a bottle of Nexium 40mg

When your doctor hands you a prescription, do you ask about the exit strategy? Most people don’t, but perhaps you should. Some drugs are very difficult to quit once you have been taking them for a while. And we’re not talking about narcotics.

It may come as a surprise that some popular heartburn medications fall into this category. Both prescription medicines such as esomeprazole (Nexium) and rabeprazole (Aciphex) and over-the-counter products such as lansoprazole (Prevacid) and omeprazole (Prilosec) are widely used for digestive troubles. But getting off one of these proton-pump inhibitor (PPI) meds can sometimes be a challenge.

Here is what one reader found:

“Had I known what I know now about Prevacid, I’d never have started it. I am off it now and have been for a few years, but I had no idea how hard it would be to wean off of it.”

Danish researchers uncovered this difficulty when they put healthy volunteers with no heartburn symptoms on either Nexium or placebo for eight weeks. At that point, both groups were given placebo, although they did not know it. Those who had been taking Nexium suffered from serious heartburn for several weeks, and the investigators concluded, “PPI therapy for 8 weeks induces acid-related symptoms in healthy volunteers after withdrawal” (Gastroenterology, July, 2009).

A People’s Pharmacy reader had a very similar experience:

“I have been trying to get off Prilosec for a couple of years. Every time I do, after a few days I am so miserable that I weaken and start it again. Whether it is really GERD or rebound, of course, is impossible to know. My local pharmacist never heard of a rebound effect from PPIs. He had no helpful advice about how to stop it. Every time I discuss it with my doc, he just says it won’t hurt me to keep taking it. I’m not sure he believes there is really a rebound.”

Many doctors think that these drugs are so safe they can be taken indefinitely without consequences. But evidence of harm has been growing. Scientists have found that people taking PPIs are more likely to come down with intestinal infections such as C. difficile or lung infections leading to pneumonia.

Without stomach acid, some nutrients are not well absorbed. A lack of calcium, iron, magnesium or vitamin B12 could have negative consequences for health. The most recent finding is that long-term PPI use may reduce blood vessel flexibility because they reduce the body’s production of nitric oxide (Circulation, online July 3, 2013).

People’s Pharmacy readers have offered helpful suggestions on gradually reducing the dose of such drugs by emptying the capsules a bit at a time. In addition, some drank water with a tablespoon of apple cider vinegar or raw cabbage juice. Others sipped herbal teas containing ginger, cinnamon and persimmon. Chewing sugarless gum may help ease symptoms because saliva is a natural buffer.

For more details on getting off PPIs, a recipe for persimmon-ginger tea and other options for treating heartburn, we offer our Guide to Digestive Disorders. 

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  1. Edwin
    Dallas, TX

    A long time ago, when I had my first colonoscopy, I told the doc I was concerned about the omeprazole because it said “don’t use over 14 days.” He said we were 30 years behind Europe… “they had been using it for a long time and it was fine. Don’t worry, just use it.” Doh! That was 20-30 years ago, and HERE WE ARE. What else are they not aware of? Gotta admit, though, they did tell us they are only “practicing medicine.” |:-(

  2. Sue

    In June 2013 I attended a fundraiser where dozens of food and drink vendors were giving samples. I came home and went to sleep on a full stomach. I woke up 2 hours later with a burning throat that felt like it was literally on fire. After that experience I was nauseous for days and the throat continued to burn. My GP put me on Prilosec for 14 days. On the 14th day I ate normally thinking I was “cured” only to wake up in the middle of the night with horrible diarrhea and vomiting. I was sent to a Gastroenterologist who put me through a battery of tests, endoscope and colonoscopy. He also prescribed Omeprazole 20 mg once a day (Prilosec) & Ranitidine 150 mg twice a day (Zantac).
    It has been 3 months since I started all of this medication. Where before I only had nausea, I now have more acid reflux symptoms. When I went for my Gastro followup last week I was told my tests looked great on paper, I didn’t have GERD, but Gastritis. You could have fooled me! I swear I developed acid reflux since I started the meds. I was told to go ahead and try to wean off the Omeprazole. So last week I started with one day on and one day off……..I felt very sick with this regiment and decided to slow down the weaning a bit.
    Now I’m doing one day full pill, alternating days 1/2 pill. I think I’ll try that for 2 weeks, then cut down a little more for 2 weeks and do it over 6-8 weeks. I still take the Ranitidine. Hopefully that will work! In the meantime I have totally changed my eating habits: No caffeine, alcohol, carbonated beverages, red or creamy sauces, no spicy, fatty or fried foods, onions, garlic etc. I feel like I will always have to watch these foods, but won’t really be well until I’m off these medications.

