If you take omeprazole to control acid reflux, you should be aware that the drug interferes with your body's ability to absorb vitamin B-12. The higher the dose of omeprazole, the less vitamin B-12 you are able to absorb. Although your body may still absorb enough vitamin B-12 to meet your needs, certain groups are at risk for vitamin B-12 deficiency.
Omeprazole and B-12 Absorption
Omeprazole belongs to a class of drugs known as proton pump inhibitors. It decreases symptoms of acid reflux by making the envirmonment in your stomach less acidic. However, an acidic environment is needed for optimal absorption of vitamin B-12, because your stomach acid activates intrinsic factor, an enzyme that aids in the absorption of vitamin B-12.
Certain Populations Are at Risk
In young, healthy adults there is no evidence that long-term omeprazole use leads to vitamin B-12 deficiency. Certain people, however, are at greater risk. If high doses of omeprazole are given for long periods of time, for example to people with Zollinger-Ellis disease, there is a risk for developing vitamin B-12 deficiency. The elderly -- even healthy elderly people -- also tend to be at risk, because stomach acid and vitamin B-12 absorption both normally decrease with age.
Deficiency Occurs Slowly
Vitamin B-12 is the only water-soluble vitamin stored in the body. Because it is stored, the body makes up for decreased levels by tapping into its own reserves. That means deficiency may take a while to develop, and therefore symptoms may take a long time to appear.
One difficulty in diagnosing B-12 deficiency is that symptoms are often vague and could be caused by many other conditions -- you may experience fatigue, weakness, rapid heartbeat, pale skin, easy bruising and GI upset. More severe cases of deficiency are the result of nerve damage, and these can include numbness and tingling, changes in mood, or even memory problems. If you have any concerns, let your doctor know.
Your doctor might recommend taking over-the-counter vitamin B-12 supplements to prevent deficiency or replenish B-12 stores. In severe cases of deficiency, intramuscular injections may be prescribed by your doctor.
- "World Journal of Gastroenterology"; Safety of the Long-term Use of Proton Pump Inhibitors; A.B. Thomson, et al; May 2010
- "Journal of Clinical Pharmacology"; Replacement Therapy for Vitamin B12 Deficiency: Comparison Between the Sublingual and Oral Route; A. Sharabi, et al; December 2003
- "Current Gastroenterology Reports"; Association of Long-term Proton Pump Inhibitor Therapy with Bone Fractures and Effects on Absorption of Calcium, Vitamin B12, Iron, and Magnesium; T. Ito, et al; December 2010
- "Archives of Neurology"; Neuropsychiatric Disturbances in Presumed Late-onset Cobalamin C Disease; Emmanuel Rose, MD, et al; October 2003
- "Annals of Internal Medicine": Omeprazole Therapy Causes Malabsorption of Cyanocobalamin (Vitamin B12)