Thursday, May 6, 2010

Omeprazole (Prilosec) Withdrawal

Writing often helps me to sort out my thoughts.  It has been that way for my entire life.  If I want to figure something out, all I need to do is start writing.  And true to form, while writing my weekly recap it suddenly occurred to me that the strange stomach aches and trembling I had been feeling for the past couple of weeks might be connected to my cutting back on Prilosec, as per doctor's orders.

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
  • Heartburn
  • Acid reguritation
  • Dyspepsia

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:


Colleen (W5211) said...

Thanks for you helpful comments. I will try the withdrawal gradually as you suggest.

Tara Finlay said...

I found your site googling for the withdrawl symptoms. I stopped taking omeprazole five days ago. Doing pretty well- I do have some rebound reflux but I am using Apple Cider Vinegar with really good results. I found the information about it here: . It is likely you have overcome your difficulty but maybe someone else finding this might find the link useful. I do not have the trembling, but I do seem to have developed Orthostatic Hypotension (the ACV apparently can cause low blood pressure) and I am having skin itching. That seems to be MY particular brand of withdrawl symptom.

Katie said...

Vinegar and Water is a great action to take with reflux. I did this myself for quite a while and recommend it!

Anonymous said...

Wow, I am so glad I stumbled across this. I was taking Prilosec for about 8 weeks also, after an endoscopy for Celiac (which I have) showed that I also Acid-reflux, which I never had a symptom of. I just realized I never checked to see if Prilosec was safe since the same doctor diagnosed both. When I stopped taking the Prilosec last week I was itching like crazy, and attributed it to something else. I took a Benedryl, which my body didn't like to much either but it stopped the itching at least so I could sleep. I think we are all just hyper-sensitive to chemicals and have to live as chemical and gluten free as we possibly can. Thanks so much!

brainhoney said...

I decided to take myself off of Prilosec. It has been quite a journey -- these last two weeks. I began using apple cider vinegar (2tbs. in a large glass of water). It was helpful and I still use as needed. I am currently experiencing intermittent pain in my lower jaw with heaviness in my stomach, but with each day, it becomes less. I wish I had done this years ago.

Ron Bailey said...

This is great information!
I have been off Priolsec for three weeks and will never use it again. My reasoning comes from extensive research on the side effects and the potential dependency on the product.

It's concerning that with such side effects and dependency potential, most Dr. do not monitor the use of such drugs.

I too have incorporated apple cider vinegar into my diet. You should do this with self control as well as overuse of this product can cause its own issues.

Stefan Schultze said...

Dear Katie, I am experiencing weird shaking and trembling after I stopped 6 weeks of Lansoprazole. Its like my entire body gets tight, I feel my heart beat due to that, my hands and feet shake and sometimes my hear beat gets up and I feel dizzy-spaced-out. This is going on for 11 days now since I took the last (tapered down oral soluble pill) of Lansoprazole. I almost feel like this could be some sort of withdrawal symptoms. I got exactly the same feeling once I took 2 weeks of Nexium and when I quit I had this same weird flu like shaking, no appetite, depression, trembling etc. What the hell is this? I don't seem anyone on the web getting this except the normal acid rebound (which I get too). Am I crazy or am I experiencing real withdrawal symptoms. Would help a lot to hear someones experience. Stefan

pnanna said...

Ok then... I have suffered from GERD for over 30 years. Went the Rolaids and Gaviscon route until nothing helped. No acid and feeling fine until something as simple as a cup of water and Mt. Vesuvius would erupt! Began using Prilosec about three years ago. Read the warnings and found that cutting the 20mg OTC tablets in half, once in the morning were all that was needed for relief. After a possible C Diff infection alert, I tried cutting back and WHAM O! Within 24 hours the GERD was back with a vengeance. Tried Tums and other more "benign" remedies but got all bloated and feeling real crummy. Spaced out and very low energy unusual for me. Will try the cider approach cause now I don't even want to eat food for the backlash.

The Only Cigar in the Box said...

Getting off Nexium now after having been on and off it for the past 1 1/2 years. Most of the time, I took it for a week or two, then jumped off. Only ill effect of acid rebounding was the return of my late-night heartburn with a vengeance. Honestly, it seems worse than it ever did before I started taking Nexium. (Also, I would like to note that until recently, I was taking Nexium at night, generally on a full stomach. To get the full effects of a PPI, you are supposed to take it in the morning before eating anything. I started taking it "properly" very recently.)

During my very last stint on this PPI, I took Nexium for an extended period of time - somewhere between 8 and 12 weeks. Six days ago, I stopped cold turkey, and the acid rebounding has been harsh. Dyspeptic symptoms started kicking in after 2 - 3 days off, and really got bad on days 4 and 5. I'm seeing some lessening of symptoms now on day 6, but still not out of the woods.

My PPI withdrawal symptoms:

- Constant nausea / upset stomach
- Loss of appetite (due to nausea)
- Plenty of gas and bloating
- Sore stomach (probably due to constantly keeping it contracting due to gas, bloating, and nausea)
- Return of nighttime heartburn with an increase in intensity

Also seem to be having some weird "spaciness" feelings every so often.

Why cold turkey? Why am I not tapering?

Honestly, in retrospect, I have seen an uptick in my anxiety over the past year and a half, and I attribute it to Nexium. And during my last 8 - 12 week stint on Nexium, my anxiety shot through the roof, to the point where I was having panic attacks. I have been on no other medications, aside from the occasional tylenol or ibuprofin. And while most doctors would dismiss my claim that Nexium can exacerbate anxiety/depression, I will stand by my story that this is a side effect of the drug.

Nancy said...

I am so relieved to hear other people withdrawing from proton pump inhibitors have experienced that trembly, spaced out feeling! (I also have a persistent, low-level headache). I started tapering my OTC Prilosec by slowly substituting OTC Zantac 150 (which reduces acid by a different mechanism), as my gastroenterologist had directed . I thought perhaps I was experiencing side effects of Zantac, so first I tried OTC Zantac 75 to see if i would have a reduction in symptoms. No difference. Then I swittched to extra strenghth Pepcid. No reduction in symptoms. I have concluded my symptoms are purely drug withdrawal. I am fortunate that I do not seem to have acid rebound, although I have been taking Prilosec for over 10 years. When I am completely off Prilosec, I will taper off Pepcid until I am, hopefully, drug free.