older man with heartburn, acid reflux or indigestion

When proton pump inhibitor (PPI) drugs were first introduced decades ago, the perception was that these drugs had hardly any side effects. Both doctors and their patients were convinced that omeprazole (Prilosec), the first PPI, was both very powerful and extremely safe. This view has held up well enough for the FDA to approve non-prescription use of omeprazole (Prilosec OTC), lansoprazole (Prevacid24HR) and esomeprazole (Nexium 24HR).

PPIs Are Not Quite as Safe as They Seemed:

Gradually, however, data have accumulated showing that the PPI drugs are not really as safe as they appeared. First we learned that people taking a PPI are more susceptible to pneumonia (JAMA, May 27, 2009).

Then researchers found that people taking a PPI medication are much more likely to experience repeated infections with Clostridium difficile, or C. diff for short (JAMA Internal Medicine, May, 2015). This infection causes potentially devastating diarrhea that can in some cases be life threatening. It is extremely hard to treat, as the name “difficile” implies.

There are a number of other serious side effects of PPIs that have been surfacing. You can read more about hip fractureschronic kidney disease, disrupted bacterial balance in the digestive tract, nutritional disturbances due to poor absorption of certain vitamins and minerals and, now, dementia associated with longer-term PPI use.

Rebound Heartburn Means Serious Withdrawal Troubles:

If you do want to quit taking your acid-suppressing drug, however, you may find it difficult. Many readers do. Here is one person who needs help.

Q. I read your article on PPI drugs causing kidney trouble. I have been on Prilosec for years, so this definitely caught my attention.

You have not given us a way to get off these drugs, though. I was diagnosed with GERD–just too much acid. I want to get off the Prilosec, but I need to know what replacement to try.

A. Researchers reported that proton pump inhibitors are linked to kidney disease (JAMA Internal Medicine, Feb., 2016).  These powerful acid-suppressing drugs include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), rabeprazole (Aciphex) and pantoprazole (Protonix). Other complications of long-term use can include mineral deficiencies, an increased risk for fracture, C diff infections and pneumonia. In one case, a patient developed stomach polyps while taking omeprazole (Internal Medicine, online July 15, 2017).

Getting Off PPIs Without Withdrawal:

Getting off such medications can sometimes be difficult due to rebound hyperacidity. Although PPI drugs prevent cells in the stomach from making acid, they keep trying to make it. Gradually they gear up to make more, so by the time a person has been taking one of these medicines for two months, the cells pour out their acid as soon as the drug is stopped. It can take six weeks or so for this over-reaction to calm down (Gastroenterology, July, 2009).

A recent review of the medical literature (Therapie, Oct. 26, 2017) concluded:

“Daily PPI exposure for more than 4 weeks is likely to trigger a rebound of acid hypersecretion about 15 days after discontinuation, and lasting from a few days to several weeks depending on the duration of the exposure.”

There are some approaches that may be helpful for stopping a PPI without withdrawal symptoms. You will find a number of tips here.

Slowly Lower the Dose:

Lowering the dose gradually, if possible, might make the rebound acid secretion less noticeable. It may also be possible to control the symptoms during withdrawal by taking other medications, such as cimetidine (Tagamet), famotidine (Pepcid) or ranitidine (Zantac). Ordinary antacids such as Tums or Maalox may also be useful in this context for symptomatic relief. Another option is Prelief, a compound designed to reduce the effect of eating acidic foods.

Try DGL:

Those who prefer a more natural approach might consider DGL, deglycyrrhizinated licorice. Most of the research on this herb goes back decades, but it has been shown to be helpful for peptic ulcers and aphthous ulcers. Readers have also found it useful.

Sip Persimmon Tea:

In addition, persimmon tea with ginger has helped a number of readers in their efforts to quit a PPI without withdrawal. Presumably the ginger, which has a long history as a heartburn and anti-nausea treatment, is the primary active ingredient. The cinnamon and persimmon may also contribute to the effectiveness of this remedy.

A systematic review of medicinal plants used in traditional medicine for heartburn symptoms demonstrated that myrtle (Myrtus communis) and quince (Cydonia oblonga) preparations worked about as well as omeprazole (Journal of Alternative and Complementary Medicine, Feb. 2017). Unfortunately, the authors do not offer instructions on using these plants.

