Getting Off Proton Pump Inhibitors

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December 14, 2022 | 6 Comments

 

I would like to describe my experiences with Omeprazole / Esomeprazole to warn others of the ease with which it is possible to become hooked on this medicine, or other so called Proton Pump Inhibitors PPIs. To start with here is an explanation of these drugs that could have saved me about 9 months of trouble plus considerable worry. I just wish I had discovered the RxISK website and posts like Fake News and the Great Purple Pill earlier this year.

It started with a number of occasions when I woke suddenly in the night with the unpleasant sensation that I was just starting to be sick (even though I was in no way nauseous). Each time I swallowed hard and then got up and drank some water to clean my mouth out. It passed, but the next morning I was still aware that my throat felt unclean.

I realised that these were acid reflux events (a term that more or less speaks for itself),.  I was vaguely aware from somewhere that acid in the oesophagus could lead to cancer of the oesophagus – which sounds quite appalling.

Getting Hooked

At first I tried chewing a couple of  Gaviscon tablets shortly before bed. These seemed to help, but I wasn’t sure I had completely solved the problem. Then I discovered Nexium (esomeprazole) in my local supermarket. Taking one tablet per day was enough to stop this problem completely. I bought a box of 14 tablets and I thought if I just ‘finished the course’ that might be the end of the problem.

They worked perfectly while I was taking them, but once I stopped, I was left with a very unpleasant feeling in my stomach, which I vaguely assumed was continuing acid reflux.

Anyway, I resumed taking Nexium and called my local medical practice,  as advised on the packet. The UK Health Service is very disrupted at the moment, and you have to wait for a telephone appointment with a doctor, and if you need a follow-up discussion you meet additional delays and you talk to a different doctor each time.

The doctor recommended that I have a test for the bacteria that sometimes cause stomach ulcers – Helicobacter pylori. Unfortunately this involved not using any PPI for a week before sending a stool sample to be tested. This was really hard because without Esomeprazole I felt really awful – although I realised that I had not suffered any more actual  acid reflux – just horrible fluctuating stomach pains and some nausea.

After I packaged up my H Pylori sample and washed my hands, I immediately popped an Esomeprazole and waited for the relief.

The test came back negative, but  this got lost in the local medical practice. Eventually, after approximately 2 weeks, I was offered another telephone consultation with a doctor in a further week’s time. The doctor was not the one I  talked to before and he prescribed a month of Losec (Omeprazole – Prilosec in the USA). He explained that this often gives the stomach time to heal, and  cures the problem.

So I had a  month of 20 mg Omeprazole, but by the end of that treatment, coming off was  truly horrendous. This led to a switch back to Esomeprazole and a surprise.

I was only just realising that at this point I now didn’t have acid reflux, but I was feeling the effect of the withdrawal of the medication.

Getting Off

I remembered that I had once been prescribed Omeprazole about 10 years previously, and the withdrawal symptoms were fairly bearable – just some heartburn. After searching the internet, I came across this website that describes my problem well and this encouraged me to try to taper my dose:

Getting Off Omeprazole-Prilosec and other PPIs

As a chemistry graduate (many years ago), I knew that Omeprazole and Esomeprazole are very closely connected, but in effect Esomeprazole is twice as strong as Omeprazole for the same dose by weight. So the medicine I was buying at the supermarket was twice as strong as my prescription medicine since both pills contained a dose of 20mg.

That certainly didn’t seem as you would expect. It is normal to expect that over the counter treatments are less powerful than prescribed medicines. I wonder how many doctors are aware of this. Anyway, I now faced the task of weaning myself off Esomeprazole.

The big complication was that Esomeprazole is a drug that is destroyed by the stomach acid, and slowly destroyed by air, so it comes in capsules that you are instructed to swallow whole. Each capsule contains a mass of tiny spheres, which are themselves coated in a gastro-resistant layer which lets the drug survive until it reaches the small intestine.

Because the capsules are hard to open, it is easy to scatter some of the contents when they break. I realised that there was a potential problem here because spilled on the floor it would have been all too easy for our cat to get one or more of those spheres lodged in his paws, which he would then  try to lick away  and maybe swallow.  A lot of care is needed if you have pets, or small children in the house.

If you use Nexium you will find the drug is sealed in hard capsules, and inside the spheres are very small – about 140 per capsule. Some supermarkets sell their own brand of Esomeprazole, which is of the same nominal strength, and consists of much softer capsules that contain significantly larger spheres – I counted 64 per capsule – so these capsules  are easier to open and manipulate.

I started my tapering down at 32 of these little spheres.

