a persimmon

Proton pump inhibitors (PPIs) have gone from doctors’ darlings when they were first introduced to having a much darker side acknowledged. These medications were originally intended to treat serious digestive disturbances: Zollinger-Ellison syndrome, peptic ulcers and severe gastroesophageal reflux disease (GERD). Initially, doctors thought these drugs had few if any side effects, particularly taking into account the very serious conditions they were treating. Over the next decade and a half, though, they were used more and more widely, and more dangerous reactions have surfaced. There is one other complication: it may not be easy to get off Nexium, Prilosec, Prevacid or other PPI medications.

How to Get Off Nexium:

Q. How do I get off Nexium? My doctor had me taking it twice a day and told me to cut back to one. I’ve had terrible heartburn, even though I started taking Zantac.

Do you have any tips for dealing with side effects? How long will it take for the stomach to go back to normal acid production?

A. Although proton pump inhibitors like Nexium are useful in some situations, they can be very difficult to quit. Stopping acid-suppressing drugs suddenly leads to rebound hyperacidity. A fascinating Danish study demonstrated this in healthy volunteers (Gastroenterology, July, 2009).

Gradual Dose Reduction:

You may need to reduce your dose even more gradually than you have so far. Adding Zantac would usually be expected to ease heartburn, but there are other approaches you may want to try: DGL (deglycyrrhizinated licorice) before meals, probiotics daily and persimmon-ginger tea at mealtime may help. It can take a few months for acid production to normalize.

Antacid When Needed:

A simple antacid such as Maalox or Tums can be helpful if used occasionally. But calcium-containing antacids should not become a habit. You might also try Prelief, which is supposed to reduce the effects of eating acidic foods.

Why Might You Want to Get Off Nexium?

The list of side effects that have been discovered is daunting. These drugs leave people more susceptible to infections such as C. diff overgrowth in the intestines that can lead to intractable diarrhea (JAMA Internal Medicine, May, 2015). People on a PPI are also more susceptible to pneumonia.

Other complications include fractured bones (BMJ, Jan. 31, 2012) and kidney disease (JAMA Internal Medicine, Feb., 2016). In addition to this, PPIs can upset the delicate ecology of the bacteria in the digestive tract (Gut, online Dec. 30, 2015). Some people taking these medicines for extended periods appear to be more prone to heart attacks (Neurogastroenterology and Motility, online Aug. 30, 2016) and to dementia (JAMA Neurology, April,  2016). Laboratory research recently revealed that Helicobacter pylori, bacteria that cause stomach ulcers, changes behavior in the presence of omeprazole, making it more difficult to treat (Turkish Journal of Gastroenterology, online Dec. 19, 2016).

We are sending you our Guide to Digestive Disorders, with a discussion of the pros and cons of proton pump inhibitors and tips for getting off PPIs, including a recipe for persimmon tea that many people find very helpful in calming heartburn symptoms while they are weaning off a PPI.

Revised 12/29/2016

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  1. Lynn
    Florida
    Reply

    For those subject to migraines, be aware that papaya, just like pineapple, in any form, can trigger one. For example, meat tenderizer containing papain can sneak in one’s diet from restaurant food or a potluck dinner with friends. As a fellow sufferer from acid reflux and dreadful belching, I’m glad to know of the suggestions readers submit and the great info provided by the authors.

  2. carolyn
    new mexico
    Reply

    My doctor recommends Zypan 8500 for heartburn and acid reflux problems. Do you know anything about Zypan?

  3. Virginia
    Reply

    I have found that sleeping on a bed wedge helps a lot with night-time reflux, also with post-nasal drip! I still take Dexilant but rare night-time roll ups of acid in my throat.

  4. Susan
    Reply

    I’ve commented on this issue in past ‘People’s Pharmacy’ newsletters. My Doctor took me off Prilosec by having me take Prilosec one day and famotitdine, the generic for Pepcid, the next. Over time I gradually further decreased the amount of Prilosec and substituted the Pepcid. It took 5 months, and a lot of rebound heartburn.

    Some remedies: Papaya Enzyme – get it at health food stores; Almonds – just a few worked really well. I occasionally took Tums, which contain Calcium, but my Doctor wanted me to get my Calcium mostly from my diet. Baking soda is another remedy, though I haven’t used it. Sometimes just taking a drink of water helps.