  3. G. Crane

    I was prescribed Nexium soon after it became available as I was waking up (fortunately) nearly every night when I regurgitated into my mouth. A very scary thing. The Nexium worked well. When I read that it was negating the Plavix taken as a blood thinner after having stents put into blood vessels in/around my heart, I tried to discontinue the Nexium using other PPI’s at the recommendation of my MD. He said it would be easier to gradually wean myself from the Nexium.
    I suffered for three months trying several different PPI’s with Xanax being a fallback if I really had a serious problem. My Cardiologist changed the medication which I took for rising BP and said that it would help overcome the negative effect of the Nexium on the Plavix.
    I am resolved to attempt Nexium withdrawal again. I am only eliminating one Nexium every other week, and I have Vinegar & water and Tums as a back-up. At this rate it will take months to withdraw from the Nexium. At 81 I may never completely get off of the Nexium dependance.
    Is opening the capsule and dumping part of the content a safe way to speed the withdrawal? The instructions on Nexium say that this should never be done.

  4. stellabrown

    I have to sing the praises of Almond Milk. Sip it for instant acid relief. Has twice the calcium, very low carbs and only 30 calories for the unsweetened. I take it in a travel mug with ice. I am only using a single tums when I go to sleep.

  5. Luke Skywalker

    I was prescribed Nexium when I first started suffering heartburn. This helped me most of the time but I wasn’t happy to keep taking them long term. I then looked further into the types of food I was eating. After discovering the acidity and alkaline levels in foods I then changed my diet to avoid most acidic foods. After noticing the effects after a few days I then started juicing high alkaline vegetables and drinking a cup in the morning and night before bed. Not only did I notice the reduction in acid reflux but also my energy levels increased.
    It blows my mind to think that this was all it told to resolve the systems of heartburn. Why aren’t the doctors suggesting this as a first alternative, do they even know the cause? If anyone out there wants to live a healthier life try taking a closer look at your diet and try reducing your intake of acidic foods. It did wonders for me and I’m sure is the answer to most digestive problems most people suffer today. Search the internet for Alkaline and Acid food charts and you will be surprised. I think generally your diet should contain 70 – 80% alkaline & 20 -30% acidic foods. I first started out eliminating all acidic foods from my diet but now happy to add 20 – 30% acidic foods.

  6. AS

    I have been reading all these articles and have been wanting to stop taking PPIs for a while now. I started on Prevacid about 16 years ago when I was 25. I was diagnosed with GERD. When Prilosec went over the counter, I switched to that. Just over 2 weeks ago I decided to try getting off my PPIs. The heartburn was terrible! The first week was horrendous! I was taking Tagamet and eating Tums like candy. I also tried Apple Cider Vinegar. The vinegar gave some instant relief like the Tums did but I had to be real careful of what I ate or I would be on fire. The second week was better. I switched from Tagamet to Pepcid and that seemed to work better for me. I had no heartburn at night and went from taking Tums every couple hours to 3 – 4 times a day.
    I am now in the middle of the third week and am nearly heartburn free. I still take the Pepcid but have stopped the vinegar and Tums. I can also eat nearly normal without episodes of heartburn. I haven’t tried pizza yet but I never ate a lot of it to start with. I did this as an experiment to see if it could be done as I so desperately wanted to be off my PPIs as I was faced with taking them for 40 – 50 more years potentially. I am not sure how this will end but if you do decide to stop taking PPIs, stick with it. The third week you should be feeling better.

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