PPI drugs have bad side effects for me. What are the other options?
April 13, 2012 8:07 AM   Subscribe

I've been trying the -zole range of PPIs for GERD-like symptoms but all have bad side effects (detailed below). Is there anything else I can try?

So far I've tried omeprazole, lansaprazole, and rabeprazole at standard dosages. All worked in stopping the symptoms (mostly heartburn, coughing/phlegm, and chronic bad breath) but all brought side effects of one kind or another. Lansaprazole was the worst, bringing depression and a feeling in my stomach like I've swallowed lead. All three made me feel generally digestively uncomfortable, like I've eaten something that disagrees with me -- sweaty, and feeling out of sorts.

The doctor has me on ranitidine (300mg three times a day). This just about works although bad breath sometimes returns. There are no side effects. However, according to his dispensing guidelines ranitidine in this dosage can only be prescribed for short periods. The symptoms are related to weight I've put on recently, and I'm losing weight, but I'll likely need the tablets for at least two/three months.

So what are the options for me? (We've also tried fluconazole in case there's a candida infection, with particular reference to the bad breath, but this has had no effect.)
posted by humblepigeon to Health & Fitness (15 answers total) 3 users marked this as a favorite
Response by poster: I should have added that I've altered my diet, cutting out caffeine and refined sugars. As it happens I'm vegan and already eat high fibre meals anyway.
posted by humblepigeon at 8:13 AM on April 13, 2012

Best answer: What I have found, as a GERD sufferer, is that:
1. You need to try different drugs, as you're doing;
2. Often, the standard dose isn't sufficient in arresting the symptoms. You can take more, under the physician's/pharmacist's direction, for a trial period to see if that works; and
3. GERD can also be affected by inflammation and congestion in the chest, such as from asthma and allergies;
4. Your "triggers" for GERD may not be dietary.

I have found that some of these drugs work moderately for me, while others do nothing. I respond best to Prevacid (lansoprazole).

My biggest trigger for GERD is stress. If you internalize stress, like I do, you may have this issue, too. (I don't have trouble with any particular foods or drinks.) When I lost some weight, my GERD didn't go away, either. Do you feel stressed?

Once I got my allergies under control with allergy shots, too, my GERD went way down. I'm currently taking Prevacid 24HR (the OTC version) every other day, sometimes every three days, depending on how stressed I am. Do you have allergies or asthma?

Have you spoken with a pharmacist about these medications and your experiences with them?
posted by FergieBelle at 8:34 AM on April 13, 2012 [1 favorite]

So... I started by taking HCL + pepsin, building up slowly, yes, increasing the acid in my stomach. That helped considerably. Then I tapered that.

I'm thinking I had bacterial overgrowth. I think GERD is from low acid, not high acid. Low acid equals bacterial fermentation in your warm, un-acidic, nutrient rich stomach equals burping up acid fizz and foam.

What made the biggest difference was massively increasing the saturated fat in my diet. A little extra fat slows stomach emptying which would make GERD worse. But a lot of saturated fat seems to mess with bacteria metabolism.

YMMV. I have no idea what I'm talking about, but that's what I observed. I don't think I'm a crank.
posted by zeek321 at 9:07 AM on April 13, 2012 [1 favorite]

I don't see pantoprazole on the list of things you've tried. Even though it's a -zole, you may want to try it. It's what my dad and I both take for GERD.
posted by disaster77 at 9:51 AM on April 13, 2012

4. Your "triggers" for GERD may not be dietary.

True. But I was going to chime in that they might be. The OP mentions high fiber and vegan as if that rules out dietary issues, but the reality is lots of vegan foods can trigger gerd and high fiber isn't compatible with some. It doesn't sound like this has been explored.
posted by rr at 9:59 AM on April 13, 2012

Best answer: Yeah, there is a lot more dietary/lifestyle advice for various types of reflux than you have mentioned.

The stuff I remember includes:
* Avoid any acidic foods, including tomatoes, citrus.
* Avoid high fat food including pastry and fried foods
* Avoid chocolate
* Avoid spicy foods
* Avoid alcohol, especially wine
* Put bricks under the legs at the head of your bed to reduce reflux at night (extra pillows don't work so well)
* Avoid wearing constricting clothes around your abdomen
* Eat smaller meals
* Stop eating at least 2-3 hours before lying down
* Absolutely stop smoking if you do
* Lose weight - you're already doing that - yay!