    I’ve never tried the vinegar cure; it makes no sense to me to try fighting acid with more acid.

    Here’s the hardest part: if you’re overweight, you’ve got to lose it. Obesity is a significant factor and aggravator for Reflux. I don’t know about anyone else, but spiced foods, even a slice of pumpkin pie, is an invitation for an unpleasant heartburn episode. Overeating is another trigger, especially now during the holiday season.

  5. DAF
    York
    Reply

    For those of you who are having difficulty taking apple cider vinegar (ACV) in water — try this: a squeeze of lemon juice, a teaspoon of good honey, and your ACV in a tall glass of water. I do this every morning and I’ve actually come to like the taste.

  6. Julie
    Georgia
    Reply

    I took Prilosec for 24 years to treat a hiatle hernia and GERD. After reading about all the possible side effects, I quit taking it this year. The process took about 3 months of very gradual dosage reduction. I still take 500-1000 mg of a calcium carbonate antacid at night. The most amazing thing is that my arrhythmia has completely disappeared. I wish my cardiologist had been aware of the link. He certainly knew that I was taking Prilosec.

  7. Mayree
    Reply

    I too was on Nexium for over 15 years, developed osteoporosis and had pneumonia once. I gradually cut back but could not kick it after seeing two gastroenterologists.

    I started the apple cider vinegar remedy using 1/4 cup honey, 1/4 cup vinegar in quart of filtered water…sipping a couple ounces several times per day and especially before bed time. I also went gluten free, dairy free and take a papaya enzyme with meals. Am happy to say it worked for me and only need the vinegar remedy when I eat chocolate or too much sugar.

  8. Joseph
    Aylett, VA
    Reply

    Due to a stomach ulcer, my doctor put me on 40 mg daily Prevacid in 1998. After the ulcer healed, I developed GERD, so my doctor had me continue on Prevacid 20 mg daily. After a few years, due to my health insurance coverage and Prilosec OTC hitting the market, I switched to it, 20 mg daily. This worked great for a few years until I started getting reflux even with the 20 mg Prilosec.

    My doctor increased the dosage to 40 mg daily, and this worked well until I decided to wean myself off PPI’s with all of the bad news hitting the media. In early 2016 I dropped back to 20 mg Prilosec daily, then once every other day, and on to once every third day. I also introduced DGL, papaya enzyme, ginger, and a probitoic, which worked well for a while, but then seemed to not work as well.

    So I switched to Pepcid, with an occasional Pepcid Complete, and have been doing quite well with that regimen for the past four months. I will never go back on a PPI; eighteen years was enough!

  9. Leonorah
    Burlington, NC
    Reply

    I had an endoscopy recently (10 days ago) for what I thought was a esophagus stricture and I was found to have an ulcer in my stomach. I have no symptoms and never have had. The GI Doc has put me on Prilosec which I really don’t want to take. I have hear you all discuss the down side of PPIs and am very leery of this medication.

    This ulcer probably came about because of the high doses of aspirin that I take every day for my rheumatoid arthritis in addition to Methotrexate and Enbrel.

    I want to discontinue taking the Prilosec given the fact that I have no symptoms from the ulcer. Do you think this is a wise thing to do?

  10. Sue
    Midwest US
    Reply

    After hearing a program about the dangers of proton pump inhibitors, I quit Lansoprazole after over 20 years of taking it or Omeprazole. I started on 300 mg Ranitidine twice a day with my Dr’s OK. I do get some reflux a few times a week and take Tums and avoid cooked tomatoes and other trigger foods. I lost 17 lbs in 2 months- weight I had been trying to lose for several years. It has not returned after 6 months of this new regime. All thanks to People Pharmacy radio program!

  11. Robin
    Reply

    I was on Omeprazole for Chronic Esophegeal Reflux for about 10 years. When all the bad findings came out, I started weaning off of it, going to every other day for a month, then every 2, every 3, etc. During that time, I took probiotics, watched my diet carefully, and drank plenty of water with food, along with taking fiber pills. I had to use Tums several times over the first couple weeks, but now I am fine. Occasional normal heartburn that one Tums cures, no reflux and no more worries over side effects!!

  12. Ana
    chicago
    Reply

    Thank you so much learned so much, been on nexium for 10years and want to get off.

