Experiments with the PPIs

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aciphexo
Regular Member


Date Joined Apr 2011
Total Posts : 377
   Posted 7/22/2012 4:23 PM (GMT -6)   
Hello all ..

To summarize my story: I get side effects on PPIs and H2-blockers (different kinds of side effects) - so have been managing my GERD without them for the last year or so. My GERD is not severe but continues to bother me off and on during the day. I've tried various natural means and am looking into TIF/Nissen as options to address my symptoms. I've postponed my TIF to after summer when I'll have more control over my diet (too many activities with kids+relatives scheduled during the summer).

So, I've been experimenting with the PPIs again (Aciphex 20mg/day for the last 10 days or so) - definitely helps with my GERD symptoms but does not quite resolve the symptoms fully. This time, surprisingly, the side effects are barely noticeable (last year - and even a few months back, 5 days on this dosage of aciphex would get pain and tingling going all over my body). Aciphex used to be the best in terms of side effects (least side effects) - which is why I've started with aciphex now.

Since my GERD symptoms are getting better on 20mgs/day Aciphex - but not quite getting fully resolved I am going to extend this experiment (btw - I am aware of getting dependent on the meds and the rebound etc. - however, since I am going to go for TIF in the fall anyway, I am not too worried about the dependency at this point - I just want to be able to manage my symptoms through the summer):

So, my options at this time are:
- Up the dosage of Aciphex to 40mg/day:
- 40mg/in the AM or
- 20mg/AM + 20mg/PM
- Try other PPIs which might help me more than aciphex. However, I am wary that these may get more side effects - and more importantly may trigger the same side effects and even with the aciphex possibly.

I am quite surprised to see that 20mg/day aciphex has not bothered me as much as it used to, so I am getting tempted to try the other PPIs - which used to help me much more for my GERD symptoms but would also cause more side effects. I have a stash of Prilosec, Nexium, Prevacid, Protonix etc. all sitting nicely in my medicine cabinet - so I have access to the full variety of the pharma arsenal :)

I just wanted to write this - to see if you all have any recommendation on what I should try next.

At this time, I am going to extend the experiment by adding another dose of 20mg of Aciphex in the PM to start with.

Post Edited (PPI-LESS) : 7/22/2012 4:26:02 PM (GMT-6)


guddan
Regular Member


Date Joined Jun 2012
Total Posts : 32
   Posted 7/22/2012 4:52 PM (GMT -6)   
Few points I believe are true
1) Its important to take PPI empty stomach 30 to 60 min. before eating atleast 500 Calories of meal containing protein. In absence of it, effectiveness of PPI gets reduced.
2) 2 times of 20 mg is better than 1 time of 40 mg.
3) one dose of 20 mg can also be substituted by 150mg ranitidine or 20mg famotidine along with PPI.Ranitidine/famotidine shouldn't be taken at same time of the day but at different times on the same day.
4) It takes 4-5 days for body to get accoustomed to a particular PPI. Hence whatever you experiment, stick to it for a week atleast for definite answer.

mudmagnetmum
Veteran Member


Date Joined Apr 2011
Total Posts : 1604
   Posted 7/22/2012 5:05 PM (GMT -6)   
It's hard, I agree. And I have found ranitidine to be NO substitute for any dose of a PPI, big or small. I tried high dose Ranitidine 6 weeks ago when I had to reduce my PPI due to my own side effects. It gave me very poor symptom relief and gave me diarrhoea on top of everything else. I managed for a couple of weeks on half dose of a PPI and 150 mg twice daily of Ranitidine - but I just gradually became more and more unwell and couldn't separate out side effect from symptoms. I'm now back on full dose of PPI and micromanaging about 3 separate side effects :-(

I would stay on the same dose and use something like Gaviscon on top of it first - it can take quite some time to reverse the side effects when they do kick in, so I would tread carefully! Lansoprazole comes in 15 mg capsules, which is useful for titrating a dose up or down - have you got any in your stash? (Your medicine cabinet sounds like mine!!). I do sympathise - I go round in complete circles with my drugs on a regular basis!

MMM
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

WJF
Regular Member


Date Joined Sep 2011
Total Posts : 273
   Posted 7/23/2012 7:09 AM (GMT -6)   
PPI-LESS,

I'd suggest sticking to 20mg daily for a few weeks more and see how it goes.

I read from a paper. H2 blocker, though is a much weaker acid suppressant than PPI, is superb at managing night-time symptom.

If you have night-time reflux.
20mg PPI before breakfast, 150mg Zantac at bedtime may perform better than 20mg PPI before breakfast, 20mg PPI before dinner (double dose PPI).

In some cases, doctor adds H2 blocker at bedtime to a double-dose regimen just to control "nighttime acid breakthrough".


hi MMM,

Did acupuncture help?

mudmagnetmum
Veteran Member


Date Joined Apr 2011
Total Posts : 1604
   Posted 7/23/2012 7:35 AM (GMT -6)   
Hi WJF

I'm still trying the acupuncture. Unfortunately I started it during an acute flare up due to having to reduce my PPI (side effects) and major stress due to having to undergo repeat gastroscopy! I've had a few weeks of treatment now and I'm kind of back where I was before I had all the trouble with the side effects. So it's hard to tell at the moment - certainly the side effects have reduced but I have a real mixed and muddled symptom picture at the moment due to anaemia.

I read an article which said PPIs reduce the efficacy of the H2s - not permanently, but it implied taking both together might be a futile exercise. Some people do manage that successfully though - I guess the drug combo magic recipe isn't the same from one person to the next.......

Oh - the acupuncturist found 'energy blocks' relating to the small intestine. I'm going to carry on with it for a bit longer - helps with the stress of the gastroscopy if nothing else!!

MMM

aciphexo
Regular Member


Date Joined Apr 2011
Total Posts : 377
   Posted 7/24/2012 9:39 AM (GMT -6)   
Not so good news .. even though I was thinking of upping the daily dose, I decided to stay with 20mg/day.

However, even on 20mg/day - I started to notice the beginnings of the dreaded side effects yesterday. So, today I skipped the 20mg in the morning and can feel the GERD symptoms starting to come back :(

So, the current plan is to continue to balance this - may be use Aciphex 20mg one day and supplement with Gaviscon+Tums on the other days. H2s give me weird (different from the PPIs) side effects too. I know with the PPIs one has to be on them on a regular basis with a decent pace to see good control of the symptoms, so not sure how much would it help, but looks like I don't have a choice but to get on / get off of them to manage the balancing of the symptoms and the side-effects.

mudmagnetmum
Veteran Member


Date Joined Apr 2011
Total Posts : 1604
   Posted 7/24/2012 2:11 PM (GMT -6)   
It's awful isn't it - constant Hobson's choice. I think the PPIs are making me anaemic (got some tests lined up on that score) - my haemoglobin has dropped slowly the whole time I've been on them, but went up when I was only on Zantac. Sadly Zantac made me unwell and didn't control the GERD one jot............

I'm glad I'm not alone in no-man's land!

MMM
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma
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