I always consumed my dose using a blob of jam, washed down with water without closing my teeth, to avoid breaking some of the spheres with my teeth.

In the early part of my tapering I used Nexium and cut the capsules open with a serrated knife. Some supermarket makes of this medicine have capsules which  are in two parts and can be carefully twisted apart.

However Nexium now also comes in the form of single tablets with a tough gastro-resistant coating, and the supermarkets seem to be following this change. As of November 2022, at least in the UK, it is still  possible to buy either tablets or capsules. If they phase out the capsules in favour of the tablets (which I’d guess are cheaper to produce), I can’t see any way that people can easily escape Esomeprazole by tapering!

As my  tapered dose of Esomeprazole diminished,  I found that the dose reductions (measured in number of spheres consumed) needed to be smaller to avoid unpleasant  withdrawal symptoms. Sometimes I also found it necessary to stay at one level a day or two longer than intended before dropping to the next step.

Don’t Rush 

I stopped tapering at a dose of 6 spheres. This wasn’t pleasant, and I really wished I’d carried on down to just one sphere per day (1/64 of the normal dose!!!!!! ), but on the other hand, I wasn’t sure whether capsules would continue to be available over the counter in the UK  much longer.

We need someone to produce Tapering Strips for PPIs – they would probably work even better than they do for antidepressants.

Editor’s Note

There are other PPI posts on RxISK – such as how PPIs can cause anxiety – If Anxious Check Drugs and Prescribing Cascades.

Other PPIs equally cause dependence and withdrawal issues as well as anxiety and other problems and they set up prescribing cascades.

  • lansoprazole (Prevacid),
  • Pantoprazole (Protonix),
  • Rabeprazole (AcipHex)

We are interested in comments from takers on these problems and also whether these pills have been reformulated to make them close to impossible to stop.

When PPIs came on the market first more than three decades ago, the recommendations were to use them for two weeks.  The instant relief they brought was a slippery slope into dependence and they are now a great example of what Dee Mangin has called Legacy Prescribing.

There are a lot of lifestyle strategies for managing acid reflux – heartburn – GERD (gastro-esophageal-reflux-disease such as using cider vinegar or pickles.  This can sound counter-intuitive but it works and is worth googling.

GERD is not a disease. It only becomes a chronic problem when you start taking a PPI.  It was created by PPI company marketing departments, when soon after these drugs came on the market, the disease they were created to treat – duodenal ulcers, vanished, cured by antibiotics.

 

 

 



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Comments

  1. Adrian Chiles takes a semi light-hearted-look at his pill-box, but the comments section shows a revealing look …

    Spike501

    14 Dec 2022 16.34

    I don’t have the time to look up studies, but there is mounting evidence that taking reflux drugs (PPI’s) long-term is not good for you
    Yes I was prescribed them a few years ago for problems caused by a Hiatus hernia and my doctor advised me of this – however, this seems to be linked with people taking multiple 30mg tablets per day for decades, I currently need 15mg every 3-7 days. I get an annual prescrption and it is monitored

    Florence1895

    14 Dec 2022 16.39

    Diagnosed with laryngopharyngeal (silent) reflux, I was put on a massive dose of omeprazole (PPI) plus gaviscon. Modifying my diet, cutting out coffee and all that yummy spiced food, drinking more water, has enabled me to stop both. Yes, I need to exercise more, and certainly need to lose weight, but I’m pretty pleased that I’ve managed to reduce my pill intake by such simple measures. Try it!

    farabundovive

    14 Dec 2022 16.47

    Much reflux is caused by helicobacter pylori, the bacterium responsible for stomach ulcers. A dose of antibiotics would knock it on the head. It worked for me. After a decade of much acidic misery, I have now been reflux-free for over 20 years.

    I’m on nine pills a day now – and I’m not even what you might call ill

    Adrian Chiles

    There is one for reflux, one for anxiety, one for vitamin D – and new ones keep on coming. Welcome to middle age

    https://www.theguardian.com/commentisfree/2022/dec/14/im-on-nine-pills-a-day-now-and-im-not-even-what-you-might-call-ill

    About seven years ago, when I was still in my 40s, my GP saw fit to prescribe me another pill to take every day. I believe it was for reflux. While I was grateful for anything to address the geysers of what felt like battery acid erupting in my belly, I was dismayed. I already took something for anxiety and two for hypertension, so this would be my fourth pill. “Four a day!” I groaned. “What’s happening to me?”

    “Welcome to middle age,” the GP said, drily.

