Prilosec needs a 4 month break?

May 16, 2008 5:34 AM

Prilosec and Zantac. News reports that using Zantac correlates with mental decline have me paying more attention to previous guidance from my doctor that Prilosec would be appropriate for me, but the directions on the package are pretty odd. Do people really take Prilosec OTC for 14 days, not take it for 120 days, then rinse and repeat? That's what the directions say, but it's really hard to believe. Why are the directions like that? Is it supposed to be working that whole time?
posted by NortonDC to health & fitness (15 comments total)

I've never followed those directions...those are a default, not a requirement. I've been taking Prilosec every day for years on doctor's orders, as far as I tell, my head has not yet exploded. Talk to your doctor for directions meant for you...they'll know better than the packaging.
posted by StrikeTheViol at 5:46 AM on May 16, 2008

Just googling around, I found this:

Taking Prilosec OTC beyond 14 days is not recommended, perhaps because in Prilosec's early research its long-term use in rats produced increased rates of gastrointestinal cancers. You won't read about this in the Prilosec OTC label, but it is contained in the prescription Prilosec package insert and the Physicians' Desk Reference.

from here.

Probably something you would want to discuss with your doctor.
posted by yeoz at 5:49 AM on May 16, 2008

I was on Prilosec 20mg in college and was on it for more than a year before I was told to stop by a doctor. I don't know if it loses effectiveness over time (IANAPharmacist). But, I think that the majority of the people who take it are not likely to change their diet significantly enough to stop taking acid-reducers completely.
posted by parmanparman at 6:47 AM on May 16, 2008

I used to have pretty serious acid reflux, and after taking Prilosec OTC for the 14 days, it was gone for a pretty long time. It *never* came back as serious as it was before. Maybe you'll only need to take it for the initial 14 days.
posted by All.star at 6:48 AM on May 16, 2008

I've been on Prilosec for years, no problems yet, but my reflux comes right back if I miss a couple of doses.
posted by infinitywaltz at 7:46 AM on May 16, 2008

When Prilosec became available OTC, there was concern that people might just medicate their symptoms and not see a doctor when they really needed to. Stomach acid is not entirely a bad thing - for example, it kills a lot of bacteria that we ingest. You can take Prilosec indefinitely as long as your doctor says it's ok. But for self-treatment, if you need it for longer than 14 days, you really should be seeing a doctor. (I'm a pharmacist... well, at least I will be after I pass the licensing exams this summer. I just graduated last week - woot!)
posted by selfmedicating at 8:53 AM on May 16, 2008

IANAD

My reference (UpToDate) says that omeprazole is frequently used under a physician's supervision for 4-8 weeks for a variety of causes, and that years-long use happens, but is associated with atrophic gastritis, bowel infections, B12 deficiency, and maybe bone density issues. For example, this study was on people treated for more than five years continuously. While there hasn't been human confirmation of long-term use causing stomach cancer, it did in rats, so people are worried about that.

It's a pretty safe drug, but if you need to use it for more than 14 days, you should probably see a physician about it is the point. For example, stomach ulcers are mostly caused by an infection and aggravated by acid. If that's what's bothering you, you need to see a physician to eliminate the infection.
posted by a robot made out of meat at 10:16 AM on May 16, 2008

It definitely doesn't work that whole time. I think the reason the prescribing information is that way is that if you have a problem requiring Prilosec that lasts longer than 2 weeks, you should come under a doctor's care.

People take Prilosec for heartburn (GERD) but prolonged GERD for months can lead to a condition called Barrett's esophagus; the continuing acid effect on the esophagus (where acid is not supposed to be) damages the lining of the esophagus in a way that is a strong risk factor for future esophageal cancer.

The incidence of stomach cancer with proton pump blockers is hypothetical in people; but PPBs do elevate a hormone called 'gastrin' to extremely high levels, levels they would never reach in the absence of those drugs. Gastrin normally stimulates the acid-producing cells of the stomach (the parietal cells, if memory serves) to produce more acid; the gastrin is produced in response to the fact that the pH of the stomach is higher than the physiological set-point. Because PPBs block the ability of the parietal cell to secrete acid the gastrin level becomes very high. My old GI prof at Columbia proposed that this was the mechanism for development of stomach cancers due to PPBs in an informal chat we had.
posted by ikkyu2 at 10:20 AM on May 16, 2008

Wow. Thanks for the info, ikkyu2. I will definitely be asking my doctor about it. I do have chronic reflux and am on Prilosec indefinitely; like infinitywaltz, my reflux does return after a couple of missed doses. I guess it's kind of a trade-off--I have a past diagnosis of Barrett's esophagus (first gastroenterologist interpreted my first endoscopy results that way, second gastroenterologist performed an endoscopy a year later and agrees that there is permanent damage, but says I don't have Barrett's yet).
posted by kiripin at 10:44 AM on May 16, 2008

But, I think that the majority of the people who take it are not likely to change their diet significantly enough to stop taking acid-reducers completely.

I work part time in a grocery store pharmacy. NO ONE ever changes their diet. They figure they can just take a higher dose of whatever heart/cholesterol/beetus drug they're already on. It doesn't wash like that. You can't double your taquito intake and think that increasing your Prevacid from 15mg to 30mg is going to be ok.

Prilosec OTC also comes in 28 and 42 count boxes. People are using it every day and they get super dependent on it. Not addicted, but if we run out, they get mad.
posted by pieoverdone at 11:04 AM on May 16, 2008

So what about those of us that diet simply doesn't work for? I get horrible reflux even on an empty stomach, even standing up, so elevating the foot of my bed and laying off the spicy food doesn't make much of a difference. I don't want to get stomach cancer, though. Then again, I don't want eseophageal cancer, either.
posted by infinitywaltz at 11:16 AM on May 16, 2008

I think it's worthwhile to point out that as far as I know, there has never been a single study demonstrating increased risk of gastric cancer in humans chronically on proton pump inhibitor therapy. These have been the market for almost 20 years now, with perhaps millions of people or more on treatment. So please take rat studies with a grain of salt. The specific study in this case had an n of only 79 and an astounding 27% had cancer in the control group! That alone makes any inferences about humans pretty dubious.
posted by drpynchon at 3:32 PM on May 16, 2008

So, no, no one here has ever followed the "14 on, 120 off, repeat" directions. Not a one. Wow.
posted by NortonDC at 8:23 PM on May 16, 2008

I did the 14-on, 120-off bit for occasional bouts of hardcore reflux when I didn't have insurance (my docs had previously prescribed AcipHex). The last time I did it, about a year ago, it didn't seem to do much for me and I stopped 8 days in.

Oddly, the acid issues went away when I started getting more fiber in my diet. I guess I'm one of those nonexistent people who actually does change their ways.

So, yeah, people do do that. I always figured it took 14 days to really quash the majority of the acid reflux, and then you were supposed to just be vigilant about it for the next four months, or tell a doc if it didn't go away.
posted by fairytale of los angeles at 9:26 PM on May 16, 2008

I've got a hiatal hernia, and I was prescribed Nexium.

I couldn't afford Nexium though, so I went on Prilosec. After reading the dire warnings about 14 days on the package, I called my doc for permission to take it every day.

His story was that the 14 day warning is to make sure that people who should be seeing doctors do so, and that I should go ahead and take it every day. His orders.

That was at least two years ago (maybe three?), and I'm fine.

So. Yeah. My doctor says you should ask your doctorb.

The "B" is for bargains!
posted by SlyBevel at 11:19 PM on May 16, 2008