Wednesday, December 8, 2010

How to quit Prilosec, (Omeprazole) and Zantac (Ranitidine)

This Blog details how to quit taking the Acid Reflux drugs Prilosec (also called Losec, OMesec and Zantac (ranitidine) in order to minimize rebound symptoms.
Let me start out by saying that I am not a medical professional. This blog details my experience in transitioning off of PPI (Proton pump inhibitor) reflux (GERD) drugs and is in no way meant to be taken as medical advice. I solely wish to provide the step by step method for quitting Prilosec that I wish someone had shown me.

If you are considering cutting down on your acid reflux medication please talk to your doctor first.

Since most of you are probably here seeking the nuts and bolts of how to quit Prilosec , I will start with a simple explanation of how I did it, and follow it with my own history and experience.



I was first prescribed a single 20 MG Prilosec a day. Eventually I got to the point where I was taking two 20MG Prilosec pills a day ( one before breakfast and one before dinner) and 150mg of Zantac (ranitidine) at bed time.

From my experience, if you suddenly stop taking the drugs you will experience severe acid reflux and heart burn symptoms. In my case they were far more severe than anything I had ever felt. Therefore, tapering down slowly is probably the best method for quitting. When I first started cutting down, I tried various strategies with varied results. Finally I was able to quit and now have no issues with GIRD, although I am also much more careful about what I eat, and use a lot of Acid Reflux realted cook books.  Anyway,   here is what finally worked for me.

Step #1
Buy a Pill Cutter.

You can find a pill cutter at your local pharmacy or online.  This will allow you to cut your Prilosec and Ranitidine.  You can use a knife until you get one, but since you'll be cutting into 1/4s it gets messy.


Step #2
Start by cutting out ¼ of your pill. If you take 20mg once a day, start by cutting your pill into four pieces and take 15mg instead. The following day take a full 20mg. Alternate between 15mg and 20mg every other day. Keep this up for 2 weeks. If you don’t have any rebound symptoms, it’s time to move on. If you have reflux symptoms, keep going another two weeks, or until your symptoms subside.

I experienced some rebound symptoms every time I dropped my dosage. The symptoms usually start to become noticeable somewhere between 5- 10 days after cutting the dosage.

Buy antacids such as Tums or Mylanta (Aluminum hydroxide/ Magnesium Hydroxide). You can use these periodically to treat your rebound symptoms.

If you take 40mg a day as I did, I would still recommend cutting it out in 5mg intervals.

Step #3
Once you’ve adapted to your reduced dosage of alternating between 15mg and 20mg each day (35mg and 40mg if you take 2 Prilosec a day) it’s time to graduate to the next step. Start taking 15mg each day(3/4 of one pill) without alternating.  Use the same strategy for step #2 and keep Tums and Mylanta on hand to combat rebound symptoms.

After 2-4 weeks you will hopefully reach baseline again. Over the course of cutting down you may hit a point where it takes you more than 4 weeks to reach baseline, don’t fret. This happened to me multiple times during the process. Just stick with it. If you have a really bad day, you can try temporarily going back up to your previous dosage.


Step #4
Now you essentially repeat step #2 and begin alternating daily between 10mg and 15mg. (30 and 35mg if you take 2 each day).


Step #5
Begin taking just 10mg each day. See Step #3

Then you essentially repeat these steps until you have slowly tapered down.
Using this method you will be off Prilosec in about 4-8 months if you only take 1 20 mg pill a day….8-16 months if you take 40mg a day.

Step #6 (Zantac- skip if you don’t take Zantac)
If you also take Zantac along with your Prilosec, now is the time to start cutting your Zantac dosage. You can cut down on Zantac the same way as Prilosec.

Cut your Zantac into 4 pieces using the pill cutter and begin taking ¾ of a pill one day, and a full pill the next day. Alternate each day just like you did with Prilosec.

Maintain your Prilosec at 10mg daily as you work on cutting down the Zantac.

Step #7 (Zantac-skip if you don’t take Zantac)
Now cut your dosage of Zantac so that you are taking ¾ a pill daily. After 2-4 symptom free weeks. Repeat step #6 but alternate to ½ a pill and ¾ a pill every other day. Once you get to where you can take only half a pill each day I would go back to reducing your Prilosec. Keep taking the ½ Zantac a day until you have fully quit Prilosec, and then you can finish cutting out the Zantac


Hooray, you’re Prilosec free! Now celebrate with a cigar, some coffee, chocolate, alcohol,, and tomato juice…..kidding.


