Antireflux drugs or proton pump inhibitors (PPIs) are among the most commonly used products. They decrease gastric acidity. In the elderly, long-term treatment is often over-prescribed. Be careful, they have side effects. By taking a few precautions, it is possible to stop a PPI that has been taken for several months or several years.
WHAT DRUGS ARE AFFECTED?
- Omeprazole: Mopral, Zoltum, generics.
- Esomeprazole: Inexium, generics.
- Rabeprazole: Pariet, generics.
- Pantoprazole: Eupantol, Inipomp, Pantozol Control, generics.
- Lansoprazole: Lanzor, Ogast, Ogastoro, generics.
WHY ARE THEY LISTED?
PPIs are indicated in the treatment of gastroesophageal reflux disease (GERD), gastric and duodenal ulcers or even the prevention of gastric lesions due to nonsteroidal anti-inflammatory drugs (NSAIDs) in people at risk (over 65 years old, history of ulcer, treatment with antiplatelet agent, anticoagulant or corticosteroid). The duration of treatment is four to eight weeks, but the case of some people requires long-term treatment.
ARE THEY OVER PRESCRIBED?
According to various studies, PPIs are largely over-prescribed, particularly in the geriatric population. In the elderly, PPI treatment is, in many cases, systematically renewed. "The reason for initial prescription is very often unknown and we observe long-term prescriptions without precise indication" , specify the experts of the Observatory of Omédit medicines of the Center region. Alarmed, the High Authority for Health has published a sheet on the proper use of these antireflux drugs in order to limit the surge in their prescriptions.
Particularly in the elderly, PPIs are often wrongly prescribed in case of functional digestive disorders without associated GERD (discomfort, difficult digestion, pain, nausea, bloating, etc.).
WHAT ARE THEIR SIDE EFFECTS?
PPIs are not harmless drugs. Prolonged use can have potentially serious adverse effects: osteoporotic fractures, kidney damage, low magnesium levels in the blood likely to cause mental disorders, digestive and even cardiac disorders, vitamin B12 deficiency, gastrointestinal infections, pneumonia, etc One study even pointed to an increased risk of dementia in people over 75 taking these medications regularly. Finally, PPIs can interfere with the action of other drugs.
If you do not or no longer need a PPI, you might as well stop it because you will thus reduce the risk of adverse effects associated with these treatments. But beware of the rebound effect when stopping treatment.
WHAT IS THE REBOUND EFFECT?
If you have been taking a PPI for several months, you may feel more discomfort and pain when stopping the medication than before. The acidity returns, sometimes more strongly. This is called the rebound effect, a known drawback with these drugs.
This increase in gastric acidity is transient, usually lasting a few weeks.
HOW TO STOP A PPI?
To avoid this rebound effect, it is advisable to gradually reduce your treatment. The independent organization of health professionals Farmaka in Belgium offers weaning from PPIs over a minimum of three weeks.
In practice. You can, for example, reduce the dose of your PPI by half, then take it every other day until completely stopped. After the last pill, try to go two to four weeks PPI-free to give your body time to get used to normal functioning again.
If you feel discomfort during withdrawal, an antacid medication (such as Gaviscon, Rennie, Maalox, etc.) may also help.
Don't forget the few lifestyle and dietary rules that help limit gastric acidity: avoid certain foods, overeating, alcohol, tobacco, eat slowly, etc.
If you are unable to stop taking your medication completely, try tapering it to the lowest effective dose or taking it only when needed.
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