What is a Proton Pump Inhibitor (like Dexilant)?
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PROTON PUMP INHIBITORS
So...you have a prescription for a proton pump inhibitor do you? Well, you are not alone! In fact, in 2008 2 out of the top 5 prescription drugs (in sales) were proton pump inhibitors! So what are they? What do they do? They sound like something from a Star Wars movie. "Quick, Luke, aim that Proton Pump Inhibitor at the Storm Troopers!" But Proton Pump Inhibitors have nothing to do with intergalactic wars, and are unlikely to aid us against alien attacks.
A Proton Pump Inhibitor (also know as a "PPI") is a medication which can reduce the amount of acid secreted into the stomach. In this article I am going to:
- Briefly explain how PPI's work
- List all the currently available PPI's
- Explain how you can pick the most cost-effective PPI for you!
HOW THEY WORK
How do Proton Pump Inhibitors work?
First, we need to understand a little about how acid is secreted into the stomach. The lining of the stomach has a variety of cells which do different things. Some of these cells secrete mucus. Some cells secrete acid. These "acid cells" are known as "Parietal Cells." Stomach acid, generally speaking, is a GOOD thing. We need it for proper digestion and absorption of nutrients. The low pH created by the acid helps other digestive enzymes to work also. However, it may be helpful to reduce the amount of acid we manufacture if that acid is causing problems like heartburn, reflux, or ulcers.
The Parietal cell comes to us fully equipped with a cool enzyme system capable of moving an Hydrogen Ion (AKA a Proton) into the stomach, in a slick trade for a potassium ion. This enzyme system is known to the science geeks as the H+/K+ ATPase Enzyme System. You have my permission to forget that. To you and I this enzyme system is affectionately known as The Proton Pump. Once these hydrogen ions (protons) are in the stomach, they combine with chloride ions to form hydrochloric acid! Yep, you remember this stuff from the science lab, the bottle with the big "DANGER" sign on it. Very corrosive!
Proton Pump Inhibitors work by disabling the proton pump in the parietal cell of your stomach. No proton pump = no proton moved into the stomach. No proton moved into the stomach = no formation of hydrochloric acid! If that isn't cool, I don't know what is! Almost makes ya want to be a scientist doesn't it???
AVAILABLE PROTON PUMP INHIBITORS (PPI's)
Today, Proton Pump Inhibitors are available both by prescription and also without a prescription (ie over the counter). Are the prescription PPI's necessarily better than those available without a prescription? No. In fact, both PPI's now available over the counter used to be only available by prescription, and still are available by prescription, in higher strengths. You should, however, never switch to an over the counter proton pump inhibitor without consulting with your doctor.
PRESCRIPTION ONLY PROTON PUMP INHIBITORS:
Aciphex Tablets (rabeprazole sodium): Aciphex comes in a 20mg tablet and is taken once daily for treatment and symptoms associated with GERD (Gastro Esophageal Reflux Disease). Aciphex does NOT have a generic available at this time.
Dexilant (formerly known as Kapidex) Capsules (dexlansoprazole): Dexilant is the newest PPI to emerge onto the prescription market. It is basically the same ingredient found in Prevacid, now availble without a prescription (see OTC below). However, Dexilant has improved the product to some degree by adding a "dual release" mechanism which allows some medication to be released quickly, and the rest to be released several hours later for sustained relief. See picture to the right. Dexilant comes in 30mg and 60mg capsules and is NOT available as a generic. Dexilant is manufactured by Takeda Pharmaceuticals. By the way, this company changed the name of their product from Kapidex to Dexilant because of numerous accounts of confusion with other similarly named products...specifically Casodex (for cancer) and Kadian (a morphine product for pain).
Nexium Capsules (esomeprazole magnesium): Nexium capsules are yet another prescription PPI for the treatment of GERD. Also known as "the purple pill" Nexium and is available as a 20mg and 40mg capsule taken once daily. Like some other PPI's, Nexium is also approved to treat an ulcer-causing infection by a bacteria known as H. Pylori. Treatment for this condition requires the addition of two antibiotics (usually amoxicillin and clarithromycin). Nexium is NOT available generically.
Prevacid (lansoprazole): Prevacid is available both as a capsule (to be swallowed whole) and also as a "solutab" which can be placed on the tongue and dissolves usually within 1 minute. It should not be chewed or cut. Alternatively, the solutab can be mixed with a small amount of water, dissolved, and then swallowed. Both tablets and capsules are avaiable in 15mg and 30mg dosages. Prevacid is taken once daily, usually from 4 to 12 weeks, depending on the condition being treated. Prevacid IS now available over-the-counter (OTC) as a 15mg capsule marketed as "Prevacid 24 HR." The prescription version of Prevacid capsules recently became available generically as well.
Prilosec (omeprazole): Prilosec was the first prescription PPI (introduced in 1989) and comes in 10mg, 20mg, and 40mg capsules. Prilosec is also available without a prescription as Prilosec OTC in a 20mg tablet (more on this below). Depending on your prescription plan and coverage, you may discover it is less expensive to use the OTC version. Talk with your doctor or pharmacist to find out.
Protonix (pantoprazole sodium): Protonix was originally a product of Wyeth pharmaceuticals, which then was acquired by Pfizer pharmaceuticals who now holds the rights to this product. Protonix comes in 20mg and 40mg tablets and IS avaiable as a generic. Generics are generally less expensive and will typically be the lowest tier on your insurance copay.
Zegerid (omeprazole with sodium bicarbonate): Zegerid is the unique proton pump inhibitor manufactured by Santarus pharmaceuticals Inc. What is unique about it? Zegeris is the only PPI that immediately releases medication into your system. All other PPI's have a delayed-release mechanism, taking several hours for the drug to get into your blood stream. Does this make Zegerid better? Well...not really. The fact is that no matter how fast it gets into your blood stream, proton pump inhibitors take several days before they are most effective. Nice try anyway Santurus. Zegerid comes in 20mg and 40mg capsules, as well as powder for suspension. Zegerid does NOT have a generic.
