Is it smart to block the production of stomach acid with powerful proton pump inhibitor drugs (PPIs)? Millions of people take these drugs to control acid reflux, ulcers or gastroesophageal reflux disease (GERD). Doctors initially thought these medicines, like omeprazole, were super safe. The FDA first approved brand name omeprazole as prescription Prilosec in 1989. The agency was so sure this acid-suppressing drug was benign that the agency approved Prilosec OTC in 2003.
But serious side effects have been reported over the years, including kidney damage, liver cancer, dementia, type 2 diabetes, heart attacks, weakened bones and even strokes. While such problems may be rare, they are worrisome. People taking PPIs are also more likely to suffer intestinal infections (see below). But the kicker is that patients taking omeprazole or similar medicines may find it really hard to stop these drugs.
How Can You Get Off Omeprazole?
This reader shares a scary scenario:
Q. I took Prilosec and then generic omeprazole for over 15 years. Every time I tried to stop, my heartburn got worse.
Last year I got extremely tired and out of breath if I climbed a short stairway in my house. When I saw my doctor, I described these symptoms. To find out what was wrong, he had me take several blood tests, including one for iron level.
He called me that evening at 9 pm and told me to take a cab to the local ER. It turns out that I had almost no iron in my body, so they did a blood transfusion. Apparently, taking PPIs long term stops acid production, as it should. But that, in turn, makes it harder to absorb minerals, including iron.
At the hospital, they ran a bunch of tests: colonoscopy, endoscopy and even a mammogram. No blood loss was found. I almost died from anemia as a drug side effect.
Never quit PPIs cold turkey. The rebound heartburn is horrible. It’s better to ease off over several months, taking one every other day, then every third day, and so on.
A. Stomach acid is essential for the absorption of many nutrients including iron. We suspect that few people are warned about this possible complication when taking proton pump inhibitors (PPIs) for indigestion.
Stopping PPIs such as esomeprazole, lansoprazole or omeprazole suddenly can trigger severe heartburn symptoms, as you discovered. That’s why very gradual discontinuation is important.
In our eGuide to Overcoming Digestive Disorders, we list other adverse consequences from PPIs and describe several strategies for getting off such drugs. This online resource may be found under the Health eGuides tab on this website.
This reader reports that DGL helped overcome a dependence on omeprazole:
Q. Stopping omeprazole (Prilosec) is really hard. When I tried, my heartburn came back worse than ever. I heard a report on public radio last year that when people stop this kind of medicine they experience rebound acidity that leads to bad heartburn.
An Internet search revealed a number of folks using deglycyrrhizinated licorice extract (DGL) to manage their reflux. When I asked at my local health food store, I learned that many people claim DGL has helped them get off omeprazole.
I went cold turkey off the omeprazole and chewed two 400 mg DGL tablets before each meal. If it was a particularly spicy meal (garlic is a culprit for me), I used an additional tablet after the meal. I followed this regimen for several months and then stopped altogether.
Today I seldom need the DGL, but when I do, I chew a single tablet for immediate relief. I continue to be amazed how effective this is.
Using DGL to Stop Omeprazole:
A. Licorice that has not had glycyrrhizin removed could be dangerous. People who overdose on natural licorice may experience hypertension, headaches, hormonal imbalance and reduced libido.
DGL, on the other hand, appears much safer. It was prescribed in Europe and South America to treat ulcers before there were PPIs (Gut, May 1976). Naturopathic physicians still use DGL when they want to avoid the side effects associated with PPIs (Integrative Medicine, Aug. 2018). Other people also report that DGL can help in gradual withdrawal from acid-suppressing drugs such as omeprazole.
PPIs and Intestinal Infections:
Researchers in Scotland have found that acid-suppressing medications such as dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec) make people more vulnerable to gastrointestinal infections (British Journal of Clinical Pharmacology, online Jan. 5, 2017). They reviewed the records of half a million Scots. Those taking PPIs were 1.5 times more likely to come down with Clostridium difficile than those not on such drugs. C. difficile can cause hard-to-treat diarrhea. This is not the first study to find that such drugs increase the risk of C diff infections (JAMA Internal Medicine, May 2015).
Scottish people taking prescription PPIs were also about four times more likely to pick up a Campylobacter infection. Intuitively, this makes sense. Stomach acid is one way that organisms protect themselves against invading germs. There is a reason why vultures, sharks, cows, pigs, crocodiles, dogs, cats and humans have strong stomach acid. It’s not a mistake!
The investigators warn that these powerful drugs should not be used casually. Patients and their health care providers should discuss when the drugs are appropriate and when and how to discontinue them. You will find recommendations in our eGuide to Digestive Disorders.
You will also how other readers have been able to get off proton pump inhibitors without suffering heartburn at this link.