Last year over 80 million prescriptions were dispensed for powerful acid-suppressing drugs such as Aciphex, Nexium, omeprazole, Prevacid and Protonix. That doesn’t even count the millions of doses of Prilosec OTC that were purchased without a doctor’s supervision.
This makes these proton pump inhibitors (PPIs) among the most popular pills in the pharmacy. One might conclude that Americans suffer a lot of bellyaches. That’s hardly any wonder, given how we eat on the run and indulge in so much fast food.

There may be another more insidious reason for the huge number of PPI prescriptions dispensed each year. These medicines might be considered “addicting.” No one is getting high on Nexium or Prilosec. But when such medications are stopped, people often suffer serious rebound hyperacidity.

Many physicians have assumed that people who suffer heartburn or reflux would naturally experience a return of their symptoms when they stopped a PPI. But an innovative new study from Denmark suggests a different explanation (Gastroenterology, July, 2009).

Researchers randomly assigned 120 healthy volunteers to receive either a PPI (Nexium) or a look-alike placebo. After eight weeks on the acid-suppressing drug, a placebo was substituted without the subjects’ knowledge. Heartburn symptoms were evaluated in both groups.

The people who had taken Nexium for two months suffered significant heartburn, indigestion and acid regurgitation after they were switched to placebo. The investigators concluded: “PPI therapy for 8 weeks induces acid-related symptoms in healthy volunteers after withdrawal.”

This doesn’t come as a complete surprise to readers of The People’s Pharmacy. Many have shared stories like this: “I started taking Prilosec in the 90s. I now take Prevacid every day. Without it, I had heartburn so bad I thought I was having a heart attack.”

Another reader reported: “I’ve had exactly the same problem with Protonix and Nexium. I’ve tried to go off Protonix three times but I suffer terrible burning in my stomach. My doctor just says, ‘Maybe you need it.’ But I know there are side effects, and I’d like to find another way to take care of my stomach problems.”

An editorial comment on the Danish study suggests that the indiscriminate use of PPI medications could aggravate the very symptoms that these drugs are supposed to treat and lead to an increased requirement for long-term therapy.

Although some patients must take acid-suppressing drugs to prevent damage to the esophagus, there are growing concerns about long-term use of such medicines. Some research indicates that prolonged use may lead to an increased risk of pneumonia, weakened bones and vitamin B12 deficiency (American Journal of Gastroenterology, March, 2009).

For an in-depth review of the benefits and risks of acid-suppressing drugs and a discussion of alternative approaches for indigestion, readers may wish to consult Best Choices From The People’s Pharmacy. It is available in libraries, bookstores and online at Doctors should warn patients about the difficulties of discontinuing PPI therapy before they hand out new prescriptions for these drugs.

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  1. urban

    The more I know the less I know…. It’s known that habit forming is a product of the solution….it’s similar to smoking and drinking……the effects do more damage than the original solution…. Stop! ask the ???? If the answers are full of disclaimers Ask some more!

  2. Shelby

    I was on a off name brand Acid Reducer because when I was about 12 I could go days without eating because my stomach would hurt so bad and it would feel as if my body was shutting down on me from the pain, my grandfather had an acid reducer due to the fact that he gets horrible heart burn so he gave me one and it helped me eat and made me feel a hundred times better.

    Now, 7 years later, I decided to stop taking them because I was taking them twice a day one when I got up and one when I laid down for the night but it seemed to be making me more sick than I was before, now I’m worried because it still seems like every time I eat I end up not feeling well and I have been wondering if its due to taking the medicine for so long or if it could all be myself making me sick just thinking about it. Seeing that I’m not the only one that has had these issues makes me feel a little better about it.

  3. Darell G.

    I have some serious issues with my stomach – heartburn, gerds and acid reflux, every meal was guaranteed pain. My doctor gave me everything available on the market to help me out. For a period I took Omeprezole, but the symptoms didn’t get away, it didn’t have a good effect on me, I suppose it’s not strong enough.
    By now, the medicine that best helped me is Nexium. After taking it, all my discomfort and pains go away, it’s such a relief. I have a good insurance so buying Nexium isn’t that a problem for me. I will continue taking Nexium as long as there is no other better drug for my problems.

  4. CK

    LC – Me too! Seven miserable days on protinix! I had drive me to the ER heartburn on it. I tried so hard to stick it out for what they think is esolphagilitis…no scope, so how could they really know.
    Now it’s been two or three weeks and I’m finally feeling a wee bit better. I was also on prilosec before the protonix for two weeks, but the dosing — 40 mgs — of protonix did me in.
    I should have stayed with the prilosec and weaned myself off. But now, I fear I’m doing myself more damage. The prilosec caused severe heartburn too.
    I also have raspy voice. I’m on the induction diet for the most part, but it’s SO hard.
    These comments have made me feel better.

  5. Shashi

    Hi Ann, thank you so much for sharing. I am now trying to get off nexium and don’t know the path to follow. I have been on some sort of PPI’s or H2Bs for the last 20+ years. About 5 years ago I became a diabetic (I don’t eat much meat and weigh 123 lbs). I became horribly constipated and Dr. recommended miralax and glycolax and all the other laxes you can imagine. My stomach was just torn.
    So I took myself off librax, night time nexium and night time pepcid plus the six a day motilium. I now only take one nexium a day. Can you please tell me how I can kick this one a day nexium habit? I tried the last eight days altering with pepcid but broke down and took nexium after seven days. I was dizzy, shaking and horrible heartburn. your assistance will be greatly appreciated. In friendship, Shashi

  6. LC

    I was protonix for 6 days. I couldn’t stand the side effects so I called to find out if I could stop. The answer was “yes.” I stopped and felt like I was recovering fine but on the 13th day out I had the worst burn sensation in my stomach I ever felt. It was like I drank battery acid. I went running for the Zantac for a day and the feeling still returned. I then reached for the protonix.
    I was miserable and was switched over to aciphex. Went to Dr. yesterday and he said to get off the aciphex and just take zantac two times a day. There should be no acid rebound. That was for those who had been taking it longer. Based upon my own experience, rebound can happen in shorter periods of time. I took zantac today. I have my doubts but RH’s experience gives me some hope.

  7. maria

    I took nexium and then prilosec for 5 yrs bf I heard they were horrible to take and they cause reflux, but there is a way to get off them and get rid of reflux! When I started I had to take half pills every day then every other day and finally not at all, when I tried to stop suddenly I had horrible reflux and withdrawals like headaches and dizziness. I also drank 1 tablespoon of apple cider vinegar 2 times a day with meals, dgl licorice chewables are good too they taste gross but get rid of heartburn, but the most important thing I took were probiotics they help lot!!!
    You have to get multi probiotics that have at least a billion, you can get them from walmart usually start with one in the morning and 1 at night after symptoms ease just take 1 in the morning.
    I hope this helps, I’ve been off all ppi’s for 2 years now I do have occasional heartburn like a normal person does but that’s hardly ever. I also lost 50lbs I think the ppi’s made me gain over the 5 yrs I was on them. good luck

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