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mytube
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Quote mytube Replybullet Topic: Side effects of medication
    Posted: 27 Jun 2011 at 8:28pm
I am experiencing lousy side effects from the medication but my GP seems to think that these are most unusual (in spite of the common side effects listed on the leaflet).

20mg Omeprazole was OK for a month, then I felt ill and had horrible buzzy scalp headaches that kept me awake at night. I've switched to 15mg Lansoprazole and felt much better for the first week, but the wretched headaches - just normal persistent ones this time - and ill feeling is back plus I've had one episode of real scary room turning dizziness and a general feeling of wooziness and blurred vision at times. The thing is that I've never had heartburn or anything but one or two episodes of acid reflux that I've ever noticed so the treatment is far worse than the symptoms.

Anyone else getting side effects or is it just me? I'm tempted to stop taking the pills and return to my previous state of good health and happiness before I had the endoscopy. But maybe I shouldn't? And maybe the side effects fade after a while?

I'm told I have 2cm Barretts.
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jcombs99
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Quote jcombs99 Replybullet Posted: 27 Jun 2011 at 9:02pm
OMEPRAZOLE is very CHEAP (25% of Mine) that's why your on it ..But PRICE doesn't matter BECAUSE it makes you sick ,Demand another and another ppi till you find one that doesn't make you sick ( 2 weeks should tell)..I'm on Precvaid which works for me but Doesn't for YOU...TAKE A PPI...LOOK FOR A GOOD ONE !!

HGD JEFF

Edited by jcombs99 - 27 Jun 2011 at 9:09pm
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johnd
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Quote johnd Replybullet Posted: 27 Jun 2011 at 11:09pm
I think maybe you should get your GP to give you the standard NHS blood tests. I did and they showed up a small calcium deficiency which is consistent with reduction in stomach acid.

I'm taking calcium and iron supplements just to head this off and I'm fine.

I also split the PPI dose over several smaller ones, which means opening up those capsules. For me, it means I need less PPI, a total 20mg Omeprazole or less.

There is a problem here which is there is no rule for how much PPI you need. Is it alleviate symptoms (which you don't have), or is it to reduce acidity to prevent further Barretts? Personally, I think if you taking enough PPI to eliminate symptoms, that is enough and no more. But there is not much clinical wisdom in this area of PPI dosage.

55yo, diagnosed 2011 at 5cm Barrett's, 3cm as at 2013 (?), so far non-D
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chrisrob
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Quote chrisrob Replybullet Posted: 28 Jun 2011 at 8:14am
Hi Mytube,

Sorry to hear of your side effects.

Although PPI's are powerfully effective drugs for controlling acid secretion, they can have numerous side-effects. (I posted this list a couple of years ago.)

Discuss this with your doctor. There are alternative drugs. You've tried Omeprazole and Lansoprazole. Pantoprazole is found more tolerable by some.

But I do caution you not to experiment with your doses without discussing it with your doctor. A couple of members on this forum have found that splitting doses "works for them" but this is contrary to accepted practice based upon how the drugs actually work.

They're not like paracetamol, for instance, which act immediately and have a short lifespan.

A single dose of PPI remains about 90% effective for about 3 days and subsequent doses within that period help maintain a level of inhibition of proton pump production having no different effect whether they are trickle topped up or taken at one go.

2 cm Barrett's is a fairly "normal" sort of size. and I would guess you would be on a fairly "normal" dose of omeprazole: perhaps 20 - 40 mg. There may be a danger in reducing that in that not enough acid production is suppressed and, though you may not feel it, it may continue to attack the columnar epithelium producing dysplasia or the squamous epithilium increasing the size of your Barrett's metaplasia.

So please do discuss this with your doctor.

Chris
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RichardT
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Quote RichardT Replybullet Posted: 28 Jun 2011 at 8:29am
As John D says, there is no hard and fast rule as to how much PPI any person needs. Older people generally need less than younger. However whatever dosage you do need, taking it in small doses over the day is much more effective than taking it as one or two large doses - and should also mean the total you need is reduced.

The theory behind that is all explained on my www site. There's also a link there to a summary article which explains the differences between the various PPIs.

Wikipedia has an article on low calcium http://en.wikipedia.org/wiki/Hypocalcaemia - it doesn't seem to match your symptoms.

What I also believe (but have yet found no proof of) is that most side effects of PPIs are likely to be in proportion to the maximum size dose you take. In my case the side effect was bile relux - which is not only horrible, but also potentially as bad as acid reflux.


But we'd all like to know why you are on PPIs - some of your history helps us to help you!