PPI's and Bone Fracture Risk
- Proton pump inhibitors (PPIs) class labeling change to include fracture risk - MPR
The FDA has notified healthcare professionals and patients of labeling changes for prescription and over-the-counter (OTC) proton pump inhibitors (PPIs) to include new safety information about a possible increased risk of fractures with the use of th
OTC PROTON PUMP INHIBITORS
There are presently 2 Proton Pump Inhibitors available over the counter, without a prescription.
Prilosec OTC: Prilosec OTC is available for patients who suffer from heartburn symptoms 2 or more days per week and are at least 18 years old. It should generally not be used beyond 2 weeks without consulting a physician. Why? Well, it is not because it is dangerous to use for more than 2 weeks. But it COULD be dangerous if you in fact have a more serious condition and you delay or avoid getting treated while taking Prilosec OTC. Take my advice: If you have symptoms that persist after a 2 week trial of Prilosec OTC...please...see your doctor!
Prevacid 24 HR: Prevacid 24 HR is also available without a prescription for symptoms of heartburn. Like Prilosec, it should only be used by those 18 years or older, and not for more than 14 days continuously. The packaging does permit the use of another 14 day course of therapy in 4 months if needed. As I said before, if your symptoms persist beyond 14 days...see your doctor!
A note about these OTC Products: If you have been prescribed prescription strength Prilosec or Prevacid, you may want to compare the cost of buying it yourself OTC. If this would save you money (remember that you have to compare the strengths to your prescription product) then you should ask your doctor about using the OTC version instead. They are the same medication and should work exactly the same way.
SAVE MONEY ON YOUR NEXT PPI!
Do you have a prescription for a Proton Pump Inhibitor? Has the cost given you worse stomach pains than you had BEFORE the visit to the doctor? There are a few things you can do to reduce the cost of your prescription proton pump inhibitor.
1) If the prescription is for Prevacid or Prilosec, check the price of the OTC versions mentioned above. Your pharmacist can help you compare the cost and see if this will save you money.
2) Remember that Prilosec, Protonix and Prevacid are all available generically by prescription. Make sure you try the generic product if you can.
3) Know your insurance. Do you know what tier your Proton Pump Inhibitor is? You can look it up on your insurance formulary. Most formularies can be found online, or you can call your insurance company and ask them. A lower tier means a lower cost to you! For an example of what an insurance formulary for Proton Pump Inhibitors looks like, see the picture below!
4) Take advantage of Prescription Manufacturer Website Coupons! If you are on a prescription OR OTC Proton Pump Inhibitor, the manufacturer might have discount coupons you can print right from their website! Here are some links to coupons for the following products:
5) Finally, check out my other articles on how to save money on prescription drugs for more tips!
AN INSURANCE FORMULARY FOR PPI'S
HOPE THAT HELPS!
As a pharmacist I get questions about medication all the time. I hope this article has answer your question "What are Proton Pump Inhibitors?" I also hope I have provided some useful information about the PPI's currently available and how to make some cost effective decisions about them with your doctor. Feel free to leave me a question if there is anything else about Proton Pump Inhibitors you would like to know!
Sincerely,
Your Pharmacist
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Hi Sharon,
The 2 week limit is only for patients who have not had their condition properly evaluated. The concern is that we might "self-treat" for heartburn...when the condition is actually something far worse and requires more serious medical attention. There is no problem, however, using these meds for longer periods if we know that the diagnosis is GERD or a related acid condition.
Good question!
Hi Jason,
I was curious what your thoughts are on Dexilant. I have been on Prevacid 30mg for about 5 years (the generic for the last year or so). I have GERD that has been breaking through lately. I have heard some pharmacists say that you develop tolerance to PPI's and others say that you don't. My doctor says it happens all the time. My problem is that I have tried all the other PPI's except dexilant. I had side effects like headache or extreme drowsiness on a lot of them probably because I am on Luvox and Xanax and I know Prilosec and some of the others may have a problem with luvox inhibiting the CY P450 enzyme system.
Have you heard if the side effects of dexilant or comparible to prevacid which I do well on side effect wise. Is the isomer different enough from regular lansoprazole to give it a shot?
Hi Jason,
Tolerance, per se, is difficult to prove. In the case of GERD, it could simply be a matter of disease progression, or other factors. Ultimately, though, it doesn't really matter if the symptoms are due to tolerance or some other factor. The question is how to respond and treat it.
I think a trial of Dexilant, if insurance wil allow it, is a reasonable step. Some may say that it "should" work exactly like Prevacid. But I have been in this field for too long to rely simply on what "seems" logical and right. What works...works. Profound, huh? LOL. Also, do not forget all the non-pharmacological approaches, as well as OTC products for breakthrough like antacids, etc. Best wishes!
Hi Jason i would like to know what's the difference between a generic and a brand name pill, is one more effective than the other and if it is, why? thanks.
Hi Pia,
Generics have exactly the same ingredients and have been shown to have the same effectiveness as the respective brand name products. When a generic becomes available, it is a good idea to give them a try. There are rare times when a person will not get the same results with a generic. It is hard to understand from a medical/scientific perspective. But this is pretty rare.
Best wishes!
PPIs are DANGEROUS (for being on them for NO REASON) - I think you all need to read what happened to me......
Meredith,
So sorry about your experience. NO medication should ever be taken for NO reason. Many patients, including myself, have taken PPI's safely and effectively.