What to expect after Quitting Prilosec.

I was prescribed Prilosec and late Ranitidine after a vocal injury from performing music on stage. I lost my voice for a few days and had severe throat pain. When I explained the situation to my doctor I was first prescribed Keflex, an antibiotic used to treat Strep Throat. When they didn’t work I was referred to a GI doctor who told me that my symptoms were most like Acid Reflux related.
This sounded suspect to me. My injury occurred immediately after a day of doing multiple performances, and I actually felt a sudden weird feeling in my throat after singing a particularly strenuous refrain.
The doctor assured me that although my initial injury may have been from over-use, my failure to heal quickly and my continued hoarseness was due to GIRD.
At this time I was in great pain and willing to try anything. The doctor started me on 20mg of Prilosec. This didn’t have any effect on my pain, and after a months or so, I was told to take 40mg a day, one in the morning and one in the evening. When I was still suffering from occasional hoarseness a few months later, 150mg of Prilosec were added to my regimen.

Around this time, my GI doctor decided that it was time to do a test where they put a camera down your throat and implant a chip into your esophagus. This chip measures the PH over a few days.
I had to cut out all my reflux meds for 7 days leading up to the test. When I suddenly quit taking the drugs I had sudden intense heart burn. I had never had heart burn before I started taking these drugs. After stopping them, I tried to do a Yoga class. When I bent over to touch my toes, I could feel a wave of acid rising from my stomach up to my chest and throat. It was extremely painful and frightening.

When I told my doctor about these rebound effects, he responded that there were no rebound effects for quitting Prilosec. What is happening is that you had built up a tolerance to the excess acid, but now that the tolerance is gone, you are experiencing symptoms. I found this hard to believe but who knows.

The test ended up showing that I had mild gastritis. I was told to just keep up with my meds. After a few months of taking the meds I began to have a lot of bloating. If I ate a large meal it could take me hours to feel normal again….even up to seven hours. At the time, I figured this was just a result of my GIRD. This was problematic enough that I talked to my doctor about it. This time he gave me a stomach emptying exam where I had to drink some kind of radioactive liquid which they would follow as it passed through my gut.

All told I was on Prilosec and Zantac for 4 years. I had off and on hoarseness, and bloating throughout this period. Since I have quit taking Prilosec, I no longer experience this excessive bloating. If I eat a large meal now, I am back to normal within a few hours. I also have less hoarseness and throat problems since I stopped taking the drugs.

Looking back, I feel like I most likely never suffered from acid reflux, or at least never severe reflux. It seems to me that the meds actually caused more symptoms for me. It’s as if taking acid reflux drugs gave me acid reflux symptoms.

Since quitting, I have had heartburn one time, after gobbling down a very greasy burrito. That’s it.

I’m sure that these drugs are helpful for some people, and along with Nexium they are prescribed very freely (Both Zantac and Prilosec are available over the counter in the US). Acid reflux is a common problem, and these drugs are apparently very effective for people suffering from reflux symptoms. However, I think the prevalence of acid reflux disease has led physicians to make hasty diagnosis of patients. Even with clear evidence that my pain was caused by vocal injury, the doctor went with what he knew….acid reflux…and really didn’t devote much time to considering the possibility that the injury was solely caused by over use. I, foolishly, went against my gut feeling and followed the gut doctor’s expert advice. For me, I believe that Prilosec and Zantac did far more harm than good. I wish my doctor would have at least recommended I try them for just 6 months and then taper off. Instead, he told me that I should stay on them for the rest of my life.

According to Consumer reports, new FDA research shows that long term use of Prilosec, Zantac and other reflux drugs in certain categories can make it hard for the body to absorb calcium. This may lead to an increase in osteoporosis and make it easier to break bones. I am hoping that these effects are reversible, in the meantime, my “All Cheese Diet” should help replenish my calcium levels.
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Seriously though, there are a lot of good diet books specifically for Acid Reflux sufferers. Here is a selection.

