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Getting Off Omeprazole

Getting off omeprazole (Prilosec) is really hard! Many people experience painful rebound hyperacidity when they try to stop.

Is it smart to block the production of stomach acid with powerful proton pump inhibitor drugs (PPIs)? Millions of people take these drugs to control acid reflux, ulcers or gastroesophageal reflux disease (GERD). Doctors initially thought these medicines, like omeprazole, were super safe. The FDA first approved brand name omeprazole as prescription Prilosec in 1989. The agency was so sure this acid-suppressing drug was benign that the agency approved Prilosec OTC in 2003. Now, though, many people report difficulties getting off omeprazole.

Serious side effects have been reported over the years, including kidney damage, liver cancer, dementia, type 2 diabetes, heart attacks, weakened bones and even strokes. While such problems may be rare, they are worrisome. People taking PPIs are also more likely to suffer intestinal infections (see below). But the kicker is that patients taking omeprazole or similar medicines may find it really hard to stop these drugs.

How Can You Get Off Omeprazole?

This reader shares a scary scenario:

Q. I took Prilosec and then generic omeprazole for over 15 years. Every time I tried to stop, my heartburn got worse.

Last year I got extremely tired and out of breath if I climbed a short stairway in my house. When I saw my doctor, I described these symptoms. To find out what was wrong, he had me take several blood tests, including one for iron level.

He called me that evening at 9 pm and told me to take a cab to the local ER. It turns out that I had almost no iron in my body, so they did a blood transfusion. Apparently, taking PPIs long term stops acid production, as it should. But that, in turn, makes it harder to absorb minerals, including iron.

At the hospital, they ran a bunch of tests: colonoscopy, endoscopy and even a mammogram. No blood loss was found. I almost died from anemia as a drug side effect.

Never quit PPIs cold turkey. The rebound heartburn is horrible. It’s better to ease off over several months, taking one every other day, then every third day, and so on.

A. Stomach acid is essential for the absorption of many nutrients including iron. We suspect that few people are warned about this possible complication when taking proton pump inhibitors (PPIs) for indigestion.

Stopping PPIs such as esomeprazole, lansoprazole or omeprazole suddenly can trigger severe heartburn symptoms, as you discovered. That’s why very gradual discontinuation is important.

Getting Off Omeprazole with Diet and DGL:

Q. I was on omeprazole daily for almost 20 years because I have a hiatal hernia that causes GERD. However, I have become concerned about the possible side effects and tried to quit several times.

It was quite a challenge, but over the course of a year I finally weaned myself off it. I now control my reflux very well by eating a very low-carb diet and taking DGL as well as famotidine when I do have symptoms.
So far, so good. Next, I plan to get off the famotidine. For me, at least, the really slow wean made a difference. DGL has been a godsend for the times I still have trouble.

A. You are not the only one who has had trouble weaning off proton pump inhibitors such as omeprazole. Your strategy of cutting back on carbs, substituting famotidine (Pepcid) for omeprazole and adding deglycyrrhizinated licorice (DGL) is sound. You should, of course, stay in touch with your primary care provider to make sure that your approach keeps working.

Using DGL to Stop Omeprazole:

Q. Stopping omeprazole (Prilosec) is really hard. When I tried, my heartburn came back worse than ever. I heard a report on public radio last year that when people stop this kind of medicine they experience rebound acidity that leads to bad heartburn.

An Internet search revealed a number of folks using deglycyrrhizinated licorice extract (DGL) to manage their reflux. When I asked at my local health food store, I learned that many people claim DGL has helped them get off omeprazole.

I went cold turkey off the omeprazole and chewed two 400 mg DGL tablets before each meal. If it was a particularly spicy meal (garlic is a culprit for me), I used an additional tablet after the meal. I followed this regimen for several months and then stopped altogether.

Today I seldom need the DGL, but when I do, I chew a single tablet for immediate relief. I continue to be amazed how effective this is.

What Is DGL?

A. Licorice that has not had glycyrrhizin removed could be dangerous. People who overdose on natural licorice may experience hypertension, headaches, hormonal imbalance and reduced libido.

DGL, on the other hand, appears much safer. It was prescribed in Europe and South America to treat ulcers before there were PPIs (Gut, May 1976). Naturopathic physicians still use DGL when they want to avoid the side effects associated with PPIs (Integrative Medicine, Aug. 2018). Other people also report that DGL can help in gradual withdrawal from acid-suppressing drugs such as omeprazole.

PPIs and Intestinal Infections:

Researchers in Scotland have found that acid-suppressing medications such as dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec) make people more vulnerable to gastrointestinal infections (British Journal of Clinical Pharmacology, online Jan. 5, 2017). They reviewed the records of half a million Scots. Those taking PPIs were 1.5 times more likely to come down with Clostridium difficile than those not on such drugs. C. difficile can cause hard-to-treat diarrhea. This is not the first study to find that such drugs  increase the risk of C diff infections (JAMA Internal Medicine, May 2015).

Scottish people taking prescription PPIs were also about four times more likely to pick up a Campylobacter infection. Intuitively, this makes sense. Stomach acid is one way that organisms protect themselves against invading germs. There is a reason why vultures, sharks, cows, pigs, crocodiles, dogs, cats and humans have strong stomach acid. It’s not a mistake!

Learn More:

The investigators warn that these powerful drugs should not be used casually. Patients and their health care providers should discuss when the drugs are appropriate and when and how to discontinue them. You will find recommendations in our eGuide to Digestive Disorders.  In it, we list other adverse consequences from PPIs and describe several strategies for getting off such drugs.

You will also how other readers have been able to get off proton pump inhibitors without suffering heartburn at this link.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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Citations
  • Bhardan KD et al, "Proceedings: Deglycyrrhizinated liquorice in gastric ulcer: a double blind controlled study." Gut, May 1976.
  • Neiworth-Petshow EM & Baldwin-Sayre C, "Naturopathic treatment of gastrointestinal dysfunction in the setting of Parkinson's disease." Integrative Medicine, Aug. 2018.
  • Wei L et al, "Acid‐suppression medications and bacterial gastroenteritis: A population‐based cohort study." British Journal of Clinical Pharmacology, online Jan. 5, 2017. https://doi.org/10.1111/bcp.13205
  • McDonald EG et al, "Continuous proton pump inhibitor therapy and the associated risk of recurrent Clostridium difficile infection." JAMA Internal Medicine, May 2015. doi:10.1001/jamainternmed.2015.42
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