Best wishes,
Jason
I have been diagnosed with gastritis and have been dealing with the symptoms for about 2 months now. I was prescribed dexilant but it cost too much money so I've been taking otc omeprazole but it doesn't seem to be working as well as I had hoped. Should I just save up and buy the dexilant instead?
Also one more question, do these medications cause diahhrea as a side effect?
Thanks
Steven
Hi Steven,
Ask your doctor about using 40mg (2 tablets) of omeprazole instead of the 20mg (1 tablet) recommended usually. Also, yes, they can cause diahhrea. But so can other things, so if it continues, let your doctor know. Best wishes.
I have a question regarding Dexilant vs Prevacid... it appears they are the same drug and as you stated in your writeup that Dexilant has the time-delayed release feature. Is this really the only difference?
I'm currently taking Dexilant now and have had great results with it (after trying Prilsec OTC and Zantac), however it is rather expensive and am considering alternatives to save money. I see that Prevacid is also available as a generic, which also helps.
Do you have any thoughts on this?
Thanks.
Hi Brian,
Yes, except for the "dual release" feature, there is no clinical difference in the way Dexilant and Prevacid work. If cost is a concern, OTC Prevacid might be worth talking to your MD about.
I was just diagnosed with GERD and some other stomach problems leading to my taking Dexilant. I can tell you from a patient perspective that Dexilant works where anything over the counter that i have taken in the past does not work! I have taken prilosec, nexium, protonix, etc., all to no avail. I know it is expensive and now my insurance company is refusing to pay for it even tho my doctor has told them that i have tried everything else. Shame that insurance companies can dictate what they are willing to pay for when i pay premiums of over $500.00 a month. For me, Dexilant has been a wonder drug and i dont mind paying if insurance wont pay. My doctor keeps giving me coupons from the manufacture for a cost savings so anything helps.
Hello Brian,
Is it safe to take Dexilant and Ratinidine? Your advice is greatly appreciative.
Thanks!
Mony,
There is no harm in doing so, but there is also really no reason to do so. Dexilant is much stronger than ranitidine, and so ranitidine would really not be doing anything.
Best wishes,
Jason
I have GERD and have been prescribed Omeprazole for the morning and Dexilant for the evening. Yes, the Dexilant is expensive but if you go to their website, you can get an instant savings card that can save you up to $55 per prescription! It's definitely a help to me. I look forward to the day their patent expires so we can get generic but that won't be until 2020.
My doctor is switching me from aciphex 20 twice a day to dexilant 60 twice a day. He is a GI specialist but I'm concerned that the packaging says once a day and he prescribed it twice a day. Should I be worried about this?
Thanks
Tony,
Just verify that dose with the MD. It is above normal, and has some risks associated with it. Your condition may require it, but I would certainly want to verify that with the specialist.
Jason
I just started taking dexilant it has been giving me chest and throat pain, shortness of breath and I can't sleep at night are those normal side effects. Please let me know thank you
Hi vhristian,
Those sound like pretty severe symptoms and probably a reaction to the dexilant. On the other hand, very bad reflux could cause that too. You should contact your MD. My guess is they will try something else. Hope it improves for you.
I am writing this because I am a little concerned about some of the medications I am taking. I visited a gastroenterologist and he did not find anything wrong in my digestive system. According to my symptoms he said I might be suffering from acid reflux and prescribed me to take Dexilant in the morning and Ranitidine at night. I have noticed some relief but I always wake up throwing up some green stuff, real bitter. Any ideas on what this might be or if the medicine I am taking is affecting my system.
Hi David,
Well, first of all your doctor should be made aware of this daily symptom. That is important. It may improve as the Dexilant and ranitidine go to work. Dexilant is stronger. Maybe ask the doctor if you can switch and take the Dexilant at night instead. Just a thought.
Best wishes!
Jason
I was recently diagnosed with gastritis and esophagitits, both mild...but I am having some serious gastric discomfort. My doctor prescribed Dexilant for me but I am scared to start it because I am worried about the side effects. Some of my symptoms seem very cardiac in nature as I have back and shoulder pain and pain down my arms. I have had several EKG's and an echo stress test.... all came back good, but I read about potential cardiac side effects (I know they are rare) with Dexilant. If my symptoms would be cardiac in nature, could I be more at risk for the rarer cardiac side effects with Dexilant? I have taken Prevacid otc though without any trouble but a lesser doe that the 60 mg prescrition. And then I saw the above post and am now even more concerned. Any info would be appreciated.
Hi Stacy,
As you know, I'm not a doctor, and not pretending to be. I can tell you from personal experience that acid reflux often feels very cardiac in nature, and can cause severe chest pain. Dexilant is as safe as Prevacid, at any normal dose. Ultimately you have to decide for yourself if you wish to take it. I can tell you a good friend of mine, a pharmacist, was recently prescribed Dexilant. She took it and feels better. Best wishes!
Hi Jason,
I have a non-diagnosed hiatal hernia. I say non-diagnosed because the doc said so without an upper GI. Symptoms were classic enough I suppose. I had some cardiac symptoms that went away IMMEDIATELY when I was put on Dexilant. After a month, I suddenly got the most epic diarhea in the history of the world. We are talking biblical here. So, I told him about it and he said to keep taking it. Well...that wasnt going to work for me so I started taking 150MG of Zantac twice a day and it worked for about 5 months. Last week, the reflux began to break through pretty badly. I hesitantly went back on Dexilant and whammo...back to huge amounts of gas and the D word. My question is this: Is there enough difference in Prevacid and Dexilant for me to give it a try? I can feel the knot around the hernia coming back (it healed completely while on Dexilant the first time around) and I don't want to do damage to my esophagus but I also cannot live with the side effects.
Hi Joe,
If it were me, I would give the Prevacid a try. If you get the same symptoms you may want to talk about other options with the MD. For example, increasing the dose of Zantac, or possibly consider taking an anti-diarrheal medication to combat the Big "D."