16 comments:

  1. I am currently trying to quit the omeprazole and found this article to be very accurate and helpful. Docs are not bad people but I think they go with what the drug reps tell them to say. I have used this stuff for maybe 7 years and have just been diagnosed with rapid bone loss! I was told by my doc that if I tried the drug for a couple of months and then tried to quit it would prove to me if I needed the drug. No mention of "rebound" > I was misled!

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  2. I've been taking 20mg of Omeprazol every day for 5 years and I'm having a hard time now trying to quit. This article is very useful and encourages me to keep trying to slowly decrease the dosage. I think doctors should read more the existing literature. There are plenty of articles mentioning rebound effects after long-term use of proton pump inhibitors like Omeprazole. I would have appreciated it if my doctor had mentioned this to me!

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    Replies
    1. I am in my third year of taking omeprazole. In Dec. I suddenly had severe knee and hip pain along with lower back pain. I was also diagnosed with a Vitamin B12 deficiency.
      I asked my gastroenterologist if joint pain could be linked to omeprazole. He said he wasn't aware of that.
      I want to taper off but am afraid I'll have more problems than I do now. Is it safe to just take half of what I've been taking? I take 2-20mg per day.
      I never thought that an OCT drug could possible cause such pain.

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  3. Zantac
    Zantac is a medicine which is used in a number of conditions. Zantac tablets, effervescent tablets, syrup and injection all contain the active ingredient ranitidine, which is a type of medicine called an H2 receptor antagonist. It is made by GlaxoSmithKline UK.
    Zantac

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  4. Thank you for sharing. I was diagnosed with oesteoporosis and Hiatel Hernia in May 2011 and have been taking 40 mg Prilosec every morning since then. First 6 months the medication mostly worked but then I started to get symptoms despite taking meds. I changed my diet. I completely stopped coffee, tea, alcohol, soda-pop for a month (the first week of stopping it and my symptoms reduced by 60-70%). I think diet and exercise plays a HUGE ROLE. I have reduced my dosage to 1.5 pills (40 mg to 30 mg) and have had no "rebound". I will reduce to 1 pill in a few weeks and keep that on for a month. Let see. Fingers crossed!

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    Replies
    1. That's great to hear, Acid Fighting Man. Good luck tapering down, I hope you stay symptom free. I've now been off all reflux meds for 13 months...so far so good.

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  5. Thank you so much for sharing your story and trying to help others taper off these drugs. I have been on Omeprazole for years and now am trying to quit. Thankfully I read your post because I just quit cold turkey 3 days ago. I haven't had the rebound effects yet, but I'm sure they are coming as I have experienced them before. My capsules are not firm, but gelatin and full of tiny pills, so I might need to contact my doctor to see if I can get the dosage reduced from 20mg to 10mg. I also bought enzymes to take before meals to help with my digestion. I too have a hiatal hernia. I am afraid of causing damage to my esophagus so will need to be aware of my diet, take probiotics and the enzymes and exercise. Thanks again for taking the time to share your story. Be well!

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  6. All you have to do is quit cold turkey and drink 12oz of RAW MILK with every meal. If you start feeling heartburn again, drink ONE MORE GLASS of raw milk. I was addicted to prilosec/omeprazone for 3 years. Believe me, it works.

    Good luck,
    -e

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  7. I really appreciate your sharing. I have very bad reflux symptoms after stop PPI. Though I am not sure if that could be rebound, since it has been more than 1 month. After reading your article, I am confident that is related to PPI. Yes I agree with you that Drs should be more careful using these drugs before they truly sure what a patience is sick for. Thank you very much for your article. That will help people.

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  8. Hi PPI free,
    Thank you for sharing your story. That is very much helpful. I too suffer from heartburn and reflux symptom after stop PPI. Just like you, I never have heartburn and reflux before. The first month of quit was miserable, I have severe reflux symptom which I was not sure if those are reflux. Because most of time I got mucus like liquid in my mouth which I originally thought it was mucus secrete in throat. After 1 month, I start to have pain in chest, back pain, unusual sensation(maybe I will describe as cold pulling feeling inside my body) which I guess reflux have caused some harm to my esophagus. I wonder have you also experienced these kinds of pain when you try to quit PPI. I started to question if I have stomach problems so my reflux isn't getting better with time but sometimes it is okay, some days it was pretty bad.

    Thank you also for the precise description of a wave of acid. That is exactly what I felt the other day but I can't describe what is that.