  13. Carol
    Wisconsin
    Reply

    I tapered off Nexium four years ago by using a calcium and magnesium supplement simply called generic “antacids” at several local pharmacies. I’d take Nexium one day and the antacids the next, then gradually getting rid of the Nexium, for several weeks and just using the antacid as needed. I also avoided heartburn trigger foods and am doing fine. I had to stop Nexium because after five years it caused me to have serious heart arrhythmia. Low magnesium levels was the cause, according to my cardiologist.. The irregular heartbeat stopped after being off Nexium for a few weeks.

    I also had tried apple cider vinegar with the mother once, but it made my heartburn worse. The worst heartburn ever. It’s pure acetic acid, so I guess I should have known better. My doctor said to NOT use apple cider vinegar, that it works for those with low acid (as does HCL which is hydrocholoric acid, but those are bad for people with a high stomach acid. Something to think about.

  14. pnopper
    Reply

    Emcee, I have the exact same story as you. I have been on Nexium for probably 8 years because of getting heartburn from another medication. Tried to get off it and the heartburn got worse. So, after reading stories from this site, I tried using the Apple Cider Vinegar while slowly decreasing my intake of Nexium. I use the Braggs ACV, it must be all natural, unfiltered, and contain the Mother. I take one tablespoon with about 6 ozs. of cold water and a little honey or stevia drops to sweeten it. It does not taste bad at all this way. I tried taking it alone and it cannot possibly be good for one’s body because it burns while going down. I have been doing this for about a month and have weaned to taking a nexium every other day (while taking ACV every day). Looking forward to not taking any more Nexium (a prior post said he got ringing in his ears from Nexium. I too started getting that when I was taking 40 mgs. a day. I switched to 20 mg a day a couple of years ago and the ringing stopped). The ACV is apparently very good for you so I am planning to always take it even when I’m done with taking the Nexium.

  15. Emcee
    Reply

    I have been on Nexium for over 10 years to ease the acid reflux caused by another rx drug I have to take. After reading about the side affects of nexium I wanted to get off, but I also read how hard it was.
    After doing some additional research for natural remedies, I came across people who mixed a little apple cider vinegar with 8oz of water and they claimed it worked. I am using this, and it does work. I am on a regimen of it one day, and nexium the next day. When I get heartburn symptoms I can drink the acv and to my amazement it works at taking it away. The hard part is getting it down. It doesn’t smell good, and tastes worse. But if you chug it quick it helps. Then I do my Jack Nicholson imitation from Easy Rider, nnk nnkk nnk, and I’m sure my face is a squinted up. But I’m hoping I can get off of it completely. And it has seemed to help ease my bursitis.

  16. Beverly
    Reply

    For me, acid reflux hurt so bad that I was ready to die if I couldn’t find relief. Sounds like a pity party, but it was bad. Doctor gave me rx for Nexium. Of course it worked. Later switched to Prilosec, and took for over 2 years. I tried to get off Prilosec a few times, only to have worse symptoms each time. Then, I cut Prilosec into quarters and took 3/4 of a tab, once daily for 3 months. Then took 1/2 tab for 3 months. Then took 1/4 tab for 3 months. Then took 1/4 tab every other day for 1 month. Then no more Prisolec!!
    It’s been almost 2 years since I stopped Prilosec. I only have a little acid reflux about once every 2 or 3 months. At FIRST sign of reflux, I chew 2 pieces of Doublemint gum. Works for me. Thank you for all the info you provide. I always recommend People’s Pharmacy.

  17. Maria
    Reply

    Digestive enzymes worked wonders for me. I had been on and off Prilosec OTC for several years, but once I began a 2 week regimen of enzymes, I improved and haven’t taken a PPI in one year now. One enzyme pill, 3 times each day with meals was all it took. (After 2 weeks I started to feel a bit queasy so I stopped the enzymes. I figured the stomach upset was simply a message that I had enough enzymes necessary for digestion and assimilation of my food.) Once in awhile I’ll take the enzyme pill for a day or two if I feel symptoms arising. Hope this is helpful to someone.

  18. Mignon
    Reply

    To AMO: Please give the brand name of the aloe juice you take, as some are awful. Just the smell of one nearly made me ill, so I have resisted trying it. I take omeprazole 20 mg and a sucralfate 1 g tablet at bedtime, as I have GERD and stomach ulcers in the past and again now. Thanks!

