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Binz
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Quote Binz Replybullet Topic: Timing PPIs and meals
    Posted: 29 May 2014 at 12:54pm
I'm currently on 2x20mg omeprazole and take 1 before breakfast and 1 before evening meal. I'm wandering if I should take the 1st 1 before lunch instead, as breakfast is just a bit of toast whereas lunch is sometimes the largest meal of the day.

Any opinions, advice ?

regards

Binz
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chrisrob
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Quote chrisrob Replybullet Posted: 29 May 2014 at 1:10pm
Although Richard believes that for him splitting doses and spreading them through the day works, experts disagree.

Since they work continuously and build up in the system, timing isn't critical. The advice is to take them at the same time each day simply t get into the habit. Half an hour before food will also ensure they reach the duodenum intact (aided by peristalsis of the food) to be absorbed into the bloodstream without being broken down by the stomach acid.

The dose of omeprazole required to achieve adequate intraesophageal acid suppression in patients with gastroesophageal junction specialized intestinal metaplasia and Barrett's esophagus.

CONCLUSIONS:
"The majority of patients with Barrett's esophagus were controlled with once daily low dose PPI and only a minority required twice daily dosing, regardless of the length of Barrett's mucosa."
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jcombs99
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Quote jcombs99 Replybullet Posted: 29 May 2014 at 8:43pm
Binz
   Play with the TIMEs but not the dose .I take 60mg per day 15mg before BK and 30mg before dinner and 15mg before sleep was PERFECT BUT changed to 30 and 30mg because I forget to many times @ bed time ....
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Pyrrhonist
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Quote Pyrrhonist Replybullet Posted: 30 May 2014 at 8:27am
> Play with the TIMEs but not the dose.

Not necesarily the best advise. There is a minimum dose size that will do anything. It may be better to take fewer larger doses. Also any one dose will be effective for a specific time. Google for drug half-life for more understanding!

No two people seem to be prescribed the same dose: there seems to be no "standard" dose. It seems to be an experiment to find out what works best for you!

There are lots of medical papers saying PPIs should be prescribed in the minimum effective dose - but there's no easy way to establish what's being effective!

Also I found that I was developing tolerance to PPIs - so the minimum effective dose will likely increase with time. If PPIs were that easy - this forum would be not nearly as busy!
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.
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Pyrrhonist
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Quote Pyrrhonist Replybullet Posted: 30 May 2014 at 8:37am
> Although Richard believes that for him splitting doses and spreading
> them through the day works, experts disagree.
>
> Since they work continuously and build up in the system, timing isn't
> critical.

Not quite... I did experiment with times. Initially I found 40mg had effect for about 20 hours (as my consultant had said). 20mG lasted about 17 1/2 hours (the half-life effect).

I found for me 16 hours between doses was most effective. 7 a.m., 11 p.m. then 4.p.m the next day.

I did experiment with 5mG doses. Subsequent experience showed that 5mG doses were doing essentially nothing. You need a minimum dose size to be effective - probably why the smallest available capsule is 10mG.

And yes - there is a build-up in the system. I found on paper that detected effects (if I remember correctly) up to 6 months after stopping.

My own feeling is that it took my system neare two years to fully recover - but that's entirely subjective and very difficult to substantiate.

It's not at all easy to keep dosing correct - especially as the goal-post changes with time.

Edited by Pyrrhonist - 30 May 2014 at 9:28am
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.
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Binz
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Quote Binz Replybullet Posted: 30 May 2014 at 10:34am
thanks all. I think i'll stick with even spacing but maybe if I know it's going to be a heavy lunch (Thursday is curry day in works canteen) will delay 1st 1 that day or do some Gaviscon as the starter.
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chrisrob
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Quote chrisrob Replybullet Posted: 30 May 2014 at 10:43am
If you know you'll be in for a troublesome day, it is OK to take an extra 20mg omeprazole pre-emptively.

And keep the Gaviscon for after the meal if needed, so it floats on top and reduces risk of reflux.
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jcombs99
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Quote jcombs99 Replybullet Posted: 30 May 2014 at 2:01pm
Dr. RT
    You should have a seat on the medical review board you have sense and you could save the NHS a lot of money but no common sense as per your posts .Maybe one seat will open up too on the Obamacare review board and you could be a double dipper also..

Jeff
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