients. Apparently these patients were mostly from poorer, more rural areas and thus couldn't afford more modern PPIs.

An alert doctor noticed this and was experimenting with H2 blockers as a covid treatment. There was even some panic-buying of brands like pepcid.

Unfortunately I can't locate the article and it seems that this potential treatment seems to have fallen by the wayside.

 

Me too. The more that is known about Covid the more I respect how serious it is!

 

Yes that is troubling to me too, thats a massive increase in risk. But i am not a scientist can someone, perhaps @Jonathan Edwards peruse the actual study to check if the conclusions are warranted from the actual data.

I reduced my dose of PPI recently because of the increased risk of osteoporosis with long term use. But i cant reduce any more i am now on the brink of 'manageable' gastric discomfort, ie it's present but doesnt keep me awake or trouble me significantly. Without them it's very painful 24/7. PPIs are a bit of a menace but also a miracle for acid reflux etc.

Do i understand this study to be saying that their use does not make one more susceptible to catching it, but is associated with worse outcomes once infected?

So does that mean that stopping/reducing them is a good idea as soon as symptoms are experienced in order to reduce risk. Their effects wear off very quickly for me - ie if i miss a dose by mistake i know about it with increased pain within 12-18hrs so their effects seem short lived? Although it says use in the previous 30 days associated with 90% increased risk, but current use only with 79% increased risk?? I'm very foggy can someone explain please

 

This really worries me as I’m due to go into hospital soon and I’m taking double dose PPIs (twice a day). I was thinking of reducing it to once a day anyway (I’m not actually monitored for these properly by any doctor, I was just told about 7 years ago that I can take them when I need them.. which is what I’ve done, on and off..and then a GP made them twice a day when gallbladder issues started.. so I can go back to my GP about it now) but not sure whether to come off them and switch to a H2 blocker like Famotidine or Ranitidine (if that’s available now or is it still banned)!

does anyone know if ranitidine is prescribed again now? In the U.K.?

 

I don't know about ranitidine, but you can buy a limited supply of famotidine over the counter. It's one of those meds that's probably best prescribed by a doctor where possible, to make sure that you're being monitored properly, but I know from a friend with a history of gastric problems that you can buy it if necessary. I got her some from a local pharmacy last year when she was stuck at home with a broken ankle.

 

Just an update, Ranitidine is not currently available over the counter in the U.K., as far as I can see, and is still withdrawn.

I asked my GP to switch me over to Famotidine. They agreed and prescribed it however, none of the pharmacies or online pharmacies have it in stock. There’s a “supply problem”.. maybe lots of people buying it up.

From what I understand Cimetidine, also in the same family, carries a lot more side effects (according to some websites, but not others).

Nizatidine was also withdrawn along with Ranitidne I think.

so that just leaves..PPIs again!

 

This might explain why.. famotidine is being bought up by people as it is being looked at as a possible treatment for Covid! It looks like this was known about in April, and it’s August now; and there’s still a supply problem which I presume is most likely related to that.

https://www.bhf.org.uk/informations...-coronavirus-treatments-are-around-the-corner
Famotidine – used to treat heartburn and stomach ulcers
Famotidine is a heartburn medication which is available over the counter in many parts of the world. The first signs that it could help to treat coronavirus came from preliminary studies in China and a single hospital in New Yorksuggesting that people in hospital with Covid-19 were less likely to die if they took famotidine.

Famotidine helps to reduce stomach acid production by blocking histamine receptors in the stomach. Researchers believe it can also block an enzyme needed for the replication of Covid-19 coronavirus. (They did this by using computers to study the proteins that the genes in the Covid-19 produce, compared them with other types of coronaviruses, predicted their structures and then cross-reference these against “libraries” of existing drugs to see which ones are likely to work on the genes in the Covid-19 coronavirus.)