Benicar Among New Causes of Non-Celiac Disease Sprue: Report

A new report highlights the importance of doctors being aware that the hypertension drug Benicar may cause sprue-like illnesses that are not celiac disease, causing users to experience chronic diarrhea and potentially suffer permanent intestinal damage if the link between Benicar and the symptoms are not discovered.  

Celiac disease is a disorder that can result in diarrhea, abdominal pain and other GI problems in response to eating gluten. Symptoms often continue if individuals with celiac disease fail to follow a gluten-free diet, and the long-term problems can cause permanent damage to the lining of the small intestines.

Also known as sprue, celiac disease occurs among individuals who are genetically predisposed. However, in many cases where symptoms similar to celiac disease occur among individuals without a genetic predisposition or where individuals do not respond to a gluten-free diet, the condition is categorized as “unclassified sprue” or “sprue-like enteropathy.”

In a report published earlier this month in the International Journal of Celiac Disease by Dr. Hugh James Freeman of the Department of Medicine at University of British Columbia indicates that doctors need to be aware of these similar disorders, whic can be caused by prescription medications like the hypertension drug Benicar, the melanoma treatment Yervoy, and some pain medications.

“Traditionally, infectious agents, such as giardiasis, were often believed to be responsible, but in many patients with a sprue-like intestinal disorder, other causes were detected,” Freeman wrote. “A number of ‘new’ drugs have also been recently recognized to cause a sprue-like intestinal disease.”

Dr. Freeman indicates that side effects of Benicar have only recently been linked to a more severe form of “sprue-like” enteropathy defined by chronic diarrhea, weight loss, and villous atrophy. He also warned that Benicar has also caused sub-epithelial collagen deposition, which is linked to collagenous sprue, which is closely linked to celiac disease. Unlike many other causes of non-celiac disease sprue, several Benicar patients often require repeat hospitalization, Freeman warned.

The report notes that Benicar-induced enteropathy was hard to detect because it can develop over prolonged periods; sometimes only appearing after months to years of treatment. This has caused many doctors to misdiagnose Benicar-induced enteropathy as either celiac disease or unclassified sprue.

Recent Studies Linked Benicar to Sprue-Like Enteropathy

Benicar (olmesartan medoxomil) is a widely-used blood pressure drug that was first approved by the FDA in 2002. It is distributed by Daiichi Sankyo and Forest Laboratories in the U.S., and other versions of the medication are sold under the brand names Benicar HCT, Azor and Tribenzor.

The first published report to suggest a link between Benicar and celiac disease-like symptoms was published in the medical journal Mayo Clinic Proceedings in July 2012, highlighting at least 22 patients from 17 different states who were treated by Mayo Clinic for chronic diarrhea, weight loss and other related symptoms. All of the patients took Benicar and showed substantial improvement when they were taken off of the medication, leading the independent researchers to raise concerns that side effects of Benicar may cause celiac disease-like symptoms.

In July 2013, the FDA released a drug safety communication to warn consumers and the medical community about the risk of sprue-like enteropathy from Benicar. The federal drug regulators indicated that these problems may surface months or even years after an individuals starts using the medication.

The FDA indicated that there is clear evidence that Benicar is causing these problems, as patients almost always see improvement when they stop using the drug and the symptoms often return when the drug is resumed.

Although the diarrhea symptoms often resolve when Benicar is no longer used, the long-term exposure to Benicar while experiencing the problems can cause permanent damage to the intestines, known as villous atrophy. This involves the deterioration or decay of the villa in the intestinal tract, which may prevent the absorption of nutrients and reduce digestive capabilities. Left untreated, villous atrophy may result in dehydration, malnutrition, a weakened ability to fight off other illness and electrolyte problems.

Since the connection was discovered between Benicar and chronic diarrhea, the Celiac Disease Center has suggested that Benicar may have been responsible for 22% of all cases of previously unclassified sprue.

As more and more consumers learn that their severe and debilitating sprue-like enteropathy may have been caused by the blood pressure mediation, a growing number of Benicar diarrhea lawsuits are being filed against Daiichi Sankyo and Forest Laboratories, the manufacturers. All of the complaints involve similar claims that the drug makers knew or should have known about the risk of sprue-like enteropathy and celiac disease-like symptoms, but failed to provide adequate warnings.