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.