Best wishes. Definitely keep your MD informed about any changes from what he/she prescribes. Take care.
will the nexium 40 g provide the same as the new Dexilant 60 i also take naritidine at night comments?
Hi Sophia,
Nexium 40 and Dexilant 60 are very similar in their acid blocking power. They belong to the same family and work in the same way. Some patients, however, do find that one will work better for them, than another. But the basic side effects and mechanism of action are the same. Best wishes.
I also suffer from GERD, and experience discomfort in my chest. After several trips to emergency and my cardiologist (cath showed a 50% blockage), my GI dr. suggested trying Dexalint or Zegerid along with Elavil to help the relaxtion when anxiety sets in due to chest pain. Do you feel this form of treatment will be effective? Also, can a second dose (20 mg) of Zegerid be harmful? I have been taking PPI's for several years, with the past few years being Omeprazole.
Hi Malford,
As for Dexilant or Zegerid, either one may be helpful at preventing your symptoms. Take them daily as directed. As for the Elavil, if it helps, then that is okay. Mostly it would just be providing a little sedation. You actually shouln't take a second Zegerid dose. It is better to get a prescripition for the 40mg if 20mg isn't enough. In this particular case, 2 of the 20mg are not actually the same as 1 40mg capsule. This is due to the amounts of sodium bicarbonate in them. Another option would be to ask the doctor about using omeprazole for the 2nd dose instead. Best wishes!
I have been on Dexilant 60 mg once a day and no relief. When should I get results??
Hi Nik,
Generally it takes a few days (3-4) before a Proton Pump inhibitor is working to the fullest. In the mean time, antacid tablets like Tums can be used for relief.
Good question.
hiys jason im on omeprazole dispersible 20 mg just had them changed after been on lansoprazole twice aday 30mg 2 in morning 2 at nite befor bed did work after 3 years...rite the omprazole doc didnt tell how meant hours apart should i take ? it iv been taking it 11am on monring an 11pm at nite is that ok
opps *DIDNT
Tracy,
That is a pretty high dose if I understand you (120mg per day). Yes, 12 hours apart is fine.
good an when you you omprazole can you eat soon after you take or you have to wait 30 mins to 1 hour?
sorry missed this am also very limited to wat i can eat an getting dipressed of this plane stuff i really dont know wat i can eat
Hi Tracy,
I usually tell people to try taking in 15-30 minutes before eating. Take it at the same time daily. As for food, I know it is tough, but try these suggestions to help improve symptoms:
• Decrease fat intake - High fat meals & fried foods tend to slow down and delay stomach emptying
• Go with smaller meals more oftern, rather than large meals
• Decrease your caloric intake if weight loss is needed- • Watch out for chocolate - Chocolate contains methylxanthine, which has been shown to contribute to GERD
• Consider backing off of coffee, depending on individual tolerance - Coffee, with or without caffeine, may cause reflux. Coffee may be consumed if it is well tolerated.
• Avoid other problem foods and items: Alcohol, mint, carbonated beverages, citrus juices, and tomato products
all may aggravate GERD.
ok an i dont eat fatty stuff never have dont drink alcohol coffee ect spicey food dont like...very healthy lady i have a lot of intake in vegys an fruit i oven everythink i drink loads of bottle water an decaff teamine has come because of stress at home as i have 3 specail needed children...iv been eating boiled fish an chicken an cabbage an spinaish an wholemeal bread an rice crispys with semmy sinked milk an gluten free and wheat free stuff at the mo i have food coming back ur my food pipe on tablets for it ect just with i could eat like a normal person so to speak
I was on OTC Prevacid as recommended by my Dr for 2 months. Symptoms kept returning. Dr gave me samples of Dexilant and ordered a scope. GI dr did scope and gave me script of Prevacid 60mg, said my insurance probably wouldnt cover Dexilant. I wanted to try so my Dr (not GI) called in Dexilant and it was covered. Took Dexilant for 6 weeks and symptoms returned. Any reason to think the Prevacid 60 would work better? I could switch but stopped taking everything because I am so frustrated.
Hi Rhonda,
Typical first step would be to increase Dexilant to the max dose. If that doesn't work, then yes, I would try an alternative like Prevacid, Nexium, protonix, etc. Switching to any of these may provide more relief. It is really hard to predict which one will work better for a particular patient. Thus...we "practice" medicine...
Best wishes
I have ben taking Dexilant for the last 6 months and it is my "miracle pill"! No other medicine I took was fighting all my symptoms. I have a Hiatal Hernia. We had to change insurance companies and they do not cover Dexilant. So, now I am trying to find a new drug that does not cost so much money. I think I am going to try Prevacid 30mg twice daily. Spoke with my Pharmacist and she informed me this should do for me what Dexilant was doing. I really hope it works!
I am taking 60 mg Dexilant daily. I am having muscle spasms in my stomach, esophagus and chest. I was having them before I starting the PPI. Can these spasms be caused by stress or by the heartburn? What's the best way to take the Dexilant if I have breakthru nighttime GERD. Actually, I've been having breakthru more often than that. could that be due to the spasms?
Mary,
Yes...and yes. Try taking Dexilant in the evening if overnight is getting worse. Also, be sure to watch for all the food triggers and consider proping up the bed a bit. Have a bottle of Maalox or Mylanta handy for breakthrough, and definitely speak to your MD about it. Hope it improves.
Hi, Mary again. I have been taking the Dexilant around 5:00 PM--a half hour before dinner. I've been on the Dexilant for over a month. I am thinking about switching over to 40 mg Nexium. My doctor gave me samples. He wants me to take bentyl for the spasms, so I tried it last night, but I just noticed on the product info that it can be a problem for people who have GERD! It did seem to get worse. So frustrating. Any insights/suggestions?
