Tips for tapering off stomach acid blockers or PPIs (esomeprazole, lansoprazole, omeprazole)

[Damianamae]

I successfully tapered off of Lansoprazole 30mg after taking it for 9 years a year or so ago because it caused me to have low iron. This is the system that I came up with (with my doctor's support) because I was terrified of rebound acid. Each week, I dropped one daily dose to 15mg and held for 3-4 weeks because I'd read that it takes 3 weeks for your body to realize that it doesn't have to produce as much acid. I tried to keep the days spaced out. Example, first day I dropped was Saturday. After three weeks, I dropped Tuesday as well. Etc. Once I got down to 15mg each day, I started the same thing with just not taking a pill one day a week. Then I started putting more and more days between them. I can't remember how many days between I was doing before I stopped entirely. I found that the rebound acid was worst on the day after the drop. To combat that, I used Gaviscon. 

 

I still need to use Gaviscon periodically, but it's nothing like when I was maxing out the daily dosage every single day thanks to work stress. 

[Altostrata]

Hi, Damianamae. Do you mean you skipped doses of lansoprazole?

[Damianamae]

I guess that’s what if amounts to, yes. I had read that there was powder inside so I didn’t want to open them up and I had no other idea of how to do it to help my body adjust.

 

I can delete my post if it’s seen as misleading to the other methods.

[Altostrata]

We just need a little more detail. How many capsules were you taking per day, at what dosage?

[Damianamae]

I started off taking a 30mg capsule once daily. When I was taking 15mg, they were also single capsules once daily.

[JackieDecides]

this reminds me my supposed taper of Omeprozole is stalled.

 

I started taking 2 pills a day and still take 1.5 a day months later but now I need 1 Ranitidine a day, almost always. so I've switched half an Ompeprazole for one Ranitidine, am I any better off? 

[ikam]

Preparing to tapper PPI, but unsuccessful 

I made a mistake by slipping a dose and adding betaine. 

I felt anxious, now I feel as if I was smoking cigarettes!!! Kind of burning... 

[Altostrata]

2 hours ago, ikam said:

Preparing to tapper PPI, but unsuccessful 

I made a mistake by slipping a dose and adding betaine. 

I felt anxious, now I feel as if I was smoking cigarettes!!! Kind of burning... 

 

Having read this topic from the beginning, what do you think you should do now?

[ikam]

1 hour ago, Altostrata said:

 

Having read this topic from the beginning, what do you think you should do now?

I need to tapper slowly, I think I will be opening the pills and count the beads... 

I have been on PPI for years, I want to stop. They caused me iron deficiency, anemia in the past... 

 

I am sure they have a bad impact on other aspects of my health... 

I was surprised last night with the symptoms I had, it felt like a short term WD... I had problems with severe sweating and generally I was waking up constantly... 

During the day, I had some strange excitation and anxiety... 

All this happened after skipping just one dose and adding betaine... 

 

I am unsure why I am so sensitive to betaine... I cannot also tolerate cider vinegar... 

 

I have been following a sensible diet, I have my bed risen, I have supplements, such as probiotics... 

I also noticed that I cannot eat a lot of things as I get severe nausea, I read that this may relate to being unable to digest as there is not enough acid in my stomach... 

 

I will wait few days now to stabilise and restart tappering really carefully... 

 

 

[Altostrata]

Please read the information we give you and use your common sense.

[ikam]

15 hours ago, Altostrata said:

Please read the information we give you and use your common sense.

Thank you Alto. I will... It seems that I am really sensitive to smallest changes in my protocol... Years of being medicated... 

[ChessieCat]

5 hours ago, ikam said:

It seems that I am really sensitive to smallest changes in my protocol

 

Please remember to only make one change at a time and if trying something new to start with a small test dose to see how you respond.  And it's also a good idea to do some research about it here (I use a search engine and add site: surviving antidepressants.org to my search term) and check for side effects and interactions at drugs.com

 

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

 

 

Edited October 13, 2020 by ChessieCat

[Sicksagittarius]

Hi @Altostrata

 

I've been taking 20 mg of omeprazole for months and increased it 40 mg of omeprazole within the past few months. If I gradually wean off of the omeprazole, since it apparently increases the lexapro in my system, will Iget stronger SSRI withdrawal symptoms because there wont be as much lexapro in my system? I'm on the trying to stabilize phase on 2.5 mg right now and its been helping. I've been having horrible stomach side effects from withdrawals such as diarrhea, stomach cramping and burning, extreme weight loss and malnutrition, limited diet etc. I want to heal my stomach problems and I learned from this thread that omeprazole is working against stomach healing. What do you recommend taking after I wean off omeprazole to stop any reflux or heart burn? 

