Indication
Gastroprotection
RAG rating
Green
Document type
Patient information
Place
Hertfordshire and West Essex ICB
Output type
Pharmacy / Prescribing
Document
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PPI Stopping Or Reducing patient letter

Patient Information – Stopping Or Reducing Your Proton Pump Inhibitor (PPI)

What are Proton Pump Inhibitors (PPIs)?

PPIs are a group of medicines that are very effective in reducing the amount of acid produced in your stomach and can be used to treat indigestion (dyspepsia), acid reflux or heartburn.  Reducing the amount of acid in the stomach or oesophagus (food pipe that carries food and liquid from the throat to the stomach) will allow the body time to heal any inflammation or irritation.  PPIs can also be prescribed to protect your stomach against irritation caused by other medicines such as non-steroidal anti-inflammatory drugs (NSAIDs) for example, aspirin or ibuprofen and oral corticosteroids (also known as steroids) such as prednisolone or hydrocortisone. You may have been prescribed one of the following PPIs: omeprazole, lansoprazole, pantoprazole, rabeprazole or esomeprazole.

Why is it important to review continuing to take my PPI?

Current recommendations suggest that most patients given PPIs should only use them for a short time, unless you are taking these for a small number of conditions that require long term management.  PPIs may be started at a higher dose which will then usually be reduced to a lower dose or stopped after a period of time.

Long term use of PPIs may:

  • Increase the risk of developing Clostridium difficile, a gut infection causing severe diarrhoea;
  • Mask gastric and stomach cancers;
  • Increase the risk of broken bones (also known as fractures), especially in the elderly population;
  • Increase the risk of pneumonia;   Reduce the body’s magnesium level leading to tiredness, muscle weakness and other more serious side   effects which include convulsions, dizziness, and abnormal heart rhythms.

Stepping down (reducing) or stopping your PPI medication 

Research has found that some people who have been taking PPIs for more than two months find that their body is producing more acid (referred to as rebound acid) to compensate for the acid reducing effects of these medications. This can mean that your symptoms can worsen again when trying to stop taking the PPI medication. If this happens to you, it should only be for up to two weeks after stopping the PPI.  

Occasional symptoms of rebound acid can be managed by taking your PPI only when needed or by taking an antacid medicine which can be purchased from your local pharmacy or supermarket. 

How will my PPI be stopped?

Your healthcare professional will usually recommend one of three options for stopping your PPI. These are:

  1. Stop taking the PPI. You may be advised to stop taking your PPI, either straightaway or when your current course is finished.
  2. Take the PPI only when needed. You may be advised to take your PPI only if you have rebound acid symptoms. When the symptoms have gone, you would then stop taking the PPI.
  3. Reduce the PPI dose. If you have taken your PPI for several months and particularly if you have been taking a high dose, your healthcare professional may reduce your PPI dose.  Depending on why you were prescribed the PPI in the first place you will either then be advised to stay on a lower dose or stop taking the PPI completely. 

If you experience rebound acid symptoms that persist for over two weeks and this is bothering you, even after taking an over the counter antacid medicine or taking a PPI on a when needed basis, you should speak to your health care professional for further advice.  

What can I do to help reduce or prevent symptoms after my PPI has been stopped or the dose has been reduced?

  • Eat in moderation and at regular times;
  • Eat meals earlier in the day and no later than, 2-3 hours before bedtime;
  • Elevate your head with a pillow by 15-20cm;
  • Avoid bending or lying down after eating;
  • Reduce your dietary intake of fat; 
  • If you are overweight, aim to lose weight;
  • Avoid tight clothing or belts which constricts your stomach;
  • Avoid or reduce alcohol intake;
  • Avoid or reduce smoking and vaping;
  • Avoid foods which cause your symptoms, such as spicy food, acidic food and drinks, caffeinated drinks like cola, chocolate, and coffee.

 

When should I ask for further advice from my healthcare professional?  

You should speak to your healthcare professional if:

  • Swallowing is difficult or painful;
  • You have unexplained weight loss.

 

Seek urgent medical attention if:

  • You experience vomiting, especially if this contains blood or material that looks like coffee grounds;
  • Your bowel movements are dark and sticky;
  • You experience chest pain that gets worse with or after exercise or pain that goes into your chin or left shoulder, this type of pain may be a sign of a heart problem. 

 

Patient resources

With thanks to and acknowledging wording taken from Patient Information. Proton Pump Inhibitors (PPIs).  West Suffolk NHS Foundation Trust

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