I've been dignosed with Hiatal Hernia. Can Dexiland heal it? Or it just control the amount a acid we produce in the stomach?
Thank you.
Mary,
You may have to give both the Nexium and Bentyl a few days to begin to work. Bentyl is okay with GERD, since you are also on a PPI (Nexium).
Joseph,
Dexilant may help control the symptoms, but not actually heal a hernia.
Dexilant is the newest PPI ... is basically the same ingredient found in Prevacid. So if the Dr. prescribes Dexilant 60 mg to replace Nexium 40 mg -taken because prevacid or prilosec weren't working-, and the only advantage is that it delayed release mechanism, then why not just take a 20 mg Prevacid in the am plus a 20 or 40 mg in the evening before bed when PPI's do the most good?
I was just switched from Protonix to Dexilant 60 an Bentyl 20. How do protonix and dexilant differ. i am having a lot of diarrhea at present (10 days post-op thoracotomy). Is this drug likely to make the diarrhea worse? I have taken Prevacid, Prilosec, and others in the past but had been taking Protonix for several years.
Irene,
They belong to the same family, though some people have had better results with Dexilant. It is not likely to make the diarrhea worse. Best wishes.
I have been on dexilant now approximately one year now. I have lost weight, and my appetite is not like it used to be. Also I feel very nervous slot and have palpitations. I also read that depression, loss of appetite, anxiety, and palpitations are a few of the side effects. I'm very concerned. Could you please shed some insight on these concerns?
Thanks
Concerned
Concerned,
All your symptoms could simply be from the anxiety. But "diagnosis" per se is the job of your physician. I recommend you make another appointment. Best wishes.
My dr wanted me to try dexilant instead of nexium (which I have taken for last 8 years) and the first day I felt a little revved up and the 2nd day I felt like I had drank about 10 cups of coffee! I guess I am not going to be able to tolerate it. I also tried prevacid one day and felt a little bit the same but not nearly as bad (but it was a lower dose, the OTC prevacid). Dr. thinks the nexium is not working anymore and that is the reason for the change.
Do you think if I stick with either the dexilant or prevacid, my body will adjust and that feeling will go away? Maybe start out taking it every other day and work into everyday?
Thanks!
Lynda,
What you are describing is pretty unusual, so it is hard to predict, but I think your suggestion about every other day is worth trying.
You mention which foods to avoid for gastritis. What about medications? Besidse NSAIDs, aspirin, and cortisone what other medications are culprits? Thank you.
Brian,
So many things can cause acid reflux. OTC supplements like iron. Prescription drugs, aside from those mentioned above, like antibiotics and some blood pressure medications. Spicy foods, alcohol, obesity...the list goes on. :) Great question. Thanks!
Is it ok to take Beano or other digestive (plant) enzymes while I am on a PPI?
Mary,
Yes, those enzyme products are safe to use with PPIs.
Hi i am 17 years old and for the past month i have no appitite whice is not normal and i havent been eating anything for weeks i feel really weak and nauseous all the time. My doctor prescribed me with nexium 40mg and so far ive takken 6 pills and it didnt help so he gave me dexilant 60mg for 1 month do you think this will get my appitite back thanks.
Freddy,
It will help - if the doctor has correctly diagnosed you and you have GERD. Your symptoms could be many things, but GERD is a good guess to start with. Give it a week or two though. Best wishes.
Do I need to space digestive plant enzymes from PPI's? If so, how much time between?
Mary - can you name a specific one you are wondering about?
One product is Beano. The other is called Plant Enzymes. It's made by "Now" It contains protease, amylase, lipase, cellulase, lactase, papain and bromelain.
Hi Mary,
No special spacing needed with the enzyme in Beano, or the plant enzyme product and the PPI products.
Among the PPIs offered, which one is the safest for long term use?
Sylvia,
There have been no studies comparing the PPI's with respect to long term use safety. I recommend they be used no longer than needed to control symptoms, and at the lowest effective dose.
I have been on a PPI for 16 days. The gastro dr tells me to stop taking it. I did that one time with a bad attack of battery acid burning in my stomach. Quickly went back on PPI. Do I wean off or follow dr's orders and just stop and use Zantac?
Lee,
PPI's do not require tapering, though there is no guarentee the symptoms won't return. Switching to something like Zantac may help prevent symptom return.
I wrote an article on heartburn here: http://pharmacist.hubpages.com/hub/constantheartbu
Hey there I was on protium for about 2 years and then it stopped working for some reason I got real bad gerd again got the camera down had touch of gasteritus and tube badly inflamed my questions are can the tabs stop working, I got zoton now today was first day should they work right away or a few days? Thanks
Hi Colin,
As with all PPI's, Zoton with take several days to begin working. Hope it helps!
Do some ppis work right away some people say they work right away I tryed nexium few days ago felt relief right away but side effects were bad was weak and light headed,, do all ppis work just the best to suit the person? I found protium brillent no probs on them just stopped working thanks again
They all take several days to be working at their best. Some may feel results more quickly. Yes, some PPI's work better for some patients, and switching is often necessary.
What are the best ppi, I was on protium for 2 years nexium I got side effects came off the gertac and razole never worked on zoton day 4 and my chest is still on fire same with yesterday like. Its so hard to find another one to work like,
Colin,
When one stops working, switching often helps. They are really all about equally effective. But some people find one to work better than another for them.
I was diagnosed with LPR reflux last December. I've never had heartburn in my life. With my reflux I have excessive throat mucous, hoarseness, and it feels at times like a spasm in my throat. I have been on 60 mg Dexilant for one year. Is this dose equivalent to two nexium? And, is there anything I could possibly implement with the dexilant to help with the throat clearing, mucous and occasional spasms? Its very uncomfortable when this flares up!!