    How right she was. Four pills. Just four! What I wouldn’t give to be back in those halcyon days. Four pills was small potatoes, entry level. There were more to come. A deficiency in vitamin D was identified, so in went a daily dose of that. Organisationally, this was a turning point. Even though the days of the week were marked on some of the strips of pills, I managed to make mistakes. I knew I had been blundering because, having been prescribed the same quantity of each medication, I had a different number of each pill left when it got towards repeat prescription time.

    I muddled through, determined to avoid succumbing to the inevitable – having to buy a pillbox – this being a sure sign that you’re on the downward slope of life. It’s like when, if you trip over, people start saying you’ve “had a fall” rather than you’ve merely fallen over. At about this time, interestingly, I slipped over in the bath, cracking a couple of ribs, which was most definitely in the “a fall” category. There was nothing for it: I had to buy a pillbox. Apart from anything else, dozens of painkillers were now, for the time being at least, popping in to join the pill party.

    Distributing the pills in the organiser was oddly satisfying. But again, mistakes crept in. The pharmaceutical industry gets a lot of stick, but not nearly enough for the confusing colours, shapes and sizes of its pills. Big, small, medium, round, oval, white, beige, whatever. It would be a great help if the same medication could be the same size, shape and colour whoever manufactures it. But no, they appear to be interchangeable. Confusion reigns. One month’s citalopram can resemble the next month’s amlodipine. Someone’s having a laugh.

    At least the ADHD pills, when they came knocking on the pillbox door, were a different shape. And they obviously improved my organisational skills. That said, many is a time I’ve arranged my pillbox most beautifully for a trip away, only to go away without it. Equally displeasing is when you tap the day’s pills out to find one or more of the other days’ lids isn’t closed properly, so off they go shooting all over the floor.

    And still new pills come. A couple of new arrivals just in time for Christmas, actually – a statin and a blood thinner. For added befuddlement, I now must take some in the morning and some in the evening, necessitating the purchase of a more advanced pillbox.

    Nine pills a day now. Surely 2023 will see me achieve double figures. And it’s not as if I’m what you might call ill. My dad, in his 80s, is well into double figures with his pill intake. If getting a pillbox is the first step on the downward slope, the second is the pharmacist sending you the pills ready arranged. Upon giving my dad a stern telling-off for not taking his meds assiduously enough, I saw that the dosette box from the pharmacy was flimsy and tricky to read. So I got him a nice clear pill organiser just like mine, and carefully filled both up.

    Predictably enough, yesterday morning I absent-mindedly knocked back his morning pills instead of mine – all nine of them. Realising in the nick of time, I retched loudly, and managed to expel them with some force across his kitchen. Great, thought the dog, treat time! I recovered eight of the pills, so one remains at large, either on the floor somewhere, in me, or in the dog.

    Reply

    • Thank you annie.
      Think you have pick on a good example of how the Main Stream Media slowly distorts its readers perception of normality and inevitability. ‘Tis also the reason I haven’t read a newspaper nor watched MSM news for many a year. It may be a bit unkind to consider Chiles as a useful idiot but it often appears to me that most of those who have been chosen to have the privilege of a high public profile, so affording them an outlet for their verbiage, are those who also believe the things that their masters want ‘us’ to believe and thus comply unthinkigly. Going by the comments at the bottom of his article it appears that many other readers just accept that pills are a normal accompaniment to growing older (but perhaps not wiser).
      This intentional misleading is not a new phenomena. Thomas Jefferson in a letter to John Norvell (June 11, 1807) wrote:
      “To your request of my opinion of the manner in which a newspaper should be conducted, so as to be most useful, I should answer, “by restraining it to true facts & sound principles only.” Yet I fear such a paper would find few subscribers. It is a melancholy truth, that a suppression of the press could not more compleatly deprive the nation of it’s benefits, than is done by it’s abandoned prostitution to falsehood. Nothing can now be believed which is seen in a newspaper. Truth itself becomes suspicious by being put into that polluted vehicle. The real extent of this state of misinformation is known only to those who are in situations to confront facts within their knowledge with the lies of the day. I really look with commiseration over the great body of my fellow citizens, who, reading newspapers, live & die in the belief, that they have known something of what has been passing in the world in their time; […]
      I will add, that the man who never looks into a newspaper is better informed than he who reads them; inasmuch as he who knows nothing is nearer to truth than he whose mind is filled with falsehoods & errors. He who reads nothing will still learn the great facts, and the details are all false.      ”
      I think the last paragraph is very important (in its proper context) for all of us who strive to change things for the better. We can get too wrapped up in reading and watching and sometimes subtle propaganda (as with the Chiles article). Although we may think we are seeing it for what it is, it slowly modifies our neural networks and changes our perceptions and ultimately how effectively we cant react to real threats.
      James Corbett, in one of his Corbett Reports, has been able to explain and put in what I think is a proper rational context, of what exposer to MSM does, and in a far more eloquently and simplified way than I can.[2] Whereas, whenever I try to explain such things it comes out sounding like Penrose/Jungian psychobabble.
      [1] Thomas Jefferson to John Norvell, June 11, 1807 https://www.loc.gov/resource/mtj1.038_0592_0594/?sp=2&st=text
      [2] Corbett  (11/29/2022) Eye-bouncing – #SolutionsWatch https://www.corbettreport.com/solutionswatch-eyebouncing/

