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) as well as 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 own personal 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 related 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. Many people also swear by Kefir, a yogurt like drink full of probiotics. Apparently it has many bacteria not found in yogurt that can aid digestion.  You can find kefir in the dairy section of any natural foods store as well as Trader Joes or Whole Foods. I've been told drinking a cup a day helps.

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, habanero peppers and tomato juice…..kidding.

What to expect after Quitting Prilosec.

I was prescribed Prilosec and later 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 that didn’t work I was referred to a GI doctor who told me that my symptoms were most likely 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 Zantac 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.  I had never in my life experienced such a thing.

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.  If  I had a large dinner I would sometimes be unable to sleep to two or three in the morning due to the bloating. 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 not chronic 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 making me dependent on the PPI meds.

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 (a newer Proton Pump Inhibitor) 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.

Every few months it seems like new dangerous side effects of long term use of Prilosec and PPIs are being discovered. The latest studies show a possible link to dementia and heart attack. It seems like just a matter of time before we see Prilosec class action lawsuits much like those you see on TV for Zofran, Xarelto, asbestos related  asbestos mesothelioma etc.

  Recently, acording to Consumer reports, new FDA research showed 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.

Seriously though, there are a lot of good diet books specifically for Acid Reflux sufferers. Here is a selection.

Lastly, please see the comments below to read the accounts of dozens of others who have had issues with quitting prilosec, Zantac, Nexium etc.   You are not alone.  I wish you the best of luck