Proton pump inhibitors (PPIs), including omeprazole, esomeprazole, pantoprazole and similar drugs, are among the most widely used prescription medications globally. Long-term use has been associated with various nutritional and side effect concerns, including reports of hair loss in a subset of patients. The mechanism is plausible through reduced gastric acid affecting absorption of B12, iron, zinc, and magnesium, all relevant to hair status.

The evidence base is modest. Several case series describe telogen effluvium associated with long-term PPI use that resolves on discontinuation or substitution with H2 blockers. A 2021 cross-sectional study found that PPI users had slightly higher prevalence of hair loss compared to non-users, but the effect was small and complicated by significant confounders (PPI users tend to be older and have more comorbidities). Larger prospective studies are absent.

Practical implications: long-term PPI users with unexplained hair loss should have B12, ferritin, and magnesium status checked. Many such patients have suboptimal levels of one or more of these nutrients that can contribute to hair issues. The PPI is rarely the direct cause but often a contributor through impaired absorption. Reviewing PPI necessity (many patients remain on these drugs longer than initially indicated) and supplementing identified deficiencies often improves the situation. Switching to H2 blockers (famotidine, ranitidine) is an option when long-term acid suppression is needed but PPI side effects are problematic.