How Can You Overcome the Upset of Heartburn?

About 25 percent of Americans have heartburn at least once a week. And 25 percent of those folks have it every day. Pharmacists across the country answer questions about acid-related medications 1.6 million times every month, a new survey found!

To help provide relief to heartburn sufferers, there’s a class of drugs called proton pump inhibitors (PPIs). You may have seen ads for Prilosec (omeprazole) or Prevacid (lansoprazole). These are examples of PPIs.

What You Should Know About Using PPIs

PPIs are available over-the-counter for self-care if you have frequent heartburn. The medication can also be given at higher doses by prescription for many other conditions.

PPIs are usually given for short courses (2 to 8 weeks) of treatment. PPIs should be taken 30-60 minutes before a meal for maximum benefit. Why? You need the medication in your system when your stomach starts making acid to digest a meal.

Usually PPIs are taken once daily. They’re least effective if taken at bedtime, so if you’re directed to take it twice daily, take it before your morning and evening meals.

Up to 70% of patients on PPIs continue to have nighttime acid symptoms. If that’s your situation, you may need a different medication like an H-2 blocker at bedtime. An H-2 example is Zantac (ranitidine).

When You Should Stop Using PPIs

Visit with your health care provider or pharmacist about the reason you take PPIs. If you have a condition that can cause esophageal damage, or you must take medication that has caused stomach bleeding, you may need PPIs for long-term protection.

The benefits of PPIs for these conditions outweigh the risks. But PPIs are often started to relieve a temporary problem such as stomach ulcers or frequent heartburn, or they may be started in the hospital while on bed rest. An issue can arise if the use of PPIs never stops.

Up to two-thirds of prescriptions for PPIs may be unnecessary. This increases costs and can lead to preventable side effects.

Stopping PPIs after you have used them longer than eight weeks can cause "rebound hypersecretion." That’s when the stomach overproduces acid. This effect can last up to three months and discourage people from stopping PPI use.

Unfortunately, people who had not had past problems with heartburn can suffer from this rebound acid overproduction after using PPIs for a long period and then stopping.

If it’s appropriate for you to stop using PPIs, first decrease to the lowest possible daily dose. Then decrease to every other day for at least a week. Ask your provider of pharmacist for more tips to comfortably end use of PPIs.

Managing risks

Although side effects from short-term use of PPIs are usually mild, we do have two main concerns with long-term use. Here are the risks and how you can manage them:

  • Infection risks: Stomach acid naturally protects our bodies from microbes. PPIs increase the risk of C. difficile, a type of colon infection associated with antibiotics. You should take a probiotic every time you use an antibiotic.
    PPIs may increase your risk of pneumonia in the hospital, so get the recommended pneumonia vaccines for your age.
  • Nutrition risks: Your body absorbs nutrients differently with reduced stomach acid. PPIs may reduce levels of Vitamin B12 and magnesium. Fracture risk is slightly increased. Consider a multivitamin. Calcium citrate and Vitamin D3 are the best choices for bone strength if you have reduced stomach acid.

If you have any questions about heartburn or a concerning stomach discomfort, schedule an appointment with your health care provider.

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Meet the Author

Sarah Bartel, RPh, is pharmacist at Aurora Pharmacy in Algoma, WI.

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The information presented in this site is intended for general information and educational purposes. It is not intended to replace the advice of your own physician. Contact your physician if you believe you have a health problem.

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