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.
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.
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:
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.
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.
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.