Weaning off pantoprazole (ppi)

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rosebloom

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Long term PPI use is a life saver for some people. There are disoders that cause the stomach to produce excess acid (Zollinger Ellison Syndrome), and, besides surgery to remove an acid producing tumor, there may not be any other remedies but long term PPI use. Otherwise, those folks may end up with esophageal cancer, ulcers and other nasties from the chronic excess acid.

I think, however, that PPI's are overprescribed often, as in my case, without proper follow up. They were considered "safe" drugs until more recent research showed the high positive correlation with fractures and GI infections in long term PPI users.

Heartburn and GERD have existed for centuries and people have managed their symptoms for just as long. My (non-medical) opinion is that PPI's should be prescribed for short term use for a majority of people and their use re-evaluated periodically. I don't think they should be over the counter medications as more people are going to take them without being properly diagnosed by a physician. Most regular folk out there (me included until recently) do not know the difference between a PPI and a H2 blocker either.

In the old days, most people managed heartburn with lifestyle changes, good old bicarbonate of soda, chewing gum, and by avoiding trigger fooRAB.

As far as what medications to use, I suggest a step up approach that begins with lifestyle changes and sporadic use of antiaciRAB. If that does not work, then there are H2 blockers like Zantac and Pepsid AC. If that does not work, then there are the PPI's.

When I was first diagnosed with reflux (via endoscopy), I was prescribed a PPI, told it was absolutely safe, my condition was chronic and I could fortunately take the PPI "forever." I was told to come back in a few years for a follow up endoscopy and to just follow up with my medical doctor who happily refilled my PPI prescription for three years until I decided to stop taking it in January. Nobody informed me of side effects, rebound, acid malabsorption, etc. I am sure those are relatively minor issues compared to what physicians deal with on a regular busy day. Nevertheless, let the customer beware. I started reading and finding all this information on my own.

Rose
 
I believe ACV is apple cider vinegar. 1 tablespoon of it, possibly diluted with water, is said to help the valve on top of your stomach work better and reduce reflux. It's a commonly cited folk remedy, fairly harmless. I use it myself sometimes.
 
Jayner:

ACV is apple cider vinegar. I buy the "organic" type that comes with the "mother" like Braggs. I take two tablespoons diluted in a glass of water twice a day sipped through a straw to minimize contact with the teeth. It seems to help, though it takes some getting used to.

Rose
 
I think that they are looking if they should keep people on them for ever, without ever trying to discontinue them.

GORD is not a disease due to deficiency of omeprazole in the diet!

Courtnay, can I suggest you buy some Rennies, and keep tem in your pocket or handbag at all times, you can suck 1 or 2 as soon as you get any acid symptoms, and control it before it becomes a problem
 
I would love to see them discontinue, but not sure what there plan will be.
I'm only going to be on PPI for a very short 3 months, hope thats not to long. I really don't feel that i need it all that much I burp hardly ever now and have no burn pain or anything. But since he did an enRABocopy and found very mild inflammation I figured Id do a few mths just to give it time to heal.
 
Hello all,

I am new to this board. Wanted to thank everyone who has posted their experiences about weaning off a ppi as it has been helpful to me as I researched how to go about it.

I have been on 40mg/day of Protonix for about 10 years. I started having stomach pain and insomnia after an injury for which I was prescribed high dose ibuprofen. After trying me on various meRAB, Protonix seemed to releive the pain/insomnia and I took it blindly for all this time. I had no clue about the side effects.

Fast forward to now, and as I was researching Protonix's safety during pregnancy, I sturabled across the bone loss issues etc. I am horrified and want off this drug ASAP!

I spoke to my GP who supports my decision to step down and eventually off. The first step was to switch from 40mg every 24 hours to 20mg every 12 hours. The second step, which is where I am at now, is to bump it back to 20mg every 16 hours. I've been advised to allow at least 2 weeks for each change to allow my body to adjust.

I am very optimistic about getting off this drug for good. My lifestyle is quite different than what it was 10 years ago, and I suspect that I never had anything more than some post ibuprofen damage. I am not really overweight, my stress levels are very low and my diet is reasonably healthy. I am trying to conceive, which may force me to push this process a bit faster, but for now I am happy to take it one step at a time.

Anyway, thanks for reading. I am really grateful for the support and shared experiences!
 
Ladybuglove: I don't think that there's a movement against ALL use of PPI's! And I don't think there should be. For people with very serious stomach conditions, they can be a literal lifesaver. It's possible that the first month or so I was on them, I really needed them.