We are sending you our Guide to Digestive Disorders including tips on getting off PPIs. We trust you will find it helpful.

Revised 5/3/2018

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  1. Vickie
    Wisconsin
    Reply

    I have been on these PPIs for a good 25 years with really early joint issues. Had a hip replacement around age 50 and my knees started going soon after. I decided to heal myself with herbal remedies and it is working. First you need to supplement with B12. I believe I read the PPIs deplete your system of this. After that I began by lowering my dose of Nexium (every other day, etc). I then started taking Pepcid 2x/day and eating less. You will find you don’t want to eat as much for fear of acid. I get a bit acidy, but use a Licorice DGL tablet…it really helps. I also sip on tea made with Licorice root and other herbs for circulation (Hawthorn) and nerve regeneration (Shaggy Maine Mushroom). It has been over two months and I just started dropping the Pepcid dose to once a day. I notice my knees hurting if I miss my tea and B12 for a couple days. I would encourage physicians to pay attention to people who use these previously thought of safe drugs. The fact that PPIs keep your stomach from secreting the substance it needs to do it’s job leads to the knowledge that they also keep other areas where they are located from secreting substance that we use to function on a daily basis.

  2. Stephanie
    Australia
    Reply

    Hi, there,
    I have been taking Somac for 7 years, and due to the latest information I decided to try and stop taking the medication. I took the 40mg tablet every second day for 6 days and have now had 5 days with no meds. I am having a glass of 1 tsp apple cider vinegar, 1 tsp Manuka honey, half teaspoon of grated ginger. A little hot water to melt the honey and then fill the glass with half pint of cold filtered water. I have Gaviscon on standby but so far ok. Feeling a bit of pressure in my stomach, and an ache in my back behind my lungs,slight headache, not sure if these are related to stopping the Somac but will keep doing this. Also small meals often not allowing my stomach to feel empty.

    • Terry Graedon
      Reply

      Somac is pantoprazole. The US brand name is Protonix.

  3. Carol L
    DE
    Reply

    I’ve been on Protonix for more than 10 years. I’ve never had GERD or acid reflux problems. I was given it as a prophylactic due to NSAID use. I’ve long been off the NSAID, but could never stop this. I thought maybe I had GERD after all, because the rebound was so bad. I’ve tried everything, DGL, D-Limonene, Iberogast, Gaviscon Advance, Carafate – while trying a slow taper. Nothing has worked. So, I did a little research on gastrin blocking drugs, because the rebound acid hypersecretion is due to the fact the body keeps pumping out gastrin, thinking you need acid, which the PPI’s reduce by shutting down the proton pumps.

    I found two drugs studied extensively in dogs, and later studies in humans. The one drug is only available for research, and with approval for those with gastrin-producing tumours. The other, Pirenzepine Hydrochloride, a selective M1 anticholinergic drug, is available in many countries in Europe & Asia, but not in the US. It is sold by the brand name Gastrozepin. I found that it is a prescription (50 mg) , except in Austria, Russia & Japan, where the 25 mg dose is available OTC. I then found that it went generic in Japan, which makes it much cheaper. This drug has been tested with omeprazole, and reduced gastrin in people taking omeprazole. It was tested with & without H2 blockers, and it is far more effective when taken with an H2 blocker.

    I went looking for online sources, & found a Russian, and an Austria website selling Gastrozepin. So, I found a Japanese mail-order pharmacy online, that sells health & beauty products, and OT meds. They have Gastrozepin & generic Pirenzepine Hydrochloride. The FDA allows the purchase of OTC meds with a limit of a 3 month supply, from another country. The website limited me to two boxes with 100 pills each. They came today, and I’ve already took two doses with famotidine.

    I have hardly coughed, and the acid in my throat is way down. Because this is a selective M1 anticholinergic drug, it doesn’t have all the problems that ones like atropine or tricyclic antidepressants or 1st generation H1 antihistamines have. It is known to be well tolerated. It lowers the gastrin significantly. This should be available in the US, available anticholinergic drugs in the US are limited, mostly due to side effects. I have enough for 3 months (100 days), which should be more than enough to enable me to finally get of the PPI. This drug is safer than taking the PPI, and side effects are minimal at the 50 mg a day dose (25 mg morning, 25 mg evening).

