Alternatives to PPI Therapy
Alternatives to proton pump inhibitor therapy (PPI therapy) exist that can provide patients with relief of symptoms without the long-term dangers. These may include antacids, H2 blockers, herbal medicine and dietary modifications.
The most common alternative to proton pump inhibitor therapy is antacids, which can be purchased over-the-counter and work by neutralizing stomach acids to relieve heartburn and acid indigestion symptoms. Unfortunately, they only address symptoms without addressing the underlying causes of these issues.
PPIs may cause rebound hyperacidity and side effects such as diarrhea, headaches, and gastrointestinal disturbances. Although these reactions are usually mild and do not interfere with daily activities of a patient, they could pose challenges when trying to discontinue taking PPIs.
These side effects can be challenging to manage, and many people struggle with discontinuing PPI use. One study revealed that only 25% of long-term users were successful in quitting successfully.
If a patient is having difficulty discontinuing a PPI, they should speak with an integrative medicine specialist about herbal remedies that may help. They could also try tapering off of the drug gradually and monitor their symptoms closely for any return of GERD symptoms.
Some experts believe antacids can be effective for treating occasional heartburn, but they do not prevent or cure GERD and may actually make the condition worse over time.
There are some concerns with long-term use of a PPI, including an increased risk for pneumonia, bone fractures and enteric infections; and the potential interaction with clopidogrel that could increase cardiovascular events. To minimize these risks, patients should adhere to the FDA’s Beers Criteria for Safe Use of PPIs according to their age and medical condition.
PPIs (Protein Phosphatases) are metabolized in the liver by specific enzymes (primarily CYP2C19 and 3A4), so a person’s hepatic chemistry can affect how well these medications work. Some individuals are better metabolizers than others; this may affect efficacy of the drug but has little bearing on clinical outcomes.
If a patient’s liver enzymes are impaired, they may need to switch their PPI type. Lansoprazole, for instance, has more potential to be metabolized poorly than omeprazole and thus patients who require high doses of omeprazole should take lower-dose lansoprazole instead.
For most patients, a once-daily dose is sufficient when taking a PPI. However, those with severe symptoms or those taking another medicine might require to take their dose twice daily.
These drugs may interact with other medications and supplements, leading to serious side effects. For instance, they can alter how clopidogrel (generic Plavix) works and lower blood-thinning levels of this drug – increasing the risk of heart attack or death in individuals who already have low levels.
They can also affect the absorption of certain vitamins, such as vitamin B12 and calcium, leading to a shortage in these essential minerals in the body.