[Altostrata]

I don't know how tapering omeprazole will affect the escitalopram in your system. For your other questions, please read this topic from the beginning.

[SkydiverSZ]

Hi,

 

What really helped me coming off my PPI was drinking Dandelion root tea, yarrow tea and sometimes liquorice tea. Just be careful with the liquorice tea as that can cause other issues if you drink too much. Also try avoiding tomatoes, sugar, carbonated beverages, alcohol and spicy food for a couple of weeks. I still drink dandelion root tea daily to maintain a healthy stomach. From the research I have done I have learned that omeprazole increases Lexapro levels by 90 to 100%. So if you are taking 2.5mg Lexapro with omeprazole it is like taking 5mg Lexapro. So you might want to raise your Lexapro slightly to avoid more withdrawal symptoms. Please keep that in mind when tapering omeprazole.

Hope that helps.

[JackieDecides]

15 hours ago, SkydiverSZ said:

From the research I have done I have learned that omeprazole increases Lexapro levels by 90 to 100%.

 

I never new that...maybe that's why when I stopped lexapro it was so hard. 

 

but I have YET to get off omeprozole. I went from 40 down to 30 but stopped there as the rebound heartburn was just too bad. 😕

 

and also I can't keep from drinking coffee. 

[SkydiverSZ]

I have found the study I was refering to: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297217/

 

During the time I was using escitalopram together with omeprazole my liver enzymes where raised. My GP put it down to my alcohol consumption. As soon as I was off the omeprazole my liver enzymes normalized. I now believe that my raised liver enzymes where caused by the combination of omeprazole and escitalopram. For anyone who is currently on this combination, it might be worth to get your liver checked.

 

It seems that a switch to lansoprazole would be a good idea as it only raises the escitalopram levels by 20% instead of omeprazoles 94%. 

 

@JackieDecides The rebound heart burn was difficult to deal with. The teas I have mentioned really helped with that. Also it was extremely important to stay away from any triggers. One piece of chocolate or a meal with tomato sauce would set me back weeks. You have got to know your triggers and completely avoid them for weeks to come. I am still careful with tomatoes and chocolate months after coming off of omeprazole.

[Miko789]

OnI 

 

The gastrologist gave stomach omepraxole and ibutine ppi . He said to take for a month  does it need taper the ibutine and ppi ? Read about in This thread had pain in stomach from pmed and stressor. One said gall bladder Anybody have this with shiprexa after long term use

7years use of pmeds prexat shiprexa. 

He concurred that was the culprit 

Hope my stomach dont get ulcer from cortizol.

Hope  gets ok.

 

 

 

 

[morgana]

hello i ended up with pancreatitis due to too much alcohol and when i came out of hospital 4 days later they gave me Esomeprazole 20mg, i didnt take it and ended up back in hospital a week later with chest pain and stomach pain, they told me to take it, i took it for about 4 weeks and ate mostly raw veggies with pasta and fruit and porridge, no meat or dairy. since than..it took a good year for my stomach pain to disappear...now days when i get chest pain, stomach pain i have usually eaten too much fatty foods such chocolate, butter, avocado's, creamy pasta dishes.. if the pain is too unbearable and i am finding it hard to sleep and breath i take a 20mg tablet usually that is enough to fix it,  until it happens again...probably need to take 1 or 2 tablets every couple of months or so... i also notice when i make changes in my taper off zyprexa which sometimes  causes me to have chest pains i find it helps with that too....just looked at pkt i got the prescription 0n 2nd Jan 2020 and i have taken 21 tablets from the pkt, so i dont use them very often..and i just looked at the use by date and its out of date....since june 2021...!....

dont know if what i have written has been any use to anyone but just thought i might add it...just in case it does

[Sicksagittarius]

On 5/22/2021 at 8:39 AM, SkydiverSZ said:

Hi,

 

What really helped me coming off my PPI was drinking Dandelion root tea, yarrow tea and sometimes liquorice tea. Just be careful with the liquorice tea as that can cause other issues if you drink too much. Also try avoiding tomatoes, sugar, carbonated beverages, alcohol and spicy food for a couple of weeks. I still drink dandelion root tea daily to maintain a healthy stomach. From the research I have done I have learned that omeprazole increases Lexapro levels by 90 to 100%. So if you are taking 2.5mg Lexapro with omeprazole it is like taking 5mg Lexapro. So you might want to raise your Lexapro slightly to avoid more withdrawal symptoms. Please keep that in mind when tapering omeprazole.