    Pirenzepine Hydrochloride was originally used to treat ulcers, but has been replaced by H2 blockers & PPI’s. Numerous studies show it’s effectiveness with stopping PPI’s & not getting the rebound acid hypersecretion. I’ve only taken 2 doses, and I can already feel a difference. I have really high hopes that this will work. i’m tired of suffering, & I want off this stuff.

  4. David
    Thailand
    Reply

    I’ve accidentally found the medical breakthrough cure to get off of these drugs without having the rebound effect. I’ve been on them for some 50 years ever since the advent of Tagamet back in the early 70’s. I’ve tried many times in the past to get off them with no success. This time, I’ve discovered quite by accident how to get off them. I’ve been dieting and have gone from the OMAD diet to the Carnivore diet and applying the same one meal a day to it. I’ve been on it now for 3 weeks. One week ago I decided to try once again to rid myself from having to take Acid Blockers daily to control my incessant heartburn. I went to the drug store and bought a supply of Maalox and Rolaids, because I knew I was going to be in for a battle once I stopped. Then I did it and waited for what I knew was coming…..HEARTBURN ON STEROIDS!

    About 15 hours passed and I started to feel a little heartburn coming, so I took a little medicine to neutralize the acid and waited, and waited, and waited. It’s now 5 days later and I’ve had ZERO heartburn. I should be in agony right now, but I’m completely heartburn free. 24 hours a day heartburn free and it’s now 5 days later. It’s as if I was never on them at all. Glory Hallelujah! I’m Free At last! I hope this helps all of you who were addicted to them like I was. The Solution is: Eat one meal a day, fast for 23 hours before you eat again. When you eat, eat Carnivore diet and water. That’s the cure!

  5. Vaudi L
    North Carolina
    Reply

    I had GERD for years. I started taking low doses of OTC meds then had to get a prescription. I’m taking Protonix. I have had many kidney infections.

    My urologist said the PPI didn’t have anything to do with the kidney issues. So I sought a different opinion. This Dr said the same. I have had issues so long now. I’m tired of it all. Help!

  6. Catherine
    Georgia
    Reply

    My success in getting off Prilosec is still in progress. I used Zantac on alternate days for a couple of months, and now use Zantac daily. In addition, I add a less than an eighth teaspoon of baking soda to all the glasses of water I drink, and am learning about diet choices from your articles.

  7. Dave
    Australia
    Reply

    When I eventually realised the problems that the PPI (Nexium) I was on was causing, particularly its ability to affect my B12 levels and which was prescribed due to a Barretts Hiatus Hernia (Barrett’s esophagus), I looked for an alternative.

    Squeeze1/2 lemon and add the juice in a glass of water before and /or after meals was the perfect answer. Completely eliminated the acid issue and caused no harm. In deed, the acid issue has been effectively neutralised for several years now so that is is a very rare incidence of any acid problem.

    Solved immediately by going to this perfect natural remedy. And the cost and health savings have been a bonus.

  8. Grace
    Reply

    This is an interesting conversation. I’m in my 70’s and have been taking both PPIs and newer NSAIDs (ibuprofen then naproxen after I became allergic to ibuprofen) since before either were OTC, … so well over 2 decades. They were each effective for the reason I had to use them. However, the combination long term has led to a new type of colitis … microscopic / immunologic colitis. Doesn’t even have a real name yet, and only diagnosed with symptoms and then colon biopsy.

    The bottom line is that one cannot take a PPI and any of the new NSAIDs at the same time or the colitis symptoms flare badly. The only pain reliever left for joint/muscle pain is aspirin or acetaminophen, since I have not been able to stop the PPI at this time.

    So I am reading the approaches to leaving the PPI to see what may be possible to free me up from the acid reflux med long term. A quick dose reduction and replacement with something like Zantac does not work for me … but some of the suggestions here may help me out. Thanks

  9. Rosie
    Michigan
    Reply

    I went from 20 mg to 10 mg of Prilosec, by opening the capsules and pouring out a few of the granules. Gradually using less and less. Then my pharmacy started offering 10 mg capsules, which I still take once per day. I figure 10 has to be better than 20! (My sister takes 40 mg per day!)