A lot of this probably won't apply to you but I've seen people who have had chronic reflux for years have some relief when trying these tips strictly for a couple of months.
posted by kadia_a at 10:21 AM on April 13, 2012

I have family members with GERD including one my mother who has been on daily ranitidine/Zantac for several years. The way I understood it, the only reason the PPI have replaced it is because they are generally more effective, and that the Zantac is far safer with fewer side effects? Someone correct me if I'm wrong!
posted by vanitas at 10:48 AM on April 13, 2012

I really wouldn't worry about staying on the ranitidine if the doctor is prescribing it to you. You can taper down to whatever he/she says is a "reasonable" level long-term, if that works.

Everyone in my family has GERD, and my father and myself have both been on prescription-level medication to treat it in varying stages of exacerbation for over 20 years apiece.

Now, that said, here's some things that made a difference that others haven't pointed out yet:

- Chew sugar-free gum. I realize you're vegan, so here's a vegan-friendly option.

- Carbonation. I drink a shitload of Perrier, LaCroix, etc. any kind of sparkling/mineral water, really. But when my GERD flares up from stress, other medications, poor sleep, etc. I can't drink it. Are you drinking carbonated/fizzy drinks? They don't have to be caffeinated - just bubbly; it's the burping that affects your GERD/breath.

- Fruit juice. Seriously, the only other thing that causes instantaneous pain like this does for me is straight liquor. It's unbearable, so I haven't drunk any (without pre-prepping my stomach with extra meds) for... I dunno, decades probably. You mentioned being vegan, so I'll spare you the "don't eat granola or any similar carb-heavy food in quantity by itself" speech as I'm sure you've already addressed this.

- Antacids. If you have been taking them daily for a long time, they can have lasting, health-impacting side effects, according to the Mayo Clinic. (Depending on the base ingredient, that is - each brand's slightly different.) I stopped taking them altogether for about a year or two, and I definitely noticed a difference. Also: don't eat these if you're on prescription meds - the two often cancel each other out, relief-wise.

Good luck - I know how bad all of this sucks, and how painful/annoying it can be!
posted by Unicorn on the cob at 10:50 AM on April 13, 2012

The only thing that's consistently reined in my GERD after almost 10 years of suffering is lots and lots of aerobic exercise. If I run 10 miles a week, I don't have any symptoms regardless of what I eat. (Though I do take a Prevacid most mornings.) Now that I'm doing about 20 miles a week, I basically don't have any GERD symptoms at all.
posted by anildash at 11:17 AM on April 13, 2012

i came in to suggest zegerid. i had never heard of it until my gi suggested it last month. it's omeprazole plus sodium bicarbonate which made me roll my eyes since omeprazole wasn't doing shit for me. but taking this horse pill at night has made my gerd almost go away. so, maybae ask your doc about that? it is otc and script in higher doses.
posted by misanthropicsarah at 11:44 AM on April 13, 2012 [1 favorite]

Ranitidine doesn't do anything for me, it might as well be an empty gelatin capsule. I have found significant relief with generic Walgreen's cimetidine as needed, adding a lot of additional fiber to my diet, and the occasional Tums for when I wake up at night burping acid.
posted by djeo at 12:06 PM on April 13, 2012

Yeah, there is a lot more dietary/lifestyle advice for various types of reflux than you have mentioned.

Put lists aside and make an investigation for yourself with an open mind.

Pastries, for example, bother the hell out of me but it's not because they are high fat (which doesn't bother me at all) but because of the wheat. My friends who are vegans eat all sorts of frankenfoods that would make me have gerd and cough that they think are healthy.

OP figure it our for yourself but check all of your assumptions, including "healthy fiber."
posted by rr at 12:32 PM on April 13, 2012

I've had some real success with the over-the-counter omeprazole products in combo with low-dose imipramine. Bonus feature is the imipramine helps me sleep and gives me a little psychological booster while fighting my IBS symptoms and the "ledbelly" feeling.
posted by The 10th Regiment of Foot at 1:06 PM on April 13, 2012

Response by poster: Thanks everybody for your replies. They're all good but I picked out a few for "best answer" that suggested to me that it's not just diet and pills that are going to tackle this.

I need to think about things like stress or even too-tight clothes (my breath did stink one day when I had one pair of tight trousers!).
posted by humblepigeon at 7:13 AM on April 16, 2012

Response by poster: One other thing: My doctor was not keen to prescribe cimetidine because, she says, it can cause the growth of breasts in men as a side-effect, in the doses I'd be taking it. One nice thing about ranitidine is that she was happy to put me on a repeat prescription because, although there are side effects, she's prescribed it thousands of times before PPIs arrived on the scene.
posted by humblepigeon at 7:17 AM on April 16, 2012

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