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What You Should Know About PPIs for Acid Reflux

Image of What You Should Know About PPIs for Acid Reflux
Image of What You Should Know About PPIs for Acid Reflux

Your acid reflux symptoms started innocently enough.

Sure, you’d deal with some uncomfortable heartburn after indulging in those buffalo wings that you knew you shouldn’t have eaten in the first place. But, you figured you could pop a few antacids and be fine.

Since then, though, you’ve noticed that your acid reflux is something that seems to be more chronic. You’re burdened with heartburn at least once a week, and sometimes it seems like even the mildest of foods can still inspire misery.

Acid reflux, which is also commonly referred to as gastroesophageal reflux disease (GERD), occurs when the sphincter that connects your esophagus to the upper part of your stomach becomes weakened or doesn’t work the way it’s supposed to.

This means that stomach acid can flow backward into your throat and cause a ton of not-so-pleasant symptoms—including heartburn, difficulty swallowing, and a bitter taste in your mouth.

Sporadic heartburn is incredibly common (the American College of Gastroenterology reports that over 60 million Americans experience heartburn at least once a month), and is usually nothing to be overly-concerned about.

However, when you realize that your acid reflux symptoms have become more persistent and severe (despite your efforts to make lifestyle changes and avoid your food triggers), it could be time to go beyond antacids and look at stronger, more preventative treatments—such as proton pump inhibitors.

What is a proton pump inhibitor (PPI)?

Proton pump inhibitors (PPIs) are medications that ease your acid reflux symptoms by reducing the amount of acid that’s produced by your stomach.

As the International Foundation for Gastrointestinal Disorders explains, there are numerous types of PPIs available (including many with brand names you’ll recognize). These include:

PPIs can be available over-the-counter (OTC), while some require a prescription from a doctor. In fact, many PPIs offer both versions—one that’s prescription and one that you can buy off the shelf (such as Prilosec and Prilosec OTC, as just one example).

So, what exactly is the difference between OTC and prescription PPIs? This typically relates to their indicated usages and dosage strengths, as opposed to their active ingredients.

For example, Prilosec OTC delivers the same medicine at the same dose as prescription Prilosec. However, the drug manufacturer states that prescription Prilosec is indicated for acid-related conditions that Prilosec OTC is not.

You may also be able to get a greater dosage of a PPI with a prescription. Zegerid OTC® is available in 20 mg strength, but you can obtain a prescription for 20 mg or 40 mg.

How do PPIs work to help acid reflux?

PPIs block acid production in the stomach—but how?

When you eat, your stomach’s acid pumps (or, to get really fancy, the parietal cells) are activated by the expansion of your stomach wall. After all, stomach acid is a big part of how we digest our food.In fact, just reading this article that mentions food is enough to get your body to start creating acid — no, really! — that’s why it’s so important to take them 30 minutes before you plan to eat.

PPI use essentially blocks these gastric proton pumps from producing acid—which reduces your acid reflux symptoms.

How do you take PPIs?

PPIs are most commonly offered as pills or capsules that should be swallowed whole.

For best results, it’s recommended that most PPIs be taken on an empty stomach—usually 30 minutes before you eat anything. This gives the medication enough time to shut down those pesky acid pumps that could cause you all sorts of discomfort.

Of course, directions can vary depending on which PPI you’re taking. Consult the instructions on the package to ensure you take the medication exactly as directed.

Are PPIs the strongest medication for acid reflux?

Yep, PPIs are the most powerful way to address symptoms of GERD and acid reflux . That’s because they fight the problem at the source: your stomach acid.

You might expect all that impact to come with some significant side effects, but (spoiler alert!) that’s actually not usually the case, especially when it comes to short-term use.

What are the common side effects of PPIs?

PPIs can provide a lot of acid reflux relief, and fortunately, they don’t come along with a ton of dire side effects.

A study about the safety of various drugs used to treat acid-related disorders that was published by the Gastroenterology Clinics of North America states that PPIs are generally well-tolerated, but that the most common side effects of PPIs include:

With that said, some research indicates that extended use of a PPI (for a year or longer) could be associated with some more severe risks, such as:

  • Acute and chronic kidney disease
  • Increased risk of bone fractures
  • Pneumonia

If you’re concerned about potential side effects or interactions with any other medications you’re currently taking, it’s best to speak with your doctor about what you can expect.

