I checked back in my Food/Symptom journal and sure enough, the trembling began within a few days of cutting my daily Prilosec dosage in half, from 40 mg/day, to 20 mg/day. The last time I experienced trembling of the same sort was when I stopped taking clonazepam. The trembling lasted about a couple weeks. Could it be that my body simply "withdraws" from chemicals in this bizarre way? Could a simple, over-the-counter drug have this kind of effect on the body? I had to check it out.
Doing the usual internet search (Google), I was amazed to find so much information available about Prilosec withdrawal. Why hadn't anyone warned me that it was possible and what I might expect?
According to many websites, the side effects for medications are also the side effects of withdrawal. The particular Prilosec I have been taking is omeprazole, delayed-release capsules. Prilosec is a proton-pump-inhibitor (PPI).
So what is a Proton Pump Inhibitor (PPI)? Without getting into too much detail, the stomach produces acid (mainly hydrochloric acid) in order to break down our food so it can be digested. This acid is released through proton pumps which allow the chemical to pass into the stomach. Sometimes the stomach produces too much acid, which may spill into the esophagus and cause heart burn or acid reflux. The proton pump inhibitor (PPI) is supposed to inhibit the body's ability to produce stomach acid.
Omeprazole (brand name Prilosec) "blocks the final step of acid production.... Animal studies indicate that after rapid disappearance from plasma, omeprazole can be found within the gastric mucosa for a day or more" (i.e., the effects linger on) (PharmaInfo).
According to the July 1, 2009 edition of Family Practice News, after 8 weeks on a PPI, patients ended up with rebound heartburn, acid regurgitation, and dyspepsia (upset stomach or indigestion). The article "PPI Withdrawal Triggers Acid Hypersecretion" by Mary Ann Moon points out that "Rebound symptoms were clinically significant in the study subjects, causing mild to moderate discomfort for at least 2 weeks after withdrawal of daily PPI therapy--a 'remarkable' finding given that 40% of the study subjects had never experienced such symptoms before, wrote Dr. Reimer of the department of medical gastroenterology at Copenhagen University and her associates."
Symptoms of PPI withdrawal may include:
- Rebound acid hypersecretion within two weeks of withdrawal
- Acid reguritation
Interestingly, the study (double-blind, placebo-controlled design, including blinded withdrawal of PPI) found that "greater than 40% of healthy volunteers who have never been bothered by heartburn, acid regurgitation, or dyspepsia, develop such symptoms in the weeks after cessation of PPI" (Gastroenterology, boldface added).
I am not the only one to believe PPIs are greatly over-prescribed. I have seen it in my friends, and I have seen it in my own family: Feeling a little indigestion? Let's put you on a PPI and dismiss it as that. As what?? My daughter was seen for an "nervous stomach" by a doctor while she was attending college. The doctor said "You must have a hiatal hernia" and prescribed Prilosec, and never saw her again. That was three years ago! She has been on Prilosec ever since, never knowing whether she actually had a hiatal hernia or not. When she stopped the Prilosec (expensive on a young adult's budget), she developed all the symptoms of withdrawal.
The internet abounds with forums and patient discussion groups regarding PPIs. Perusing a handful of these websites, I found some patient-oriented information with regard to PPI withdrawal:
- Taper off slowly to reduce stomach pain and hypersecretion of stomach acid
- Take Rolaids Antacid tablets as needed during withdrawal
- pH levels may be out of whack
- Food allergies and sensitivities may crop up
- May experience loss of appetite
- Trembling, shaking, "buzz"
- Troubles with Vitamin D and calcium defiencies to the extent of severe bone density problems
- Risk factor for Clostridium difficile -associated diarrhea
Incidentally, it is a known fact that "long-term use of proton pump inhibitors increases the risk of hip fractures in adults over 50" (Ray Sahelian, MD, "Proton Pump Inhibitor Drug benefit and side effects, safety, danger and risk").
I'm not saying all doctors over-prescribe medications, but I do think that both sides of the equation carry some blame. Most patients (particularly American patients) want a quick fix. If they don't feel well, they go to the doctor and get something for it. In an attempt to avoid expensive tests and follow-ups, many doctors will give the patient what he or she asks: a quick fix. There are many more factors and sides to this ideology, but that is not my purpose in writing today.
I do have to say that I think there is a big gap between the pharmaceutical industry and patient knowledge. Somewhere between those two points lies a gap that needs to be addressed and filled. The pharmaceutical industry is getting far ahead of the medical industry and governing the direction which doctors should take. Shouldn't the medical industry govern the pharmaceutical industry, rather than the other way around? Just my two-cents...
Recommended Further Reading: