‘PPI use was recently reported to increase risk of death.
The results were significant and the methodology robust.’
– NPS Medicinewise
The drug was originally designed to heal ulcers. Yet everyone knows someone taking a PPI for indigestion.
Its overuse finally rang alarm bells and recently long-awaited changes came into effect for all PPIs listed on the Pharmaceutical Benefits Scheme (PBS) – esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole.
Changes to restriction levels, terminology, clinical criteria and number of repeats have been made thanks to the Pharmaceutical Benefits Advisory Committee (PBAC) “agreeing that high-dose PPIs are overprescribed in Australia, for excessively long periods of time…”.
Unless you have been diagnosed with hypersecretory conditions, including scleroderma oesophagus or erosive oesophagitis, you should not be taking PPIs. Luckily the PBAC changes now make it clear that severe GORD conditions require a clinical diagnosis, like endoscopy.
The changes are intended to improve the appropriate prescribing of PPIs, and yet visit your GP and the news hasn’t filtered through.
You only need mention indigestion and out whips the script for a PPI. Often it isn’t tracked and patients end up staying on it for years, long after their bout of indigestion, which is normal, has resolved.
The reality is PPIs should be given only to those who have a real need. It should involve a gastroscopy by a specialist and a recommendation for “short-term” use of the PPI.
The patient should be advised diet is key to preventing reflux. Yet many are too quick to tell us to pop a pill instead of changing dietary habits.
We should be more scared of the side effects of PPIs than we are to eat less and consume fewer trigger foods (spicy, fatty, sugary).
So if you’re on a PPI, here’s the advice from the PBAC: Diet and lifestyle modifications may be sufficient in people suffering mild and intermittent gastro-oesophageal reflux symptoms (no more than one episode per week).
Think back to when you were prescribed the drug. Were you asked to modify your diet or was the script just written out and you’re now on it for life?
I was among the lucky ones, for want of a better phrase, that reacted badly to PPIs after a gastroscopy revealed erosive gastritis. I was told to take it for 4-8 weeks, then repeat the gastroscopy to see whether the ulcers had healed. They had.
It took me four months to get off the drug safely. Yes, twice as long as the time I was on it. And for all that time the side effects were frightening. I experienced extreme joint pain, nausea, headaches, water retention, heart palpitations and sweats. My blood pressure dropped to 87/49 and I was dizzy 24/7. Worse, within two months on the drug I gained three kilos. In the four months it took to get off it I gained another two. Yes, five kilos and yet the average weight we put on a year is less than a kilo.
TAKE UP THE CHALLENGE
It’s time to pump up the volume on getting off PPIs. This month’s HealthStorylines challenge is to seek help from your GP to quit the drug. It may take months and you’ll need to interchange your PPI with a H2 blocker. That is, take one PPI one day, H2 blocker the next in the first week. Each week you’ll swap out the PPIs for more H2 blockers until you’re only using a H2 blocker. Then gradually wean yourself off the H2 blockers in the same way until you are off them completely.
It’s a good idea to get a referral to a dietician at the same time you wean yourself off the drug. Eating a healthy diet and using over-the-counter aids, like Mylanta or Gaviscon, will help reduce reflux rebound.
You owe it yourself to feel great. As a Health Care Ambassador for Health Storylines it is important to be part of the movement to raise awareness of living a healthy life. Education is key to becoming your own health advocate. You can improve your quality of life through your own data. It’s as easy as tracking symptoms via a journal, or diet log.
Join me here each month in health challenges that are easy to achieve. It’s never too soon to keep your health in check. Just click on this link to get started.
RoamingRAVE has used the Health Storylines app since being diagnosed with midgut neuroendocrine tumours in 2016. After more than a year documenting her health, she was invited to become a Self-Care Ambassador as part of a pilot to encourage others to track their health.