However, some doctors are now trying to manage milder problems without resorting to PPI's and trying to limit the length of use. Before, they'd just say, "Take 'em as long as you need 'em, there's no harm in it." Now, some are recognizing that there is potential harm in using them for years and years, so the goal is to taper people off after letting the digestive system heal somewhat.
 
And thats exactly what the drug companys want rose - a person with an ulcer who takes omeprazole for 4 weeks doesnt make them much cash, neither does a person with a flareup of heartburn who takes it for a month, then goes back to simpler remedies.

They get rick off of people taking their PPI's day in, day out, year after year - they pushed them hard that way to doctors and I am sure they still do.
 
Just my 2 cents. Have you looked a Manuka Honey, also a mild diet with some baking soda and water twice a day, should cure mild stomach inflamation.
 
What ever did doctors do before PPI's

I have to say that I think a significant amount of the GORD around is due to disease mongering by the drug industry - GORD seemed to become a popular disease about the same time as Losec/Prilosec hit the market.
 
rennies are an otc antacid in england and australia - like tums or rolaiRAB in the usa
 
Congratulations on taking charge of your health, and I pray that your efforts are soon rewarded with a healthy child.

The taper-down plan your doctor wrote sounRAB reasonable to me. Probably better than what I did, and my withdrawl wasn't bad at all. (I also blame Ibuprofen for my stomach woes!)

It can take a while to get off of PPI's. If you start to have symptoms during the taper-down period, don't worry too much, they usually subside. Possibly Tums will help with that (and it'll build those calcium reserves, too.)
 
Hi all,

Just an update to say I have successfully halved my dose to 20mg/every 24 hours. I have had no major issues with increasing the time between my doses by 4 hours every 2 weeks. It has taken me 42 days to halve from 40 to 20, but it's been essentially pain and discomfort free! Yay!

I have had 2 or 3 episodes of mild reflux, triggered by fried food. I treated both with ACV only and have not had to resort to Gaviscon or Rennies yet. Since fried food is something I eat only occasionally now, I find this quite acceptable and I have not changed my diet at all whilst stepping down.

I've had a few random occasions where my stomach felt like it was "bubbly", usually right before or after a dose but I have not been able to link it to anything. Sometimes I "know" that my does is due as my stomach feels a bit tight, but again, it's not painful and it's really good to know I can train my cells off of this drug.

Interesting discussion re the use/overuse of this drug. I didn't ask my GP at the time what the outcome of their meeting was, but I can try to remeraber to when I next see him in August. Having experienced my health care systems, I would say that the GPs I have had since being in the UK have been much slower to prescribe where other remedies might be of some help first. Although care comes first, it feels like a more measured approach. The again, I've only had 2 GPs so my my experience is quite limited!
 
I hope that there isnt a movement not what I intended when I said discontinue, there slightly useful but hopeful there is another method besides years of usage. I do believe its possible for my few mths on them they will be useful but I think after long term usage they become less effective for a lot of people. Maybe they will just take them off the OTC counters for those with minor issues, prob all they will do.
 
It can be done but, in my experience, it took approximately three months. I tried to rush at the onset and ended up experiencing pretty bad acid rebound for the first two months. If I have any good advice to give is to taper off slowly. Accept it will take a while to be PPI-free and step down in a very gradual fashion to minimize rebound. It sounRAB like you have a good plan and I am happy to read your doctor is supporting you on this.

I am one of those people who ended up with osteopenia after using a PPI for only three years. I was headed to become one of those statistics of women over fifty who take PPI's and end up breaking their hip. I am now hoping to reverse or halt the bone loss so I don't end up with osteoporosis.

Good luck to you and please take your time.

Rose
 
Thank you both for your supportive replies! :angel:

janewhite1: I have experienced very minor symptoms at the beginning of both steps, but nothing outrageous so far. It's helpful to know that is normal! :)

rosebloom: I read your story. Amazing and inspiring! Thanks for the reminder to be patient. It's difficult once you decide to get off of it to wait out the process. :)

My GP will be following my progress as I am his first patient to try and wean down. I was put on protonix in the US through Kaiser, but now live in the UK. My GP told me that the week before I consulted him, there had been a meeting of all the docs in the practice about the long term effects of PPIs and whether or not they wanted to continue to prescribe them as readily. The docs here are not *quite* as beholden to the drug industry as in the US, so maybe there will be a shift in prescribing tendencies here eventually.

In the meantime I am finding ACV to be a great help (and hey it's supposed to be an appetite suppressant as well lol!) and I will keep chipping away at my hourly intervals.
 
I wonder though if they don't prescribe then...what will GERD and gastriits and other acid problem people be prescribed?
 
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