      Reply

  2. Just incase anyone asks due to the news coverage, regarding another drug used for treating GERD.
    Ranitidine (Zantac) which is a H2 receptor blocker was very popular until suspicion rose that it caused cancers. To be more precise, a contaminate carcinogenic chemical N-Nitrosodimethylamine (NDMA) thought to be the result of the drug breaking down due to heat, either during storage or manufacture. There is currently a 50,000 strong law suit against the manufactures. [1]
    My take on this: Low dose, short term use would not unduly worry me, but I think a warning is warranted (plus jail time to bring manufactures to heel).
    As this RxISK article is about a different class of drug I’ll just leave a link for those here who may be interest, to the Motion for Supplemental Reports which provides a picture as to the evidence, probable risk and legal argument, [2]

    [1] The long list of defendants and plaintiffs.
    https://www.govinfo.gov/app/details/USCOURTS-flsd-9_20-md-02924

    [2] https://www.aboutlawsuits.com/wp-content/uploads/2022-10-04-Motion-for-Supplemental-Reports.pdf

    Reply

  3. That magic word ‘inhibitors’

    Proton Pump Inhibitors

    Selective Serotonin Reuptake Inhibitors –

    So lets forget all the previous stuff and just do one to take over from the ones that were inadequate – ie adjunctive…

    ‘ If some symptoms of depression persist while on an antidepressant, adding a different type of medication, often referred to as an adjunctive treatment, to the existing regimen may help.’

    Juan Gérvas Retweeted

    Mark Horowitz
    @markhoro

    Just based on the company’s press release cariprazine has been approved for MDD on the basis of two 6-8 week trials that both showed no stat diff from placebo. Long list of adverse effects. Anyone looked at the approval docs?

    http://bit.ly/3FFTxEn

    “Patients with inadequate response to standard antidepressant medication are often frustrated by the experience of trying multiple medicines and still suffering from unresolved symptoms. Instead of starting over with another standard antidepressant, VRAYLAR works with an existing treatment and can help build on the progress already made,” said Gary Sachs, MD, clinical vice president at Signant Health, associate clinical professor of psychiatry at Massachusetts General Hospital, and lead Phase 3 clinical trial investigator. “For adults living with major depressive disorder, because of inadequate improvement in response to standard antidepressants, VRAYLAR is an efficacious adjunctive treatment option with a well-characterized safety profile.”

    The Dangers of Proton Pump Inhibitors

    https://chriskresser.com/the-dangers-of-proton-pump-inhibitors/

    Alison
    April 6, 2018 at 6:34 am

    Anyone taking these drugs should look for an alternative urgently
    My husband had a massive ulcer burst in 2012 – He was prescribed Omaprezole
    From a happy go lucky, comical, nothing ever got to him type of person, he changed to having severe paranoia and horrible thoughts, so bad that for a whole year he wouldn’t leave the house and we couldn’t leave him on his own.
    I watched him almost cry in pain with leg pain and back pain, stomach polyps , rashes etc. He went for tests but at no time did his GP suggest that he should stop taking Omaprezole to check whether these could be the cause
    He was not monitored by his GP. On the few occasions I managed to stop him taking them, he went back on them because the acid reflux was so bad. Little did we know that the Omaprezole was very likely making it worse.
    He raised the question of the Omaprezole with his GP on a couple of occasions but was told to continue taking them.
    He is no longer here due to paranoid thoughts going around his head and he took his own life.
    We had no reason to believe these pills could cause such bad effects but having read more and more into it, the comments various people have made whilst taking these pills, has made me realise that the effects on him over the last 6 years have been down to these killer pills.
    I knew him well – I had lived with him for 32 years before these horrible events started happening and could not believe what was happening to him.
    Although I tried and tried to get him off them, I now have to live with the regret of not doing more research on these killer pills than I did and not taking them away, making him look for alternatives . If I had, he would still be here.
    So anyone who is taking them, please seek an alternative urgently.

    Reply

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