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Taking Your Reflux Meds Correctly

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Proton pump inhibitors (PPIs) can relieve the heartburn and discomfort associated with gastroesophageal reflux disease (GERD), as well as heal damage done to the esophagus by the stomach’s acids. But if you’re looking for optimal results, make sure you’re taking these powerful drugs properly. According to a recent study in the American Journal of Gastroenterology, 61 percent of users aren’t doing so.

Researchers surveyed 610 patients taking over-the-counter (OTC) and prescription PPIs about their symptoms and reflux drug use. They found inconsistencies in dosing frequency and timing, which led to poor symptom relief.

Only 39 percent of consumers who purchased OTC PPIs used their drugs correctly. Of the patients whose primary care physician prescribed their PPIs, 47 percent took their drugs correctly. Patients who had a gastroenter- ologist prescribe their drugs fared best: 71 percent followed the proper dosing directions.

A 2001 study found that only about one-third of primary care providers told patients to take their medicine before breakfast, the best time for effectively relieving symptoms and healing esophageal damage. Conversely, most gastroenterologists told patients to take PPIs before the first meal of the day. As a result, gastroen- terologist patients reported significantly better outcomes, including greater symptom relief, than consumers or primary care patients.

The mainstay of GERD relief

PPIs reduce the amount of acid produced in the stomach and are ideally taken once a day, immediately before the first meal of the day, to maximize acid suppression. Prescription PPIs include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (AcipHex), dexlansoprazole (Dexilant) and an omeprazole/ sodium bicarbonate combination (Zegerid). Prilosec, Prevacid 24HR, Nexium 24HR and Zegerid are available without prescription.

Some studies have reported that long-term PPI use could lead to hip, wrist and spine fractures and increase risk of Clostridium difficile infection, which can cause diarrhea and fever. Other risks associated with long-term use

are low magnesium, calcium and vitamin B12 levels. Some evidence suggests a link between PPI use and increased risk of pneumonia. To avoid complications, use the lowest dosage for the shortest duration possible. Ask your doctor at each annual visit whether you still need a PPI or if the dose can be reduced.

Nonprescription antacids, such as Maalox, Mylanta, Gaviscon and Gelusil, and OTC and prescription H2 blockers, such as Tagamet HB, Pepcid AC, Axid AR and Zantac 75, can remedy occasional heartburn. But GERD often requires long-term therapy.

PPI pointers

Try these tips to get the best relief from PPIs, unless otherwise directed by your doctor:

• Take your daily PPI about 20 to 30 minutes before your first meal of the day.

• If your doctor prescribes a second dose, take it before dinner.

• Don’t skip doses; PPIs must be taken consistently every day to be most effective.

• Tell your doctor if you’re taking clopidogrel (Plavix). PPIs may lessen clopidogrel’s effect.

• Don’t take an OTC PPI for longer than 14 days, and for no more than three times a year without your doctor’s consent.

• If you’ve been taking an OTC PPI for more than two weeks, ask your doctor if you should see a gastroenterologist for a better diagnosis and treatment.

• Be aware that it takes four to seven days of continuous use for maximum effect, although some people feel better each time they take a PPI.

• Try an antacid or an H2 blocker for occasional symptoms. Some people find relief with “on-demand therapy”—taking a PPI as needed only on days when you expect symptoms to be worse—but talk with your doctor before skipping doses.

• If you’re prescribed a PPI and an H2 blocker, take the PPI before your breakfast and boost your relief with H2 blockers later in the day. 


Posted in Digestive Health on April 15, 2016

Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Health After 50 Disclaimer

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Health After 50 Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the editors cannot be answered in this space.

The views expressed here do not constitute medical advice, and do not represent the position of Scientific American Health After 50 or Remedy Health Media, LLC, which has no responsibility for any comments posted on this site.

Is there a reason you omitted the recent discovery of a strong correlation of chronic use of PPIs with risk of Chronic Kidney Disease (CKD)? For those for whom this is relevant, CKD seems at least as important as the other side effects noted in the summary.

Posted by: DenisBH | April 15, 2016 10:48 AM

I'm surprised there is no mention of melatonin (circadin) in the article. Taking this drug has given me amazing relief, so much so that a hiatus hernia operation has been averted.

Posted by: 70something | April 15, 2016 2:33 PM

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