Long-term use of drugs like Omeprazole and Metformin, among the most prescribed in Croatia, can lead to serious vitamin B12 deficiency and other side effects, with a particular concern being the so-called "rebound" effect when attempting to stop.
Omeprazole and Metformin, widely available and among the most prescribed medications in Croatia, especially among the elderly, are under scrutiny from experts. Family physician Dr. Amir Khan and specialist Simon Mills have warned of the hidden dangers of their long-term use without proper monitoring.
While their effectiveness is unquestionable, it is crucial that patients are aware of potential consequences and regularly consult their doctor about the necessity of continuing therapy. The warnings come at a time when concerns about the long-term use of these drugs continue to grow.
Dr. Amir Khan described Omeprazole, which belongs to the group of proton pump inhibitors, as a "brilliant drug for acid reflux and stomach protection." However, he also highlighted its lesser-known side that emerges with long-term use.
"It's a brilliant drug for acid reflux and stomach protection, but if you take it for months or years, it can reduce the absorption of nutrients like vitamin B12 and magnesium. That's why therapy should be reviewed periodically. Check whether you still need it and whether you're on the lowest possible dose to control symptoms," said Dr. Khan.
Vitamin B12 deficiency can develop slowly and unnoticed, with consequences including chronic fatigue, neurological issues like tingling in the hands and feet, memory difficulties, and mood changes. Reduced nutrient absorption also increases the risk of muscle cramps, intestinal infections, and in rare cases, kidney problems.
Specialist Simon Mills, in the podcast "Diary of a CEO," further emphasized the seriousness of the situation, particularly addressing the difficulties of stopping the medication.
"The list of problems arising from long-term omeprazole use is growing and is serious. More and more consequences are being linked to its long-term use," Mills said.
He also explained why it is so hard for patients to get off this drug. "Once you're on it, it's very hard to stop because of the well-known 'rebound' effect. When you stop omeprazole, symptoms return with much greater intensity. So the only solution is to take more omeprazole, and people find it very hard to come off it."
Although withdrawal can be difficult due to increased stomach acid secretion, experts emphasize that this drug should not be taken indefinitely and it is always worth discussing dose reduction with a doctor.
Dr. Khan also addressed Metformin, a cornerstone drug in treating type 2 diabetes, which is used by many patients in Croatia. He explained that the drug "works very well," but can cause unpleasant side effects, especially at the start of therapy.
"It works very well. But, especially at the beginning, it can cause diarrhea, bloating, stomach cramps, and nausea. In many people, these symptoms subside after a few weeks. So don't lose hope too quickly, but there are alternatives if you need them," he explained.
Special caution is needed for patients taking both Metformin and Omeprazole simultaneously. According to research, each of these drugs can independently lead to a drop in vitamin B12 levels. When taken together, this risk increases because Omeprazole reduces stomach acidity, which is necessary for extracting the vitamin from food, while Metformin can block its uptake in the digestive system. Therefore, health agencies have recommended that patients on long-term use of these drugs have their vitamin B12 levels regularly checked.
Dr. Khan concluded with a clear message to patients who experience side effects and consider stopping the medication on their own initiative.
"When we prescribe medications, we always weigh the potential benefits against the risk of side effects. We only give them when benefits outweigh risks. But if you're taking medications and having problems with them, don't just stop taking them. Come and talk to us because we often have many alternatives we can offer you," concluded Dr. Khan.
Although these drugs are essential for many patients, their long-term use requires careful medical supervision and open communication between patient and doctor to find the lowest effective dose that will safely control symptoms.