Hope that helps.

 @SkydiverSZ Thank you so much for this helpful information! Have you seen anyone on this site with the experience of tapering off omeprazole while tapering off lexapro I could tag to ask for their experience? Also, how would I figure out how much to raise my lexapro by and how much to decrease my omeprazole? Thanks!

[Sicksagittarius]

On 5/15/2021 at 6:40 PM, Altostrata said:

I don't know how tapering omeprazole will affect the escitalopram in your system. For your other questions, please read this topic from the beginning.

@AltostrataAccording to this journal article, (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297217/), Escitalopram  (lexapro) concentrations were significantly higher in patients treated with omeprazole by 93 percent. For some reason these two specific drugs interact and so I'm afraid of how to lower it in a timely manner without it putting me back into deep withdrawals

 

"most pronounced effect was seen when omeprazole or esomeprazole was combined with escitalopram, causing an almost 2-fold increase in the escitalopram levels. Thus, when omeprazole or esomeprazole is combined with escitalopram, it should be considered to reduce the dose of escitalopram. In contrast, the effects of the other PPIs on escitalopram and of all PPIs on citalopram and sertraline were so small that they could be considered clinically insignificant."

[Altostrata]

If you want to go off omeprazole, you will have to do it gradually and monitor the effects. If you feel you are getting withdrawal symptoms, it may make sense to increase escitalopram.

 

Please note you are taking only 2.5mg escitalopram. The liver enzymes involved in metabolized this tiny amount of escitalopram and whatever amount of omeprazole you're taking may be having no problems at all processing both drugs simultaneously. There may be no difference in escitalopram levels or effect when you go off omeprazole.

 

I doubt if any of the subjects in those studies were taking as low as 2.5mg escitalopram. They probably were taking 10mg, 20mg, or more.

[Altostrata]

Please keep this thread on-topic: Tapering off PPIs.

[Sicksagittarius]

On 5/22/2021 at 8:39 AM, SkydiverSZ said:

Hi,

 

What really helped me coming off my PPI was drinking Dandelion root tea, yarrow tea and sometimes liquorice tea. Just be careful with the liquorice tea as that can cause other issues if you drink too much. Also try avoiding tomatoes, sugar, carbonated beverages, alcohol and spicy food for a couple of weeks. I still drink dandelion root tea daily to maintain a healthy stomach. From the research I have done I have learned that omeprazole increases Lexapro levels by 90 to 100%. So if you are taking 2.5mg Lexapro with omeprazole it is like taking 5mg Lexapro. So you might want to raise your Lexapro slightly to avoid more withdrawal symptoms. Please keep that in mind when tapering omeprazole.

Hope that helps.

Hi again @SkydiverSZ

 

I've been tapering off of omeprazole and trying to decipher if stress or the taper are causing my WD symptoms, like unfocused vision. Did you taper omeprazole specifically while on lexapro and did you have WD increase? Thanks!

[Sicksagittarius]

has anyone had experience tapering off of specifically the PPI omeprazole while on the SSRI lexapro? I'm on 2.5 mg. I read lexapro can double in your system according to this journal article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297217/

 

However, if I'm interpreting it right, I think people of older age have the issue of doubled levels of lexapro in their system from omeprazole and not so much younger ages. My brain is slow right now so if anyone can interpret the article more clearly that would be much appreciated! Has anyone had had personal experiences with increased lexapro WD symptoms as they wean off of omeprazole?I'm trying to decipher if my symptoms could be related to that or if its my stress. 

 

info from article: 

-Age was associated with a significant increase in the C/D ratios for all the 3 SSRIs. the age effect was shown to be relatively low in the age range 20–60 years, whereas it increased considerably in the higher age groups

-For citalopram and escitalopram, the C/D ratios were roughly doubled in patients aged 80 year, 

-patients elder than and younger than 65 years were compared, the mean concentration of citalopram was 2.0-fold higher in those elder than 65 years. The corresponding ratios were 1.8 for escitalopram and 1.3 for sertraline

-age affected the C/D ratios significantly for all the 3 SSRIs.

[Miko789]

I took omeprazole for 2 days in a row, if i stop does it need to taper,??  i started for precaution though i feel much better now but i guess the two days in arow changed my stomach chemistry   and im getting my stomach upset  does it need to taper,?

