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WHAT ARE PROTON PUMP INHIBITORS (PPIS)?
Medications used for treating stomach problems like heartburn, ulcers and indigestion include Nexium®, Prevacid®, Prilosec® and Dexilant®.
WHY SHOULD YOU CONSIDER STOPPING?
- Risk of osteoporosis and fractures
- Risk of intestinal infections by Clostridium difficile
- Risk of kidney disease
- Risk of lung infections
- Risk of low iron and vitamin B12 level
- Risk of cardiac events when taking both PPI and Plavix (clopidogrel)
WHEN SHOULD YOU CONSIDER STOPPING?
Have you been on your PPI for more than four weeks? Discuss with your doctor about the risks/benefits of continuing PPI use and ways to reduce your risk of PPI complications.
Reasons you may need to continue to be on PPI include:
- High risk of stomach ulcers
- On NSAIDs or other medications that increase the risk of ulcers
- Barrett’s esophagus
- Severe esophagitis
- Reoccurring symptoms of indigestion/heartburn
HOW WILL YOU STOP?
STEP 1: Preparing to stop
- Avoid fried/fatty foods, chocolate, coffee, citrus, soda, spicy foods
- Stop smoking
- Avoid alcohol
- Weight loss
- Eat small meals and wait 2–3 hours before lying down
- Elevate the head of the bed
STEP 2: Lowering dose or stopping your PPI
- Discuss tapering off with your doctor
- For occasional symptoms, your doctor may recommend taking an antacid (Tums®, Maalox®) or an acid blocker like famotidine (Pepcid®). Avoid Zantac® as it is currently recalled.
- Ask about on-demand therapy where PPI is temporarily restarted to alleviate symptoms and stopped after symptoms are resolved.
STEP 3: Follow-up
Discuss with your doctor about your symptom management and implementing lifestyle changes for better symptom control.
SOURCE(S)
American Family Physician, Choosing Wisely Canada, UpToDate