Experiments with the PPIs

Hello all ..

To summarize my story: I get side effects on PPIs and H2-blockers (different kinds of side effects) - so have been managing my GERD without them for the last year or so. My GERD is not severe but continues to bother me off and on during the day. I've tried various natural means and am looking into TIF/Nissen as options to address my symptoms. I've postponed my TIF to after summer when I'll have more control over my diet (too many activities with kids+relatives scheduled during the summer).

So, I've been experimenting with the PPIs again (Aciphex 20mg/day for the last 10 days or so) - definitely helps with my GERD symptoms but does not quite resolve the symptoms fully. This time, surprisingly, the side effects are barely noticeable (last year - and even a few months back, 5 days on this dosage of aciphex would get pain and tingling going all over my body). Aciphex used to be the best in terms of side effects (least side effects) - which is why I've started with aciphex now.

Since my GERD symptoms are getting better on 20mgs/day Aciphex - but not quite getting fully resolved I am going to extend this experiment (btw - I am aware of getting dependent on the meds and the rebound etc. - however, since I am going to go for TIF in the fall anyway, I am not too worried about the dependency at this point - I just want to be able to manage my symptoms through the summer):

So, my options at this time are:
- Up the dosage of Aciphex to 40mg/day:
- 40mg/in the AM or
- 20mg/AM + 20mg/PM
- Try other PPIs which might help me more than aciphex. However, I am wary that these may get more side effects - and more importantly may trigger the same side effects and even with the aciphex possibly.

I am quite surprised to see that 20mg/day aciphex has not bothered me as much as it used to, so I am getting tempted to try the other PPIs - which used to help me much more for my GERD symptoms but would also cause more side effects. I have a stash of Prilosec, Nexium, Prevacid, Protonix etc. all sitting nicely in my medicine cabinet - so I have access to the full variety of the pharma arsenal :)

I just wanted to write this - to see if you all have any recommendation on what I should try next.

At this time, I am going to extend the experiment by adding another dose of 20mg of Aciphex in the PM to start with.

Post Edited (PPI-LESS) : 7/22/2012 4:26:02 PM (GMT-6)

It's hard, I agree. And I have found ranitidine to be NO substitute for any dose of a PPI, big or small. I tried high dose Ranitidine 6 weeks ago when I had to reduce my PPI due to my own side effects. It gave me very poor symptom relief and gave me diarrhoea on top of everything else. I managed for a couple of weeks on half dose of a PPI and 150 mg twice daily of Ranitidine - but I just gradually became more and more unwell and couldn't separate out side effect from symptoms. I'm now back on full dose of PPI and micromanaging about 3 separate side effects :-(

I would stay on the same dose and use something like Gaviscon on top of it first - it can take quite some time to reverse the side effects when they do kick in, so I would tread carefully! Lansoprazole comes in 15 mg capsules, which is useful for titrating a dose up or down - have you got any in your stash? (Your medicine cabinet sounds like mine!!). I do sympathise - I go round in complete circles with my drugs on a regular basis!

MMM

Hi WJF

I'm still trying the acupuncture. Unfortunately I started it during an acute flare up due to having to reduce my PPI (side effects) and major stress due to having to undergo repeat gastroscopy! I've had a few weeks of treatment now and I'm kind of back where I was before I had all the trouble with the side effects. So it's hard to tell at the moment - certainly the side effects have reduced but I have a real mixed and muddled symptom picture at the moment due to anaemia.

I read an article which said PPIs reduce the efficacy of the H2s - not permanently, but it implied taking both together might be a futile exercise. Some people do manage that successfully though - I guess the drug combo magic recipe isn't the same from one person to the next.......

Oh - the acupuncturist found 'energy blocks' relating to the small intestine. I'm going to carry on with it for a bit longer - helps with the stress of the gastroscopy if nothing else!!

MMM

It's awful isn't it - constant Hobson's choice. I think the PPIs are making me anaemic (got some tests lined up on that score) - my haemoglobin has dropped slowly the whole time I've been on them, but went up when I was only on Zantac. Sadly Zantac made me unwell and didn't control the GERD one jot............

I'm glad I'm not alone in no-man's land!

MMM