Medicines for heartburn and reflux: how much for how long?
Proton pump inhibitors (PPIs) are used to treat a range of medical conditions of the stomach and oesophagus (food pipe). They are very effective medicines when used appropriately and, for many medical conditions, need to be taken for only a short time. If you have been taking PPIs for a while, ask your doctor to review them to make sure you are getting the best from these medicines.
What are proton pump inhibitors?
Proton pump inhibitors (PPIs) are medicines that decrease the amount of acid the stomach produces.
There are many types of PPIs including:
- Omeprazole (e.g. Acimax®, Losec®, Probitor®, Meprazole®, Omepral®)
- Lansoprazole (e.g. Zoton®, FasTabs®, Zopral®, Lanzopran®)
- Pantoprazole (e.g. Somac®, Gastenz®, Ozpan®, Salpraz®, Pantofast®, Pantoloc®)
- Rabeprazole (Pariet®)
- Esomeprazole (Nexium®).
Most brands are available in different strengths. The strength you take depends on why your doctor has prescribed the PPI and for how long you have been taking it.
Why are PPI medicines prescribed?
Proton pump inhibitors (PPIs) reduce the amount of acid the stomach makes, so they are used to treat a number of medical conditions in which stomach acid causes inflammation. The PPI reduces the acid produced, which allows the inflammation to heal. The most common condition for which they are prescribed is gastro-oesophageal reflux disease.
Gastro-oesophageal reflux disease
Gastro-oesophageal reflux disease (GORD) – you might call it heartburn or reflux – is a common problem which occurs when acid rises from the stomach into the oesophagus. This can cause pain and inflammation of the lining of the oesophagus.
PPIs can also be prescribed for other medical conditions including peptic ulcers, Barrett’s oesophagus or severe inflammation of the oesophagus.
For patients taking medicines that may cause ulcers or inflammation of the stomach, PPIs may be prescribed to help prevent this. These medicines include non-steroidal anti-inflammatory medicines (NSAIDS) and aspirin.
If you are not sure if any of your medicines is a proton pump inhibitor, ask your doctor or pharmacist.
What else can be done?
You might be able to help improve your reflux symptoms by:
- avoiding dietary triggers that you feel make your reflux or heartburn worse. These may include fatty or spicy foods, coffee or alcohol.
- eating smaller more frequent meals rather than large meals.
- not eating just before you go to bed or lying down after you have just eaten.
- losing weight if you are overweight.
- stopping smoking, as smokers are more likely to have reflux symptoms. Discuss quitting with your doctor or pharmacist.
Image of Stomach and Oesophagus (food pipe)
How long should I take a PPI medicine?
How long you need to take a PPI will depend on why it was prescribed for you.
Most people with GORD do not need to take PPIs continuously. To start with, PPIs are generally prescribed for four to eight weeks, which allows time for the oesophagus to heal. After the first eight weeks it is a good idea to talk to your doctor about your treatment. Your doctor may suggest taking a lower dose, or taking your medicine only on the days you have symptoms. Sometimes your doctor may prescribe a different type of medicine or suggest stopping the medicine altogether.
In some situations it may be necessary for PPIs to be taken long term. Generally this is for rare medical conditions or when you have been taking a medicine that can irritate the lining of the stomach.
Like all medicines, PPIs can have side effects so it is important to discuss these with your doctor. Although side effects are usually mild and uncommon, some can be serious. This is why PPIs should only be taken for as long as they are needed to treat the condition and at the lowest effective dose.
Stopping a PPI medicine may need to be done gradually.
Always talk to your doctor before stopping, starting or changing any of your medicines.
When should my PPI medicine be reviewed?
Ask your doctor to review your PPIs if:
- you have been taking your PPIs for a long time.
- your PPI medicine was first started while in hospital, and you are still taking it (it might have been needed only for the hospital stay and during initial recovery at home).
- You were initially prescribed a PPI and your symptoms have improved. You may be able to reduce your PPI treatment by:
- using a lower dose
- only using the PPI on the days you have symptoms
- stopping your PPI medicine altogether.
When PPIs are first stopped, some people may experience worse reflux, called rebound symptoms. If this occurs, talk to your doctor, who may recommend a more gradual approach to reducing your medicine.
For more information: Talk to your doctor and pharmacist.