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.