Thanks,
Nathan
Natdaddy,
All PPIs are equivalent when taken at standard dosages, but some people will find one to work better than others. Try Mucinex and lots of water for the mucous.
is there a chance my protium work again if i tryed them again? i was told in chemist that the cheaper brand of protium may not work the same as the original protium is this true?? they wanna try me on pariet now, zoton day 6 today and still burning not as bad but acid still breaking true like
I was on dexilant 60 mg for 5 days. On the 5th day I had a severe case of uncontrollable diarreah and severe upper abdominal cramps. I stopped taking and diarrea and cramping continued along with burning stomach. Is this a side effect? I have tried all the ppi listed and they have all given me similar side effects. Any suggestions? Aciphex was the only one that didn't give me the runs but I had severe cramping in my calfs at night. I am at a loss.Will my body adjust to the aciphex over time?
Shar,
Yes, it is possible these symptoms are side effects from the PPI's. You will have to discuss options with your physician. One might be a reduced dosage. Another might be switching to an H2 antagonist (e.g. Pepcid, Zantac). Leg cramps are an unusual side effect for PPI's. You might try Aciphex again and make sure you drink plenty of water. I have written a separate article on leg cramps too. Best wishes!
Hi, I have recently been to the doctor and she had started to have me on dexilant 60mg for a month because it seemed everything I was eating was causing extremely painful heartburn. I went back for a follow-up 1 month later with better results but the pain was still there just not as severe only when I had eaten certain things. She then referred me to a specialist which i see on the 13th but she had placed me on the cheaper Pantoprazole Sod 40mg to save me money, however it seems to have no effect. I'm now getting a refill of the dexilant 60mg so i can at least eat until the appointment. But why would the pantoprazole not have the same effect as the dexilant? She had said they were very similar but I was just curious as to why. Any information would be greatly appreciated! I'm only 21 and just curious, I like information especially if it's something that I am taking health wise. Thank You! :)
HI Brittany,
Good question. Honestly...if scientists could figure out that answer...they would solve a great mystery and make a ton of money. Why "similar" meds don't work "similarly" is a puzzle. Thus we are left with a "trial and error" approach often. Thankfully you have something that works, but I'm sorry it is so expensive. Hope your appointment goes well.
thanks for taking the time to answer these questions; information is power!
Hello there, would taken 20 mg of protium twice and day be weaker than taken 40mg twice a day? And would cheaper brands of ppis not work the say way? Heart by chemist no? Thanks
Hi John,
Well, yes, in theory. But there is a maximum benefit that you get to with PPI's. A higher dose doesn't necessarily translate into better efficacy. If prescribed as such, it is worth trying. And the cheaper PPI's are not less effective. Best wishes.
4 years ago I was diagnosed with Barrett's Esophagus. Having previously tried OTC meds along with prilosec, prevacid, protonex it was determined that Nexium was my answer to all my symptoms. Having just changed insurance to Fallon I am now being denied authorization for this medication. I am told I have to switch to Dexilant. I am in near panic worrying about what this will to my stomach and esophagus especially in that you state that Dexilant is the same compound as a drug that failed for me. How long before I know if Dexilant is causing harm? What symptoms will occur again? Sure would like to avoid cancer. Thanks for any recommendations.
Pam,
Sorry about your discomfort. Dexilant is a good drug and may work just as well as Nexium would have. Follow your doctor's order for this. Give it several days to see if it is going to help. If not, see if your doctor has Nexium samples that you could try before paying more for it. Best wishes.
I went to my doctor a few days ago. I had one day where I had heartburn and an acid feeling in my throat. How ever after that incident I havent had any of the symptoms since but kept waking up with chest pains and would have them a after every single meal for about 45min- 1 hour. I sleep fine and don't wake up with any kind of heartburn. I do have the feeling of air stuck in my chest and keep burping a lot throught the day. They are small burps and dont really make me feel too much better. The doctor told me he thinks I have GERD and gave me a 5 week supply of Dexilant. I have taken it for three days and although the chest pains are almost not there i still have the feeling of air in my chest and keep wanting to burp. Do you think that Dexilant is the proper thing I should be taking? or is it possible that maybe i was misdiagnosed. The doctor did listen to my heart and ran an EKG to rule out any heart problems. What my main concern is... Can GERD be just chest pains after eating and the feeling of being filled with air?
Hi Al,
Your symptoms are consistent with GERD, and I can tell you from personal experience that the chest pain may accompany GERD. My advice would be to continue with the Dexilant for the full 5 weeks. However, stay in touch with your doctor, especially if the symptoms get worse. Best wishes.
sir,
extremely well written being a surgeon myself and a neurosurgeon with 30 years of experience i had great difficulty in explain g the mechanism "YOU HAVE MADE IT A CHILD'S PLAY,
REGARD
Dr.vijayaraghavan krishnaswamy
Hi,
I am wondering about the cancer risk with long term use of all the PPI's. Is one less risky than another?
Thanks!
Julie,
They are all equally safe and effective in appropriate doses. The cancer risk is not clear. Plenty of studies show no relationship between PPI's and cancer. Best wishes!
Hi there: I have been taking omeprazole for months, but it really only worked for the 1st 6 weeks, then its effectiveness kind of wore off. A friend suggested I try 5 or more days without it, then start taking it again to try and "reset" its effect. But all the info here is really useful. My next step would be to try Prevacid. I thought it was more or less the same as omeprazole (Prilosec), but you give me hope that it might have a different effectivity for me. Thanks !! :-)
Hi,
I have been diagnosed with GERD. I tried Nexium 40mg but it did not seem to help enough. I was on Pantoloc 40mg for 6 weeks, all my GERD related symptoms went away but my legs became very stiff and I developed runners knee. Within a week of coming off Pantoloc and returning to Nexium my legs got better and even my knee tracking problems went away, but my GERD symptoms returned. I am looking for a PPI that will work like the Pantoloc did but without the side effects. Do you know of any people with muscle cramps or other muscle related side effects on Dexiliant. I have even tried Pepcid, but it also made my legs stiff and did not work on my GERD sysmptoms very well.
