Transitioning from a PPI to an H2 blocker
10 years ago or so, I had severe symptoms of having food stuck in my esophagus and not being able to swallow or bring food back up. This put me in the hospital a few times until an endoscopy diagnosed me with a schatzki ring. My gastroenterologist nipped it in one or two places and prescribed omeprazole 20 mg once per day. This worked fine for years. My current primary care physician wants me to come off of this proton pump inhibitor (PPI) and use an H2 blocker instead. I agree. I tried about a 10-day transition alternating between the two medications and then went to the H2 blocker (Famotidine) for 3 months with no omeprazole. I had swallowing difficulty symptoms almost every meal. They were mild to severe ( inability to swallow or bring food back up for 20 minutes with a production of fluid [saliva?] which required spitting and some small amounts of food coming up). So, I went back on Omeprazole about a month ago. Now I have obtained a prescription both. I would like to try to wean myself off of the PPI and onto an H2 blocker again. Here is my plan:
● Alternate omeprazole 20 mg /day early am with famotidine 20 mg before breakfast and dinner for 14 days. Then alternate with PPI every 3rd day for 14 days. Then alternate with PPI every 4th day for 14 days.
Does anyone have any experience with this transition? Any suggestions.
Interested in more discussions like this? Go to the Digestive Health Support Group.
I have been on Omeprazole for over 5 years now, it works well, why transition off of it? I had an esophagectomy with partial gastrectomy and a pull through for esophageal cancer at the junction. I know my anatomy is a little different, just wondered why if it is working for you.
@fatherofstickyrice, have you also had esophageal cancer? Like @susanmaa, I'd also like to understand why you wish to transition from PPI to an H2 blocker. Is your doctor suggesting this?
No, thankfully, I have not had esophageal cancer. My doctor has recommended that I transition from a PPI to an H2 blocker because of the association of long-term use of PPI's with bone density loss (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6914803/).
Thanks for that background information. I moved the discussion to the Digestive Health group (https://connect.mayoclinic.org/group/digestive-gastrointestinal-problems/) so that you can connect with others like @jackiem95 @pines @ngorman25 and others who may be able to provide some input and experiences.
To help the transition I have done some other things as well:
– cut out possible triggers from my diet: chocolate, citrus, mint, fats, spicy foods. This was harder for my wife who is Thai and cooks for me.
– Reduced the size of breakfast, lunch and dinner and incorporated a morning and afternoon snack. I aimed for satisfied/not hungry but not full / stuffed. This was also difficult for my wife who always offers more.
– Made sure I did not lay down until at least 3 hours after any meal. This was difficult for me in that if I did not sleep well, I had no opportunity for a nap.
– did not exercise vigorously right after a meal
– Made sure that my phone was not at the table during meal time. Ate in a meditative way conscious of flavors and textures and swallowing.
– Elevated the head of my bed about 4 inches.
I"ve been tapering off of the PPI since 13 January. On 24 February I took my last dose. Six days later, having taken the H2 blocker morning and evening, I had a severe swallowing incident while eating cubed fresh mango. I renewed my vigilance and have not had another incident.
I've transitioned fairly well. I have occasional mild to moderate swallowing problems.
I have similar problems. Have a hiatal hernia and was also diagnosed with a "nutcracker esophagus" when I was tested for swallowing abilities. I've been on 80mg of pantoprazole for awhile now, but recently went to 40mg in the morning and 20mg famotidine before bed. I'm close to half sitting in bed and now used to it. The swallowing issue is worrisome, but I've never had food really stuck, just maybe hard to get down but eventually did. Since I'm from Sweden, I started reading about a device that was developed there called Iqoro. It's a piece of plastic that you put in front of your teeth and pull to create a vacuum. This trains the muscles in your esophagus. Takes months to feel a difference. I had my sister send it to me since it's not approved in the US (but it is in Britain). They have a website that is also in English. My test is to see if I can drink a glass of water without stopping. I'm getting close!
I’ve been on Prevacid my entire adult life. 27 years. Slowly transitioning off. I’m scared.
Update: it’s going well! I’m on famotidine (h2 blocker) only. I take 20 mg am/pm.
I also quit caffeinated coffee. I was on Prevacid for 27 years so I’m trying to be kind to myself.
Anyone else ?
Great, to know that tranisitioning to H2 is possible. Probably going to use the weaning off approach that stickyrice mentions. The PPIs were apparently never studied for long term use and after what happended with Zantac its buyer beware. Also recent mendium term studies show an increased risk of Gastric Cancer, a chance I am not willing to take.
" Long-term use of PPIs was still associated with an increased GC (Gastric cancer) risk in subjects even after HP eradication therapy"
"The long-term use of proton pump inhibitors (PPIs), a class of drugs commonly used to treat acid reflux, is linked to a more than doubling in the risk of developing stomach cancer."
"After a median follow-up of 5.0 years, the use of PPIs was associated with a 45% increased risk of gastric cancer compared with the use of H2RAs"
You can google the quotes and see the links and articles