Edited by RichardT - 28 Jun 2011 at 8:30am
www sites and contact:
www.Torrens.org.uk/Med/
www.GreenBottom.org

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chrisrob
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Quote chrisrob Replybullet Posted: 28 Jun 2011 at 8:41am
Richard: "However whatever dosage you do need, taking it in small doses over the day is much more effective than taking it as one or two large doses - and should also mean the total you need is reduced." Where is the research for this? It is totally contrary to the way PPI's work.

Some side effects may increase with larger doses of PPI.
In my own case, although I used to suffer horrible bile reflux initially, that actually diminished when my dose was increased to 80mg. However, the effects of hypochlorhydria (particulalry non-absorbtion of minerals) increased considerably. But I will not make unqualified assumptions based on my experiences to provide advice to others.
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RichardT
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Quote RichardT Replybullet Posted: 28 Jun 2011 at 8:41am
> A couple of members on this forum have found that splitting doses "works
> for them" but this is contrary to accepted practice based upon how the drugs > actually work.

Yes - it's contrary to accepted practise. However it is totally consistent with all the theory of how the drugs work that I can find. With the slight proviso than initially a higher dosage may be needed to kick it into operation.

Yes, discuss it with your doctor. But if you are prescribed say, 30mg per day - no doctor should object to your taking 3 separate doses of 10mg. I discussed this dosage with my doctor, and the reasons. She agreed that I could be right. The consultant said she was glad I'd found a regime that worked for me.

The doctors will experiment with you by trying larger doses, different drugs. Smaller . more frequent doses is just another experiment, backed up by theory. I have yet to find a doctor who is aware of the drug's half-life.

Yes - I am on 3 separate 5mg doses. A bit of a pain splitting a 10. But it seems to be more than I need. I've missed an occasional dose and gone 48 hours on 2 doses! Then I chickened out.

Doctors prescribe PPIs by the bucket load and there are very few people who have problems. The doctors think it's safe! So as you have problems - you should indeed let the doctors know it's not as simple as they think.


www sites and contact:
www.Torrens.org.uk/Med/
www.GreenBottom.org

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RichardT
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Quote RichardT Replybullet Posted: 28 Jun 2011 at 9:31am
PPIs are a 'pro-drug': the actual chemical is metabolised in the body into the active form.

PPIs are cleared by the liver. Half-life of that clearasnce is said by various sources to be between 0.5 and 1.0 hours. So a high concentration in the blood is cleared fast by the liver.

Some of the PPIs are absorbed by the parietal cells (these are the cells that produce acid). There they are irreversibly bound to the H+/K+-ATPase enzyme that is the proton pump.

These cells cannot then produce their acid and to produce acid, new cells must be produced. The half life of this process is around 50 hours. It's a natural roces = all bodily cells die and are replaced by new.

To maintain the acid suppression, new cells must be 'poisoned' as they are produced. This takes only a very low level of the drug in the bloodstream. It's clearly more efficient if the drug concentration in the blood is constant, but that's impractical.

Or you can wait a whole day for a whole bunch of new cells and poison he whole lot by a large dose. Nor nearly as efficient - because of the high level in the blood, nmost of the PPI is cleared by the liver before it can work.

All of this is biochemistry rather than medicine. To find papers you have to look for biochemistry and pharmacodynamics rather than at medical research.

I can easily elaborate on the above, but it gets rather to technical for a short answer. I may put it on a www page.


It is also a fallacy that no acid is best. Ideally one would balance the acid level at a point just low enough not to annoy the oesophagus. I was told this is a PH of about 3. Again, not very practical: it would involve poisoning most but not all of the parietal cells. And swallowing a pH monitor, I suspect!
www sites and contact:
www.Torrens.org.uk/Med/
www.GreenBottom.org

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mytube
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Quote mytube Replybullet Posted: 28 Jun 2011 at 9:36am
Thanks so much for your kind replies. What I don't know is if the side effects settle down after a while as the body gets to tolerate the invasive drugs. Is there anyone out there who had headaches at first but these have diminished? And if I keep swapping, how long should I put up with each drug? I so wish that I was like the general population it seems who feel well on them. I'm finding it hard to work feeling ill but I can't give up my job. And are these drugs anticholingeric does anyone know? New research warns against combining drugs which are - and I'm taking codeine to get me through the day.
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johnd
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Quote johnd Replybullet Posted: 28 Jun 2011 at 9:39am
Chris: "A single dose of PPI remains about 90% effective for about 3 days"
I'm curious, because if that is correct then, in all honesty, splitting the dose would be ineffective. Is there a sound research basis for that statement?

In my own experience, if I stop taking PPI's I start to feel something well within 24 hours.

Coming back to the original poster, whose blurred vision is probably getting blurrier by the minute reading this forum, he/she could reasonably ask the doctor to check out for side effects, amongst which could well be mineral malabsorption.
55yo, diagnosed 2011 at 5cm Barrett's, 3cm as at 2013 (?), so far non-D
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