The document above describing a PDF that explains how to take your PPI properly is no longer available online. The pertinent information has been copied below. It is written for medical professionals, so there is some technical information included. Just take what is useful to you and disregard the rest!"You want to assure patients that PPIs are very effective drugs; however, it is important that they be equally aware that it may take some time before they have symptomatic relief. Then, whether or not they experience immediate relief, this medication must be taken everyday continuously and on a long-term basis in order for it to be effective.
Taking PPIs on an as needed basis will not provide adequate acid inhibition in patients with more complex reflux, as PPIs do not permanently bind to proton pumps. Without routine use of the drugs, actions can be reversed by regulatory body mechanisms. Principally, glutathione reductase is responsible for reversal of acid inhibition by breaking the covalent bonds between the drug and the proton pumps.
Additionally, PPIs only work on activated proton pumps. Because of the body’s natural regulation process, inactivated ones will ultimately be activated, resuming acid secretion. Eventually, with continual and consistent use, maximal suppression of acid secretion can be achieved. Conversly, once PPIs have been discontinued, symptoms can return quickly, reinforcing that PPIs are not a cure for acid reflux.
All these points cannot be emphasized enough to patients.
Next, it is prudent that patients understand the importance of taking PPIs properly. Patients should be instructed to take PPIs in the morning, as this is when the amount of proton pumps located on the parietal cells is the greatest. PPIs should also be taken at least an hour before breakfast because they are absorbed in the small intestine, and it takes at least 30–40 minutes for the drug to empty out of the stomach and into the small intestine. Maximizing the absorption of the medication is the first step to ensuring optimal drug benefits.
If a PPI is taken with food, complete absorption and subsequently, full drug effects, will be lost. After the hour has passed, the type of meal eaten
after taking a PPI is very important for maximizing the effectiveness of the medication. Patients should be informed that their first meal after a PPI should be a protein-rich meal (e.g., milk, cheese, yogurt). Protein stimulates the release of gastrin, the major hormone responsible for regulating acid secretion. Gastrin is located in the antrum and stimulates acid secretion through various mechanisms including direct stimulation of proton pumps on the parietal cells and enhancing histamine release.
Without sufficient protein in the meal following PPI intake, only about 10% of the proton pumps will be stimulated by the meal, and the other 90% of the pumps will remain inactive or “asleep.” A protein-rich meal will better activate the release of gastrin to stimulate all available proton pumps, this ensures therapy is most effective, as PPIs can inhibit meal-stimulated acid secretion.
I find that one of the best ways for patients to understand the repercussions is to talk in dollars and cents. They will only get 10 cents on every dollar if they do not eat enough protein after PPI intake.
Dose escalation may be necessary, so it is important patients try not to get discouraged with their therapy. Dosing is highly individualized, based on the level of inhibition required for each patient. Some patients will require twice a day dosing with PPIs due to severe reflux. For such patients, their first dose should be taken in the morning, an hour before breakfast, and their second dose should be taken in the evening, an hour before dinner. Patients should also be instructed to avoid taking their evening dose at bedtime.
An even smaller subset of patients will have nocturnal acid breakthrough (NAB), requiring an H2-blocker at bedtime. Patients should be directed not to take H2-blockers simultaneously with their PPI doses, or it may result in reduced efficacy on acid inhibition overall.
Separating the evening PPI dose and bedtime H2-blocker dose as much as possible will ensure optimal acid inhibition. Unfortunately, resistance to H2- blockers may occur quickly. A 2002 study evaluated the combination of twice a day PPI therapy with bedtime H2-blockers for patients with complicated gastroesophageal reflux disease.
While results showed an 18% initial response rate, NAB resumed in 50% of those patients after one week and in 62% after one month. Hence, emphasizing the importance of continued use despite the lack of symptomatic relief becomes
14 PRACTICAL GASTROENTEROLOGY • JANUARY 2007
Digesting the Complexity of
PPI Management and Care
Stuart A. Frank, M.D., FACG, Clinical Associate Professor
of Internal Medicine, South Western Medical
School, Dallas, Texas.
by Stuart A. Frank
Nissen Fundoplication 2/09
Allergy/Asthma"Whatever you fight, you strengthen, and what you resist, persists.”
“Worry pretends to be necessary but serves no useful purpose”
“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
Post Edited (dencha) : 8/18/2015 2:22:34 PM (GMT-6)