  19. Liz H
    Reply

    I had severe heartburn for years. I was eventually on Nexium and another pill whose name I’ve forgotten. A nutritionist with a PhD told me my body wasn’t getting enough protein, even though I was eating plenty. He told me to start a supplement of Betaine Hcl with every meal that included protein. Along with this I was to gradually wean myself off the meds. I was amazed how quickly it worked. With sufficient stomach acid, I digested foods quickly. This eliminated both the reflux and the irritation of the stomach lining. I eventually was able to stop the Hcl. I occasionally take some Tums, but not often.

  20. LCH
    Reply

    I was on Nexium after using Prilosec, Protonix and some other medications for Barret’s Esophagus which is a precancerous acid reflux condition. After about twenty years I suddenly couldn’t step on my right ankle. I wore a boot to relieve the intense pain. I had just taken one step down without even falling or twisting my ankle. I wore the boot for six weeks. My ankle was some better.
    A sales person at a popular organic, health foods store told me that Wobenzym N relieved his pain. I had only taken one dose and in three hours my pain was immensely relieved. I also think the Nexium caused calcium loss which was probably the culprit in causing the pain.
    My alternative doctor thinks I will not have a problem if I stay on a candida free special diet. He himself was operated on for his acid reflux problem but it came back. He recommends a special diet to stay free from the acid reflux condition. I also used aloe vera juice, and the licorice substance. Upon reading the side effects of licorice I quit using DGL tablets. I also am careful to maintain a diet that has lots of ground flax seed. Perhaps this might be helpful to some of you. I think I have some diverticulitis. Am on a wheat free diet with lots of vegetables.
    I found Prilosec to be very dangerous. While taking it my brain did strange things. I would make an appointment for the fifth day of the month at three o’clock and show up on the third day of the month at five. I told my physician that I had Barret’s esophagus but instead said Garret’s. She corrected me and I told her I knew that but it just came out that way.
    We discussed my other mental disturbances and decided that even though most doctors would say it wasn’t the drug she thought it probably was. Immediately after I stop taking the Prilosec my mind returned to its proper function. I have stopped eating wheat and am using the Wheat Belly Diet at the suggestion of my physician.

  21. alxzba
    Reply

    would like to receive comments. Thanks.

  22. Shelley
    Reply

    Here’s my story. After taking Protonix (pantoprazole) for perhaps 10–15 years for my GERD, I was taking 2 pills daily (40 mg. each). Last year, I went on a gluten-free diet and was able to reduce my intake to 1 pill daily.
    This year, after careful consideration RE: the risk for hip fracture from taking this drug, I decided to follow the protocol to begin weaning myself from this drug. I started Jan. 1st and have reduced my intake to every other day–I’ve tried to go longer, but the acid is too unbearable.
    During the first two weeks, I had a couple heartburn episodes which got almost unbearable in the next two weeks. I tried everything–almonds, apples, baking soda, and finally MOM. But MOM gave me diarrhea, so I had to curb my use. I discovered aloe juice during this time (inner blade, ONLY) and it worked for a day or two. I drank from 2–24 oz. daily as it stopped working completely for me.
    Finally, as a last resort, I went to the doctor, who prescribed Ranitidine. I take 150 mg. twice daily. This has been working for me along with occasional shots of aloe juice. I’m maintaining the every other day dosage for the time being.

  23. AMO
    Reply

    I was on heartburn meds for about 15 years. I tried everything, some prescription, some OTC. Was on 40 mg. of famotidine when I developed tinnitus. That caused me to research, as I decided I would never take another anti-acid. I found a recommendation to drink aloe juice. I have now been on it for about a year and have no gerd. Once in a great
    while I may have a little and a swig or 2 of ACV does the trick. Worth a try!

  24. Karen
    Reply

    My doctor had me on Nexium, once a day before meals, for quite a few years. It really was wonderful not to have reflux after meals and at night. I started reading how my body really needs the stomach acids so I decided to eat supper at 4pm and not take the Nexium. Well, what do you know? Because I was eating alone I didn’t have as much food, and no reflux resulted. I could go to bed and not fear the usual pain of reflux. What a relief. I eat my lunch at 11am and then supper at 4pm, and haven’t looked back. This sounds hard to do if you have a family, but for the reward of no reflux it is so worth it.

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