Question: Hello!
I am trying to decide whether or not to try Pantoprazole or Omeprozole, or continue to use neither. I have had GERD for several years and Omeprozole worked well for me. I used it rather regularly for a couple of years. More than a year ago I had fairly severe toxic hepatitis which my doc and I decided was caused by my Simvastatin (after I did a lot of research on the internet. Simvastatin is clearly indicated by the Mayo Clinic as a drug that can cause toxic hepatitis.) At the time I discontinued both the Statin and the Omeprozole and all my symptoms went away. My liver enzymes have been checked several times since and they are normal. I have taken no medications since.
For more than a year my GERD was under control with diet and I was basically symptom free. Then I drank too much coffee for about a month and my GERD was aggravated. I haven't been able to get it under control since then. I would like to try a PPI as it worked well in the past but I have been reading that Omepozole also can cause liver toxicity and both my doc and I are nervous about my starting it up again since we can't really be sure if it was the Simvastatin, the Omeprozole, or the combination that caused the hepatitis.
I've used Pepcid AC, went 11 days without any caffeine, then went back to mostly green tea which I used before and I seemed to be okay with, used tums; I try to watch my diet and do fairly well. I exercise. I am not overweight. I don't drink. I try sleeping half sitting up when I can stand it. I've been doing all I know how to do to get better without a PPI.
I was thinking I might try 10mg of Omeprozole (moving to the usual 20 if necessary) and use it for a relatively short time (up to a month or 6 weeks at most) to see if I could clear up my symptoms. Hopefully after a this time I could get back to doing well with lifestyle and not need a PPI. I would get my liver enzymes checked after a week to 10 days and then again after a month. Hopefully, I'd stop the medication by then. My doctor suggested, however, I might want to try Pantoprazole instead, as maybe it is less toxic to the liver. I have been trying to research it and haven't found enough information to see if it is true that it tends to be less toxic. It looks to me like the other side effects for Pantoprazole may be worse than those of Omeprozole. I have a friend who used it and had a lot of side effects. He uses 10mg of Omeprozole regularly.
Sorry to go on and on. I'm finding it difficult to know what to do. Should I try one of these PPIs? If so, which one? If not, are there other suggestions?
Thank you for your time! XXXXXXX (67yo)

Thank you.

Is there a low dose that I should try to start? What is the lowest dose you think I should take?

Would you suggest taking 20mg once a day? If so, when? My doc has given me the prescription for 20mg - 2 times a day. My preference is to start with only once a day though I also wondered about taking it twice a day for just a few days and then going down to once. As I said before I want to be very cautious with taking any med due to the liver problem I had before. On the other hand, if I'm going to take it at all l want to do it in the best way possible and give it a chance.

My thought is to get my liver enzymes checked in 10 days to 2 weeks.

Thank you for your help. It is good to have a second opinion.