Thanks!
Dean,
Sounds like you will need to try some other products. Talk with your MD. My advice woudl be to start with a low dose of Omeprazole. Take it at bedtime and get plenty of fluids during the day. Then increase the dose after 1 week. See if that helps. As I mentioned, talk this over with your MD first. Best wishes.
Hi, i would to get your opinion on which PPI would be best for someone who already suffers from bile acid diarrhea I take colestid at night which has helped me immensely, but know I have gastritis and GERD. I have taken Zantac twice a day. It helped, but seemed to make the the chest pressure and throat tightness worse. I tried aciphex for two weeks and actually helped with the diarrhea, but not much help with the Gerd. Should I try taking the aciphex twice a day or would you suggest trying a different PPI? I am concerned with the based ones such as Prilosec, nexium , and Dexillant because of the diarrhea. It seems after reading reviews on Aciphex- that it is the only one that does not cause diarrhea. Is this because it is "rabeprazole sodium" as opposed to Magnessium based? Any input you could offer would be greatly appreciated. Thank you!
Lynn,
The good news is that you have tried most of the available PPI's so there are not too many more to attempt. Protonix caused less diarrhea than others in studies. But Aciphex is one of the best for low incidents of diarrhea. Either talk to the MD about increasing the Aciphex dose or switching to Protonix. Best wishes.
Hello,
I'm a 34 year old male who was given 30mg samples of Dexilant this past summer by an ENT after having the sensation of having something caught in my throat, and some minor chest tenderness. A month or two later, my PCP wrote me a script for Dexilant, but the script was written for 60mg. I talked to my PCP, and I guess there was just a miscommunication between us, but he said 60mg should be fine. The 30mg did improve the situation to an extent, but obviously, 60mg does work even better. I'm wondering, though if 60 might be too much if one doesn't necessarily need it? I'm also wondering if there is a risk of weight gain involved with Dexilant, as I've read of complaints about other PPIs and weight issues?
Thank you,
Rick
Rick,
60mg is a reasonable dose, though we always like to go with the "lowest effective dose" for sure. Most PPI's have a VERY small reported weight gain (less than 2%). But think about it - many people are not eating due to GERD. So some weight gain is just because they are working...so people can eat again. They do not cause obesity. Best wishes!
I am a 45 year-old female with a small hiatal hernia, LPR and angioedema (several allergies). I take 60 MG Dexilant in the morning at least 30 min. before eating, and take Zyrtec 25 (histamine #1) mg and Ranitidine 150 (histamine #2) both at morning and night (sometimes with the Dexilant). I am allergic to sulphites, sodium nitrate, and borderline on Carageen gum (in Dexilant capsule) and yellow #5. The head of my bed is raised which helps tremenously. However, in addition to still feeling a small "lump" in my throat, I have stomach upset after taking Dexilant for at least a few hours. If I forget to take it, little to no upset stomach. Should I remove the capsule and swallow it with applesauce as I have read to avoid the carageen gum in the capsule that may be the issue? Or is there something else with this combination of meds making me sick to my stomach? Dexilant was the pill with the least symptoms - maybe because of the dual release formula. I'd been on Zegerid (gave me a sore throat), and Protonix previously. I also get a LOT of gas...is there an alternative? I think I also had some other prescriptions, but had bad reactions (one changed my vision). I have been on Dexilant for about a year and was told I'd be on this or similar meds rest of my life due to the hernia. It's getting old to feel ill every day. Thoughts?
Jo,
Yes, the best thing to do in this case would be to empty the contents of the capsule into a spoonful of applesauce. Then you would have very little left to bother your stomach. The pellets are enteric coated, so they will not dissolve in the stomach and thus cannot irritate. Best wishes!
I have been taking it for a month now and my mouth is constantly dry,my stomach seems to have gotten worst, and seems that it stops mucus production, which I need.
My doctor wrote a prescription for 20 MG of Omperazole once a day 30 minutes before a meal for a month. I have not seen a gastro doctor AND have not been diagnosed. He simply prescribed me the medicine for the symptoms I was having. Is this safe? My symptoms are non-traditional, such as back pain, chest, and stomach pain. I've already been tested for cardiac issues, and it's been ruled out. I just don't know how safe it is for me to be in the medication if I don't have a problem with acid in my stomach. My doctor told me there's no problems with using it for a short-term time, to rule out acid reflux...but I am leery. I took my first dose of the medicine today.
Leslie,
The symptoms of GERD are pretty broad, and can include all those things which you mention. The process of diagnosis is often a process of ruling out one thing at a time...moving from the most common...to the more rare. I believe your doctor is taking a reasonable approach. On a personal note...I had the same symptoms you describe. It was GERD. Prilosec worked. Give it a week though, and do not skip any days. Best wishes.
Thank you for your prompt response. This is day two of the medicine and I don't currently feel my back/chest pain feeling any better. My stomach issues have been less noticeable. I'm wondering how many days this medicine takes into effect. I take it with apple sauce, since I have a hard time swallowing pills. I'm really hoping this works...
Leslie,
You are welcome. I usually tell people to give it a week. Some healing has to occur before you can feel better, even though it will begin working sooner.
How many days into Omeprazole should I stop, if it does not work?
Abby,
I generally tell people to give it 2 weeks before calling your doctor about requesting an alternative.
How many days into an omeprazole trial do you start to get side effects? I've been on it for 6 days and am just noticing some stomach discomfort (stomach issues) ect...I'm not sure if it's the drug causing it or just a stomach bug, but still would like to know when side effects can take into effect.
