One of the most common medications I see in both nursing home patients and folks in the community is proton pump inhibitors (PPI’s). I am sure you have heard of them. Brand names include: Prilosec, Nexium, and Protonix to name a few. The generic name usually ends in -prazole such as Omeprazole, Esomeprazole, Pantoprazole, etc. You can even get some of these medications without a prescription. They are very effective for treating heart burn or GERD (gastroesophageal reflux disease). However, they are typically not meant for long term use. The Prilosec OTC box states “Do not take for more than 14 days or more often than every 4 months unless directed by a doctor.”
***Now, I am NOT talking about more serious conditions such as peptic ulcer disease, Barrett’s esophagus, bleeding GI ulcers, etc. PPI’s can be used appropriately long term for treating those conditions and you should follow your providers instructions.
Today, I am simply discussing GERD and mild to moderate esophagitis. Let’s discuss both what to do when your medication is not working and what to do when your medication is effective!
First, what should you do when you are taking a PPI and it is not effective (you are still having symptoms)? I would recommend getting a pharmacogenomics (PGx) test! Why? The effectiveness of these medications can depend on how fast you break them down or metabolize them. CYP2C19 is the enzyme most responsible for breaking down PPI’s. If you break down medications quickly at CYP2C19 you are at risk of having an insufficient response to most PPI’s. I can tell by a simple cheek swab which PPI’s would most likely be effective and which ones may not work for you. If you are using high doses of PPI’s or use them twice a day instead of once a day, that may be a sign your PPI is not effective and you should consider a PGx test.
Next, what do you do if you have been taking a PPI long term (8 weeks or more) and your symptoms are well-controlled? If your provider agrees, consider decreasing your dose. If you are taking 40mg, ask your doctor about switching to 20mg. If you are taking 20mg twice a day, ask your doctor about switching to 20mg once a day. If your symptoms are still well controlled for 8 weeks after decreasing your dose, then try stopping the PPI and just use it when you need it. These are recommendations from deprescribing.org.
Why is it important to decrease your dose in an attempt to taper off of PPI’s? Long term use of these medications is associated with higher risk of fractures, C. difficile infections and diarrhea, community-acquired pneumonia, vitamin B12 deficiency, and low magnesium levels. Reducing the dose and discontinuing these medications reduces your risk for side effects.
To summarize, if your acid reflux medication is not working consider a PGx test. If your acid reflux medication is working well and your symptoms have been well-controlled, consider a dose decrease or only using it when you need it. As always, never make any medication changes without the approval of your provider.
Don't settle for generic GERD treatment. Schedule a consultation today and unlock the power of your CYP2C19 gene for personalized relief.
Sources:
Prilosec - Proctol& Gamble. "Products". Prilosec.com. https://prilosecotc.com/en-us/products/prilosec-otc. Accessed January 16, 2024.
2. Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid J, Rojas-Fernandez C, et al. Proton Pump Inhibitor (PPI) Deprescribing Algorithm. August 2018 https://deprescribing.org/wp-content/uploads/2018/08/ppi-deprescribing-algorithm_2018_En.pdf Accessed January 16, 2024.
Comments