People’s Pharmacy: Heartburn medicine nearly killed reader

Q. My doctors treated my persistent acid reflux for years by prescribing various proton pump inhibitors (PPIs). They diligently tested my calcium levels, but never looked at potassium or magnesium.

I was admitted to the emergency room in intense pain, and a surgeon there recognized that I had undetectable levels of those minerals. The hospital gave them intravenously for three weeks, and after I was discharged, the doctor told me I had nearly died.

During that time, the gastro doctor kept me on a PPI. Once I did my own research, I realized the drug was the cause of the imbalance and stopped taking it. Years later, I learned that my father-in-law nearly died from the same reaction.

A paper on the Food and Drug Administration website warns about this PPI side effect, but none of my doctors had read it. If people must look out for themselves, there should be warnings on over-the-counter drug packaging to alert them about this problem.

A. Thank you for sharing this scary experience. Although the prescribing information for PPIs like Nexium or Prilosec warns doctors about dangerously low levels of magnesium and potassium, OTC labels do not mention this problem.

People who would like to learn more about potential side effects of PPIs and alternative approaches to heartburn may be interested in our “eGuide to Overcoming Digestive Disorders.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. I’ve had several slightly annoying skin changes on my face and ears. My doctor says they are pre-cancerous lesions from sun exposure and shrugs his shoulders.

As I see it, “pre-cancerous lesions” could become cancer. So, when I found an article about diclofenac as an anti-cancer agent, I started applying Voltaren Gel to my actinic keratoses. Some are clearing up.

A. Thank you for providing the link to the article in eCancerMedicalScience (Jan. 11, 2016). Dermatologists consider topical diclofenac less effective against actinic keratoses than some of their more potent treatments, such as freezing, lasers, 5-fluorouracil or photodynamic therapy (Archives of Dermatological Research, July 2023). On the other hand, Voltaren Gel is available without a prescription. Be sure to have your annoying spots examined by a dermatologist before you start treating them yourself.

Q. Physicians no longer hand patients paper prescriptions; everything is electronic. I seldom need prescription medications, but having paper is good for two reasons. First, I know what medication and dosage was prescribed and can compare that with what is handed to me at the pharmacy. Second, it gives me time to find the pharmacy with the best price without having to have pharmacists call each other to transfer scripts.

Have there been studies on the best prescribing method, paper or electronic?

A. There have been a few studies of this topic. Most focus on benefits for the health care system rather than the patient. One study found that there was a learning curve of approximately two months (British Journal of Hospital Medicine, Sept. 2, 2015). At first, it took longer for junior doctors to write electronic prescriptions. Later, they took about a minute less.

In addition, a study at a university hospital found that medication errors were less common (but more serious) with electronic prescribing (Journal of Evaluation in Clinical Practice, October 2016). We don’t know, though, if the office will be able to provide you a paper prescription once they have switched to electronic prescribing.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”