I know you're not a doctor, but maybe you could give some insight. Do gallbladder problems and esophagus issues, like GERD, often get mistaken for each other? My doctor put me on medication for GERD, but I'm not sure I have it. I haven't been officially diagnosed for it and I think I may have a gallbladder issue instead. Could the PPI be harmful to my body if I do not have a need for it?
why cant the time release capsules be taken in yogurt. why just apple sauce??
omeprazole user,
Side effects would typically be seen in the first week or two. But "stomach discomfort" is such a general symptom it is hard to nail down the cause without a more complete exam. I would contact your physician for a consult. Best wishes.
Laura,
I can tell you that the symptoms of GERD are often confused with other conditions, as similar types of pain and discomfort are typical of other conditions too. That said,in medicine, we start with the most likely and least intrusive (and least expensive) approach. Thus, GERD is probably reasonable, and a PPI is very safe (even if you don't have GERD). If symptoms don't improve in a couple weeks...then they will go on to "diagnosis B" (whatever that is). Hope that helps.
Megan,
Dexilant mentions applesauce. Probably that is what they used in their studies. However, any cool, soft food is just fine.
Doctor prescribed Dexilant for GERD and Cymbalta yesterday. Took the first pills together last night and approximately one hour later I was hurting so bad in my chest I thought I was having a heart attack. Cold sweat, dizzy, chest pain through to back,and nauseau. Went to ER and blood work showed no heart attack but not sure what caused this symptoms. Have you heard of any serious reactions with either drug similar to this? or could it be because I took them together?
Sandi,
Would need lots more space for questions, etc. to really advise you well. Starting both those drugs at the same time is unusual, as they are entirely unrelated. But maybe you have been on 1 or both before. I would talk to your doctor, and consider getting the GERD under control first - if possible - before trying to treat something else. But again, I can really only advise you to seek a medical evaluation again. Best wishes.
I have a small hiatal hernia and barett's esphogas (both recently diagnosed). I have tried Prilosec 24 and Prevacid in the past and had pretty severe allergic reactions to both medications. My doctor would like me to try Nexium next and then Dexilant if the Nexium doesn't work. I'm concerned about both of these drugs because my understanding is that Nexium has the same ingredient as Prilosec and Dexilant the same ingredient as Prevacid. I have a wonderful doctor who I am very happy with but I don't think he has the time to figure out which of these drugs is safest for me to try. He wants me to try and rule them out as I have symptoms. Because the previous symptoms were so severe I'm very nervous about going through the side effects again. Is it possible that Nexium and/or Dexilant may not cause an allergic reaction even though some of the ingredients are the same as Prilosec or Prevacid? Are there any other PPI's or acid reducing medicines that I can be sure won't cause a similar reaction? Any advice you could give would be greatly appreciated. I need to treat the reflux as soon as possible. Thanks in advance!
Lisa,
By "allergic" reaction do you mean hives/rash? I ask because we try to distinguish between an "allergic" reaction and a "side effect." An allergic reaction is more serious and dangerous. If the reaction was a side effect, then Nexium is an option. If that doesn't work, I would try a different type of medicine - like Pepcid AC or Zantac. Sadly there is no guarentee a side effect won't occur again. Hope this gives you some options.
I am an 81 y.o. woman with osteoporosis and would like to take Prilosec for the shortest possible time, so as to not compromise my bones. I took the first pill this morning and have had complete relief of heartburn. Is it unreasonable to take it for just a couple more days and then quit, and see if that might be all I need?
Reading all your previous comments has been very helpful -- thank you!
Dottie,
I would give it at least 30 days to allow for healing. There will be no risk to your bones during this time frame. Then talk to your doctor about your symptoms and your concerns for fractures. Best wishes.
Hi Jason - are you ready play Dr. House?
I am a 29 y/o male who had gained a little extra weight and started a diet called the Paleo Diet - No Grains, Wheat or Dairy - low sugars low carb and lots of meat - red meat, fatty cuts etc as well as all the veggies i could eat and dark chocolate fruit and nuts for sweets.
Things were great I dropped 15lbs in the first month of strict paleo eating. i reintroduced some carbs to the diet (bread) and my troubles began.
I started to get a knot in my stomach after eating almonds, so i thought this was the key although it was only sometimes as i really enjoy them and took the risk of continuing to eat them. Then it would be burping uncontrollably all night, all day really anytime i ate anything with normal heartburn that i had experienced for years. I took pepcid and zantac to control this but went from zantac 75 to 150 bc of the new pain.
I Went to see a GI after about 3 weeks of pain - now 20lbs down from the starting weight, still trying to stick to this diet with adding in of Rice because i was getting so sick. The GI suggested an Endoscopy (Ulcer) and sonogram (gallbladder) both came back negative as did my blood test - meanwhile he started me on DEXILANT!!! I love IT - but my insurance wont cover it.
2 things - thoughts on the diet contributing to the heartburn and stomach issues?
thoughts on the next best thing other than 60mg dexilant which has slowed the issues altogether, I can eat without fear of disgusting uncontrolable burping and having to leave work or not sleep :)
davegluck,
Hi. The shift toward more fatty foods caused the GERD to kick in, but you were probably borderline before this. With your doctor's permission, start with Prilosec OTC or try one of the other OTC products like Prevacid. These are similar to Dexilant (and much stronger than Zantac)
Thanks!
sharon Levander 17 months ago
I liked your explanation of the different proton pump meds
I would like to know why you stated that these meds should only be used for 2 weeks. I was diagnosed with Gerd many years ago & was on it form several months. Now it has returned & I am concerned about staying on it for very long because I have read that it can cause many side effects. I would appreciate any information that you might be able to give me
thanks
sharon