Who should take PPIs?

When it comes to acid reflux, PPIs shouldn’t be the first thing you turn to for relief. Most people with sporadic symptoms have great success with less severe options, such as antacids or H2 blockers (like Zantac® or Pepcid AC®).

However, people who struggle with more frequent heartburn might need a PPI to better prevent this intense level of discomfort.

According to Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation, you might need a PPI if:

  • You experience heartburn at least twice a week for several weeks
  • Food or acid often come back up into your throat
  • You take antacids or H2 blockers and you make the recommended lifestyle changes (more on those later), but your heartburn still doesn’t go away

Who shouldn’t take PPIs?

Again, PPIs are intended for people who struggle with chronic acid reflux symptoms—and not for people who want relief from an occasional or mild case of heartburn.

Beyond that, there aren’t many people who are excluded from being able to take PPIs. The FDA has even approved certain PPIs for use in pediatric patients.

Can you take PPIs if you’re pregnant?

Yes, PPIs are even reportedly safe for women who are pregnant.

One article published in Gastroenterology and Hepatology says that all PPIs (with the exception of omeprazole) are classified as category B drugs by the United States Food and Drug Administration (FDA)—which means they’re perfectly fine to use during pregnancy.

Omeprazole is classified as a category C drug . However, since that classification, numerous other studies have concluded that omeprazole is just as safe as any other PPI when taken during pregnancy.

When should you talk to a doctor?

It’s best to speak to a doctor before even taking a PPI, so that you can explore all your options and be sure that medication is the right choice for you.

The Mayo Clinic states that if you’re experiencing things like frequent heartburn, trouble swallowing, nausea or vomiting, weight loss, and symptoms that persist despite OTC medications, set an appointment with your doctor when you can talk through your symptoms and the best course of action in treating them.

Of course, you should also call your doctor immediately if you begin taking a PPI and experience any adverse reactions or side effects.

What PPIs does Evens offer?

Evens currently offers four types of FDA-approved PPIs:

Omeprazole and Esomeprazole are offered in either an OTC version (20mg dosage) or as a prescription (40mg dosage). Rabeprazole and Pantoprazole are available only in prescription strength (20mg dosage).

What are other treatment options?

When it comes to treating your acid reflux symptoms, PPIs are often looked at as the last resort. That’s for good reason—there are plenty of other (less severe) treatment options available, including:

  • Antacids: These are taken when you’re already experiencing heartburn symptoms. They’re available in tablet or liquid form and neutralize your stomach acid — which provides some relief from that burning sensation.
  • H2 blockers: These lower the amount of acid that your stomach releases while simultaneously protecting and healing your esophageal lining. They can be taken to control symptoms that you’re currently experiencing, as well as a preventative measure. While they tend to work faster than PPIs, they’re not as long lasting.
  • Lifestyle changes: Things like losing weight, eating smaller meals, and stopping smoking are good for your entire body, but they also reduce the amount of strain on your lower esophageal sphincter so your stomach acid stays where it belongs.

That’s not all. There are also tons of different home remedies (from chewing gum to drinking ginger tea) you can try to ease your acid reflux symptoms—before resorting to a PPI.

PPIs are a great option to prevent your acid reflux symptoms. But, that doesn’t mean they’re the right choice for everybody—and, much like with any other medication, it’s important that you’re informed about the ins and outs before adding it to your own regimen.

The above questions and answers will at least inform you with the basics so that you can ask your doctor informed questions (and, of course, be extra-impressive when you whip out the term “proton pump inhibitor”).

The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Esomeprazole, Omeprazole, Pantoprazole, and Rabeprazole are oral medications used to treat gastroesophageal reflux disease (GERD; acid reflux). Tell your doctor if you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. Tell your doctor if you are taking any of these drugs: atazanavir, clopidogrel, nelfinavir, rifampin, rilpivirine, or St. John's wort. Do not start, stop, or change the dose of any drug without checking with your doctor. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: headache, falling asleep, abdominal pain, diarrhea, constipation, gas, dry mouth, upset stomach. Full prescribing information for esomeprazole is available here. Full prescribing information for omeprazole is available here. Full prescribing information for Pantoprazole is available here. Full prescribing information for Rabeprazole is available here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: or call 1-800-FDA-1088.