Tapering off these medicines can be challenging as people can have symptoms for up to 10 to 14 days after discontinuation due to rebound hyperacidity
So, be sure to let your patients know that they may feel worse for a couple of weeks before their body readapts.
This is a common quote I hear, “I tried to go off that medicine but my reflux came back with a vengeance, Doc".
You can reduce this rebound and the severity of the symptoms by preparing ahead of time to address underlying causes and by creating a “bridge plan” to successfully wean off a proton pump
inhibitor (PPI). Before the quit date:
Taper down the dose. For example, if someone is on 20 mg of omeprazole
twice daily, I will reduce the dose to 20 mg a day for 10 days and then 20 mg every other day for 10 days before stopping.
Address emotional stress. Extreme stress can cause vomiting
. Mild to moderate stress can cause reflux.
Improve nutrition. Caffeine is a big culprit. Taper a person’s caffeine dose before you taper the PPI. Encourage less acidic food and more basic food groups to include vegetables, fruit, and fiber. The bridge:
Prescribe another pill to replace the PPI during the bridge. I go back to an old coating drug, sucralfate
1 gm before meals and before bedtime for 2 weeks.
Another option is deglycyrrhizinated licorice (DGL). Licorice coats and soothes the stomach.
Glycyrrhizin is the mineralocorticoid in licorice that causes salt retention, hypokalemia
, and high blood pressure
. The DGL removes this. Patients can get this over the counter.
Hope I have answered your query. Let me know if I can assist you further.
Dr AJEET SINGH, General & Family Physician