[Erimus]

I’ve been on and off 10-40mg of omeprazole since around March 2016. I didn’t know it at the time but anxiety and stress at school were giving me IBS symptoms. Every time I went off it the symptoms came back with a vengeance, nobody explained the rebound acidity these drugs cause.

 

I cold turkeyed around 20mg in July 2019 because I was sick of taking a pill every day. Cue intense stomach pains due to the rebound acid. I went back on it because I thought I would need it for life.

 

In April this year (2022) I successfully reduced from 40mg to 20mg by a gradual slide. I counted beads in around 5 capsules and took an average. I wanted to spread the 20mg drop over a month so divided the number of beads by 30. It worked out at a reduction of about 0.71mg/day. I didn’t notice any rebound this time. This is how I’m going to taper down to 10mg.

[JackieDecides]

On 7/15/2022 at 9:48 AM, Erimus said:

In April this year (2022) I successfully reduced from 40mg to 20mg by a gradual slide. I counted beads in around 5 capsules and took an average. I wanted to spread the 20mg drop over a month so divided the number of beads by 30. It worked out at a reduction of about 0.71mg/day. I didn’t notice any rebound this time.

thank you for posting this, it's very good info. 

 

I haven't tried to reduce my long time omeprozole use lately (years!) but I'd like to again. 

 

one problem is the most affordable omeprazole I've found is a tablet, not a capsule. but if it works it might be worth the money to be able to taper. 

[ChessieCat]

2 hours ago, JackieDecides said:

thank you for posting this, it's very good info. 

 

I haven't tried to reduce my long time omeprozole use lately (years!) but I'd like to again. 

 

one problem is the most affordable omeprazole I've found is a tablet, not a capsule. but if it works it might be worth the money to be able to taper. 

 

To help reduce the cost you might be able to do a combination of a smaller sized tablet and capsule.

[Erimus]

5 hours ago, JackieDecides said:

I haven't tried to reduce my long time omeprozole use lately (years!) but I'd like to again. 

 

one problem is the most affordable omeprazole I've found is a tablet, not a capsule. but if it works it might be worth the money to be able to taper.

Hello @JackieDecides

 

Do you buy your omeprazole over the counter or is it a regular refill you get? In the UK you can get it OTC or on a repeat prescription. The 10 and 20mg capsules are relatively cheap here, both via prescription and online.

 

Its worth pointing out that in order to be successful in coming off you need to deal with the original reason for your reflux etc. If it’s caused by nervous system instability (due to withdrawal) it will be difficult to come off without problems until this regulates. A lot of people have reflux due to food sensitivities they are unaware of (gluten, lactose etc.), or low stomach acid. It can take a while to work out what the problem is.

 

Theres some good videos on YouTube by a man called Dr Berg about all this.

[Erimus]

These drugs (PPI’s) are only intended to be used for 6-8 weeks. They are very effective for short treatments to deal with acute symptoms. Sadly many people like you and I end up on them for years because medical doctors are uneducated on the underlying causes of gastric distress. They are meant as a temporary fix whilst you deal with the cause of your problem (poor diet, stress). Over time they actually make the initial problem much worse as they lower the acid levels in your stomach, creating a more alkaline environment. You end up with vitamin/mineral deficiencies and poor digestion, as well as worse problems.

 

Theres actually a test you can do to see if you have low stomach acid. It’s a baking soda test:

 

1. First thing on a morning on an empty stomach.

2. Mix about a teaspoon of baking soda glass of water and drink it. Start a stopwatch as soon as you do.

 

3. Time how long it is until you burp/belch. If you haven’t burped in 5 minutes you have likely have low acid levels.

This test isn’t the be all and end all. But if you’ve been on a PPI 10+ years it’s pretty likely you have low stomach acid regardless.

 

As I reduce my omeprazole I’ve been adding a small amount of apple cider vinegar in a glass of water into my diet.

[Erimus]

To follow up. I tapered my omeprazole dose from 20mg to 10mg in July using the same slide, as seen in my above post. It all went incredibly smoothly, except for a setback when I caught covid. I’m now on 10mg which is a hard tablet. When I want to come off it after the sertraline I’ll ask to be prescribed the 20mg capsules so I can precisely create the required doses with much more ease. 

 

None of this would have been possible without the sort of nervous system stability I currently have, which I haven’t had in around 16-18 months. The last 2 years have been a hell of a learning journey regarding prescribed medication, digestion, diet and gut health. It’s been horrible but I would never have found out that I needed to stop PPI’s without this injunction from psychiatric medication.