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  9. Thank you so much for this. You have echoed so many of the same feelings I've had since being given Omeprazole a year ago -- without a diagnosis of any kind. I also have full-blown osteoporosis so I feel the doctor was even more irresponsible in prescribing this. I am now going to try to get a pill I can cut, and follow your excellent method. I appreciate this. I do feel much of what happens in medicine is due to profits made by pill companies. And doctors know we want quick relief. My pain was horrendous -- enough though that I quit all bad habits immediately. I think that and eating properly and sleeping almost sitting up would have been enough. Instead I am now addicted to a seriously dangerous medicine. And I think I do have acid reflux, unlike your situation. Thanks again!

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  10. I wanted to ask if Gerd or losec causing heavy breathing problems on exhale ? Or any other weird symptoms like swollen tongue feeling or like you have to catch your breath when sleeping? Thanks

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  11. This is awesome. I totally had the exact same thing happen while singing. Now 5 years later after taking the same thing I am trying to stop. Thanks for the info. I went to an every other day so far and went off the zantac months ago.

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  12. This was a fascinating post and very similar to my story. I am a professional singer and voice teacher and have had a very hoarse throat for two years. I was diagnosed with strep throat over and over...9 times in 1 year and finally went to an ENT that said i had silent reflux and I was placed on 60mg of Prilosec. After 8 weeks I feel no better and have gained 8 pounds and feel bloated all the time. I plan to have a follow up visit to get off of this medication. I feel worse on it. Very tired, lots of headaches and very hungry.

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  13. For those who have problems mainly at night with acid; try sodium alginate. It was in Malox night liquid about a year ago and it worked for me.. but after my first bottle it was suddenly not available (very frustrating). Google it.. it is in the European version of Gaviscon advance at a high concentration. I ordered a bottle of pure sodium alginate through the web and am hoping it will arrive today.

    I wish I read your post 3 days ago when I attempted to go off Losec. The acid rebounded the second day and I am worst today. My gastroenterologist did not warn me about this even though I asked if it is okay to go off and on it. Everything you said rings true from my experience of Losec. The rebound is the worst that I have ever had it. THANK YOU for your instructions I will give it try.

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  14. Hi.
    I am 51 .. will be 52 in Dec. I have been taking Omeprazole/Prilosec since I was 27. I have been on this medication daily since then. I use the generic Omeprazole which comes in 10 mg capsiles with 9 lil pellets in them. I was able to reduce my use to 4 pellets ( there are 9 in a 10 mg capsule) of a 10mg capsule daliy. Total amount is 31.1 mgs per week. This is slightly more than 3 10 mg capsules for the week. I have tried to cycle down to to nothing. I was off of prilosec for 8 days. I tried to use calcium.... I tried to use baking soda... I tried Zantac all diring that down time in order to beat the horriffic rebound. I had tried 50 times over the years. This was the farthest I got. I had to go back on. I started to have severe gastritis. Hoarseness came back. The fire in my esophagus was hell.
    Over the years of useage... I was getting severe joint pain.. idiopathic in nature. Xrays showed nothing wrong. Hip pain that was severe. MRI showed nothing. The first years I used Prilosec, I got atrial fibrillation. Or nervousness/anxiety symptoms. I am a Chiropractic Physician. I have never had any of those sudden symptoms. I figured it was a magnesium issue caused by the drug useage. I approached my MD, and he had never heard that Prilosec could cause Magnesium loss. I told him I thought that was the issue. His answer was take Xanex. I never took them. I took Mg. The anxiety went away.. so did the atril fibrillation. THEN... they discovere the drug DOES cause Mg loss... and now it's added to the meds.

    I wish... wish I could beat this med. I have tried so many times. The rebound for me is from another planet in terms of pain and discomfort. The other remedies from Apple Cider... is a joke.. and a prescription for an ambulance for me. The eating an apple is almost as bad. Drinking milk raw or otherwise is not workable for me.. Too caloric... to high in fat as well. This drug can be a miracle.... but it is harder to quit than an opioid.

    I have cycled down to this base line. To many reading this... will think it's minimal useage. BUT.. now think of 24 years of useage.

    My next plan is to go 4 pellets one day.. 3 pellets the next day. USUALLY what happens is then I need to take calcium on the lower useage day. TOO MUCH calcium throws all your cardiac pumping balance out of whack and helps harden arteries. There has to be a better way.

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