  10. Jeanette
    Manchester. U.K.
    Reply

    I went gluten free to help manage ulcerative colitis. As a happy side affect of going gluten free I found that I no longer needed the ppi (omeprazole)

  11. Ron
    Reply

    I took 30Mg Prevacid for years. A couple years ago, I went to over the counter 15 Mg, and skipping once or twice per week. A tablespoon of antacid before bed usually as well. Also take a probiotic each morning and try not to eat anything after 6PM.

  12. John
    Reply

    Mastic gum, probiotics, and not eating heavy meals late. Sometimes would take Zantac if needed a little help. Ginger also worked well for me. Tea or capsule.

  13. CAROLE
    Western Australia
    Reply

    I was told that Lossec was a safe drug, and I have been on it for years due to severe heartburn. I have completely weaned myself off it by changing my diet to a whole food, plant-based, no-oil diet.

  14. sharon
    NC
    Reply

    My way to get off PPI after 15 years of use of 20 mg per day. Just stopping or changing to non PPI meds did not work. Bought my regular omeprezole in capsule form. Broke, crushed, and ground the contents. Divided it into empty capsules–pill crusher and capsules purchased from Amazon. I took 6 months and gradually lowered amount in each capsules. When I went off within about 2 weeks I had mild rebound which lasted about 6 weeks. I found Pepsid helped me get through it. I have been off PPIs for 8 months now and use only Pepsid.

    • Melissa
      Easley, SC
      Reply

      Hi! may I ask what your Rebound symptoms where? Thanks in advance

  15. Larry M
    Raleigh, NC
    Reply

    Even a short period on PPIs can set you up for withdrawal symptoms. I was prescribed Pantoprazole for 30 days following a gastro-endoscopic ultrasound as part of a CPVA (heart procedure). I rarely had heartburn, but I had it for a month after ending the Pantoprazole. The bacterial imbalance persisted for a couple of months but has resolved.

    If this happens again, I’ll taper off, maybe spreading the last week’s supply over two weeks on alternate days.

  16. Stephen
    New Port Richey, FL
    Reply

    I am 70 years old and was on prilosec over 10 years. Followed regimen of nightly apple cider vinegar with occasional zantac and mylanta along with 30 pound weight loss. It took a couple of weeks. Had to get used to deluted vinegar taste. Continue to take it nightly. Was put on prilosec after got ulcer with complications of hiatal hernia and probably due to taking Aleve, etc. All ok now and in process of looking more weight, exercise, and goal to reduce other meds.

  17. Sha
    Texas
    Reply

    People’s Pharmacy articles and comments on those articles helped my 5 yr old! She was diagnosed with gerd and put on 3 meds with long lists of horrible side effects–but those made me uncomfortable!

    Our mantra became veggies, veggies, veggies, fruit, fruit, and a little bit of meat, etc. Lots of veggies (ideally 3 per lunch or dinner meal) seems to prevent her constipation, which is a big contributing factor to her gerd. We found which foods were big triggers, and which foods to avoid. We also have added Calm Magnesium 3 times a week, 1 fiber gummy per day, a good daily probiotic and enzyme, and a loaded fruit/veggies/seeds smoothie a few times a week.

    We very very slowly backed off of the Omeprozol. We opened the capsule and literally counted out the pellets inside, and did 1 or 2 pellets less daily, through each week or sometimes even every other week. I figured there was no rush–we wanted it to be successful long-term! We backed off so slowly I think it took maybe even 6 months to get from about 20 little pellets inside that capsule to 1 pellet. (She ate it inside an applesauce bite).

    Read these articles and comments! They helped!!

  18. Bonnie
    Reply

    A NP friend of mine introduced me to Papaya Extract tablets, one after every meal. She told me that it helps with gastric acid and reflux issues. I have used them and I can tell that it has helped after eating a meal. I still use Protonix but would love to be able to drop that med and use this Papaya Extract tabs only!

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