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Should you stop your heartburn medication?

June 11, 2017

Proton pump inhibitors (PPIs) are medications used to control frequent heartburn, gastroesophageal reflux disease, and inflammation of the food pipe (esophagitis). The common PPIs are omeprazole (Losec ® ), esomeprazole (Nexium® ), lansoprazole (Prevacid®), dexlansoprazole (Dexilant® ), pantoprazole (Tecta® , Pantoloc ® ), and rabeprazole (Pariet® ).

Gastroesophageal reflux disease needs 4 to 8 weeks of treatment and peptic ulcers 2 to 12 weeks.

Adults 18 years of age and older who have continuously used a PPI for longer than 4 weeks should ask their doctor about deprescribing.

Deprescribing involves decreasing the dose, stopping the medication, or using it “on-demand” (as needed only).

It is best to discuss this decision with a doctor

Certain conditions such as Barrett’s esophagus, severe esophagitis, or bleeding gastrointestinal ulcers may require ongoing use. Patients who use regular daily doses of nonsteroidal anti-inflammatory drugs (NSAIDs) may also need to use a daily PPI to protect the gut.

Reflux symptoms are sometimes caused by other medications (e.g., acarbose, anticholinergics, beta-agonists, benzodiazepines, caffeine, digoxin, calcium channel blockers, erythromycin, estrogen, alcohol, narcotics, nicotine, nitroglycerin, orlistat, progesterone, theophylline).

How to stop

Stopping your PPI suddenly may worsen acid reflux symptoms due to a “rebound hypersecretion” effect. The withdrawal effect lasts for 2-4 weeks and can be blunted by decreasing the PPI dose by 50% for a few weeks or increasing the interval between doses to every 2 or more days. Sometimes an alternative medication like ranitidine can be substituted in.

Why would you want to stop your PPI?

Although PPIs are generally very well-tolerated, they can lead to uncommon side-effects such as diarrhea, vitamin B12 deficiency, magnesium deficiency, gut infections (Clostridium difficile, Salmonella and Campylobacter), hip fractures, and pneumonia.

 

Link:

http://www.open-pharmacy-research.ca/wordpress/wp-content/uploads/ppi-deprescribing-algorithm-cc.pdf

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