Transplant; Stomach Acid Reducers like Pepcid

Hey there buddy!
My Mayo team prescribed protonix (pantoprozole) as a preventative measure due to the variety and quantity of post-transplant prescriptions. I assumed vomiting your meds reduces their effectiveness. As I reduced to only Myc and Tac (cellcept and prograf) as my primary immuno-suppressant drugs I asked if I could not take the protonix as an experiement to reduce costs, albeit very minor. Within days I was experiencing a lot of GERD (gastrointestinal reflux disease) so I went back on the protonix and have not looked back.
Best always,
s!

I had the same experience as @scottij… My Mayo team also prescribed protonix (pantoprozole daily while I was on Tacrolimus. Being a stem cell transplant, I eventually was able to stop taking the anti-rejection meds and weaned off the Protonix. But it’s very important to protect your stomach lining and esophagus from any acid damage. So taking something like Pepcid or Protonix is definitely a good idea.

Were you having heartburn, indigestion??

Hi @scottij 😊 It's awesome to hear from you! Thank you for sharing your experience with me. My story is very similar. But the reason I stopped Protonix was since my transplant and the start of my medications, my liver enzymes have been elevated. So first, they had me stop the Bactrin, then I stopped the Protonix, etc. Now that months have passed, the GERD is here! My local gastroenterologist told me to try Pepcid. I am not sure if that will work and I am not sure what it's going to do to my liver enzymes. Do you take Protonix an hour before your Myc and Tac? Have you seen any issues with your liver enzymes? I forget...what's your dosage of Myc and Tac?
Thanks a million for jumping in Scott! I know I can always rely on you 😊

Before my lung transplant, my pulmonologist reduced the amount of Pantoprazole that I was taking by prescribing Pepcid. I also had hiatal hernia repair (had a very large sliding hiatal hernia where the stomach attached to the left lung further complicating breathing) the year prior to my transplant. The transition from taking Pantoprazole twice a day to once a day replacing second time with Pepcid was an easy transition for me with no adverse effects. I have had GERD for so many years without relief that I have had 7 ulcers in my throat. However, the doctors don't know if the damage to my throat will ever fully heal even though I no longer throw up multiple times a day (no longer throwing up).
Since my transplant, I am only on Pantoprazole once a day and the acid is under control. So your doctors need to see what works best for you. Not everyone reacts the same way nor do you react the same way at different times.

Hi @loribmt 😊 Thank you for letting me know your experience! Yes, I am experiencing heartburn, sour taste, white tongue... It's terrible. It has been two years of taking the meds with no stomach protection, trying to protect my liver. This week, my transplant nurse suggested Protonix again, but my local gastroenterologist wrote a prescription for Famotidine 20mg (Pepcid) because of my liver enzymes I think. I am not sure which is best for my situation.
I was happy to hear that @chickytina had what sounds like a positive experience with Pepcid.
@chickytina Am I reading your post correctly, that you had a good result and experience taking Pepcid?

I had GERD probably for at least 15 years before being treated, which is why I have so much damage to my throat. I was then on Pantoprazole twice a day for almost 5 years. I did have a positive response to the two used in conjunction. My doctor tried just cutting down the dosage of the Pantoprazole at first and I started throwing up again. I then had the hiatal hernia repair. Right after the surgery is when the pulmonologist switched me over to the combination. It appears that it worked for me. However, it depends on how severe your case is also. My case was very severe that even certain smells would make me throw up. I would try Pepcid for a month or two and see what relief you get and if not then ask for the stronger Pantoprazole. From my understanding Pantoprazole causes more damage in the long run, but talk to your transplant team as they know what interactions the medicines have and other complications such as damage to your liver or kidneys.

@scottij @loribmt @chickytina Thank you soooo much for jumping in so quickly to help me and giving me such excellent advice! 😊 I really appreciate it. It is so comforting to know that you are always there for me. Yes, I think I will start the Pepcid tonight (since I have it filled) and try it for the month to see if I get relief. Does it normally take about a month for things to quiet down when taking an acid reducer?

@hello1234 Aw thanks for the props! The latest news from the regular blood tests is that kidneys are in great shape as is the liver. I am very assiduous about hydration so I think that helps. Myc dosage is 750 mg in the AM and in the PM. Tac goes down at 3mg in the AM and 2.5 mg in the evening. I take my protonix when I rise (around 3;45 AM...I know, that is weird) and breakfast usually follows about an hour later though my schedule changes throughout the year based on weather and sun rise times.

Are you regularly monitoring your liver enzymes through blood tests? I suspect any additional medication will necessitate a blood test to see how it affects your system. Your doctors should decide what and how to gather that information
Best always,
s!

Pepcid works fairly quickly. So definitely start taking it ASAP. It doesn’t take a month to start working.
Not trying to frighten you but without getting that acid/acid reflux under control you’re risking damage to the esophageal sphincter, Barrett’s Esophagus, stomach ulcers and tooth erosion.
Omeprazole works better and longer. (Prilosec, Nexium) Each pill generally will last 24 hours. Pepcid works faster than Omeprazole but for not as long. So if you find the Pepcid isn’t working as well you can switch. But again, check with your transplant team. You have frequent blood work done anyway, so checking on reactions to any of these products will be noticed quickly. Don’t be afraid to try them!

Gaviscon is a great over the counter acid reducer because it coats the esophagus and stomach lining. And you can use this as the same time as the long term products.

Avoid eating acid producing foods. https://www.healthline.com/nutrition/acidic-foods

Don’t eat several hours before bed and don’t drink a lot of liquid before bed either. You don’t want your stomach full.
Try sleeping on your left side. https://www.everydayhealth.com/gerd/managing/sleep-tips-for-people-with-gerd.aspx.

Avoid caffeinated or carbonated beverages.
Elevate the head of your bed or prop with pillows so you’re not lying flat.
These are a few helpful hints to avoid acid reflux.

Do you take any over the counter products in the meantime?

@scottij Thank you so much for your very detailed response. It really helps me to know exactly how you are timing your meds and acid reducer. I am hopeful that the Pepcid works as well as the Protonix. You are right on target at suggesting close monitoring of my liver enzymes after adding this med. Matter of fact, I am scheduled for a blood test on Wednesday morning after a few doses. (Starting my Pepcid tonight). Thank you again Scott for all your kindness and wisdom. You are very knowledgeable and I appreciate your experience. 😊