If you have been taking medication for a long period of time, it’s important to have regular discussions with your doctor or pharmacist to make sure the dosage - and the drug itself - is still the best choice for you.
One example of a type of medication that should be reviewed regularly is Proton Pump Inhibitors or PPIs. PPIs are some of the most commonly prescribed medicines in Canada, mostly for stomach issues like heartburn or GERD (gastroesophageal reflux disease). Chances are you or someone you know is taking one. Most PPIs are available only by prescription, but some such as omeprazole (Olex®) and esomeprazole (Nexium®), can be purchased without a prescription at the pharmacy. These medicines can be very effective and come in a variety of formulations, brands and generic options.
Examples of common PPIs currently available in Canada:
- Rabeprazole (Pariet®, generics)
- Pantoprazole (Pantoloc®, Tecta®, generics)
- Omeprazole (Losec®, generics)
The question is - once you’ve started taking a PPI, do you need to continue taking it long-term? There are risks associated with taking PPIs including an increased risk of bone fractures, magnesium deficiency, pneumonia and an intestinal infection called C. difficile. It’s important to be aware of these potential side effects, and work with your health care team to weigh the risks and benefits.
If you are currently taking a PPI, answer the following questions to see if you should talk to your healthcare provider about a possible change:
Question 1: Have you been taking a PPI for longer than one year?
- YES — Please read on as you may be a candidate to stop your PPI.
- NO — Has your doctor mentioned how long you need to stay on a PPI? If not, please read on.
Question 2: Do you know why you are taking a PPI?
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You may be a candidate to stop your PPI if:
- it was prescribed for symptoms of heartburn, GERD or esophagitis (which are now controlled).
- you had an infection with H. Pylori and it has now been treated.
- you were told you had peptic ulcer disease.
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You don’t know why it was prescribed:
- This is a good time to talk to your doctor about whether it may be appropriate to stop your PPI.
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You should not stop your PPI if:
- You take other medicines such as anti-inflammatories that increase your risk of GI (gastrointestinal) bleeding.
- You have a history of a bleeding GI ulcer.
- You have Barrett’s esophagus.
If you think you might be a candidate to stop your PPI therapy please speak to your doctor, pharmacist or nurse practitioner as they can discuss possible next steps with you. There is no need to rush to make a decision about stopping, and it is recommended to come up with a plan of action before you stop - including possible diet and lifestyle changes.
Think about some of the things that have triggered heartburn for you in the past. This could include certain foods such as spicy or high fat meals, caffeine, maybe even tomato sauces or citrus fruits. Are there ways that you can limit or avoid these? Other things that can help to prevent heartburn for many people include:
- Eating smaller meals.
- Avoiding lying down or going to bed right after eating.
- Losing extra weight or avoiding clothes that are tight around the mid-section.
- Considering quitting smoking.
- Elevating the head of your bed.
There are different strategies that can be used to stop your PPI. Your healthcare provider can discuss some of these with you. Be sure to also discuss a back-up plan in case symptoms of heartburn or reflux return. Strategies that can be helpful are:
- Keep an antacid on hand.
- Medications like ranitidine (Zantac) or famotidine (Pepcid) can be taken periodically.
- Some people will continue to take their PPI on an as-needed basis for a short time.
If you have been taking a PPI for longer than one year, your symptoms are now well controlled, or you are not certain why you are taking the medication, it might be a good time to check in with your healthcare provider for a regular prescription assessment.
Additional information available at the following resources:
