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Tapering Pantoprazole

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Posted 10/4/2017 1:49 AM (GMT 0)
I've been dealing with gerd for a few years now.

It started when I was having what I call "nausea episodes". I was also dealing with other symptoms such as "regurgitation" and burning of the throat. I didn't know what it was, so I saw my medical doctor as to what to do to treat it. He suggested I take the Prilosec OTC, which helped. I did the 14 day course and I was feeling better. So as per the label, I stopped taking it after completing the 14 days. Unfortunately, my nausea came back so the MD referred me to a specialist to find out what was going on (GI Doc).

So the GI doc did an endoscopy (back in 2014) and found out I am hyper-acidic and confirmed a diagnosis of GERD. My GI started me on Pantoprazole 20mg in the AM (before breakfast) and Gaviscon for breakthrough. about a month into my treatment, I was still having some troubles balancing my symptoms. So the doc increased my Pantoprazole to 40mg/d and added Pepcid 40mg at bedtime for the breakthrough. (and to continue Gaviscon as needed)

This change worked really well for me at controlling my GERD until around Nov. 2016. The nausea started to come back again so I went to the GI, he increased my Pantoprazole to 40mg twice daily and the Pepcid 40mg at bedtime.

This controlled my symptoms and he had me on this regimen for 6 months. When I saw him again and told him how well I was going, he was happy with my progress. He was concerned for me in the long term. (side effects), so he started having me taper the medication. I started by alternating between taking the double dose pantoprazole (80mg/d) and 40mg/d. I was able to manage this, so I stuck at 40mg/d for a while.

I saw my GI (on 9/11/17) and told him how I was able to adjust from taking 80mg/d to 40mg/d and was happy. So since this appt, he reduced my pantoprazole further. I take 40mg one day and 20mg the next. (back and forth). (and continue the pepcid 40mg bedtime)

The first 3 days I had some nausea which I figured might happen after learning about acid rebound. Then after the 2nd week into this, I've had some on and off symptoms.

I forgot to ask, but I think the ultimate goal is to get off of the Pantoprazole and just use my bedtime Pepcid to control my GERD/Acid Reflux.

Any tips on how to continue to adjust? If you have any questions, please ask, I may have missed something.

Thanks.
Posted 10/6/2017 7:31 PM (GMT 0)
I'm still adjusting to the taper of the pantoprazole my GI doc made last month.

I'm alternating between 40mg and 20mg a day.
I still take my Pepcid 40mg every night at bedtime.

I'm split on how I feel about the taper of the Pantoprazole. Part of me wants to continue the taper (he has given me 3 months to adjust to the 20mg/d) and the other part wants to go back up to 40mg/d. I still feel comfortable continuing my Pepcid 40mg at night, as I feel it does help me with my acid reflux.

Did I forget something from my original post?
Let me know, so I can add them to this thread.
Posted 10/11/2017 12:41 AM (GMT 0)
It's been about a month since I've been tapering from 40mg/d Pantoprazole down to 20mg/d. (I'm alternating between 40mg and 20mg each day)

I'm still taking the 40mg Pepcid at bedtime.

Doc is attempting to get me off the Pantoprazole because he doesn't want me to develop the long term side effects. (never mentioned anything about the Pepcid, so I guess that's staying)

I've noticed that I've had some nausea on and off. (one of my original gerd symptoms)

I have been trying hard to avoid my triggers. (which I think is helping at least in part, because while I'm having some nausea the past few days, It's not as strong as it was pre-treatment).
Posted 10/14/2017 2:26 AM (GMT 0)
Hi
I'm taking Pantroprozole myself. However I have frequent urination. I looked up to see if it was a side effect from the medicine. It is one but lesson common. Is it possible that's what's causeing my frequent urination.
Posted 10/15/2017 7:23 PM (GMT 0)
It's possible. I don't get this side effect.

How long have you been taking the pantoprazole?
Posted 10/18/2017 9:13 PM (GMT 0)
Updating you guys on my process of getting off the Pantoprazole.
(I'm currently alternating between 40mg and 20mg each day; Still taking my Pepcid 40mg @ bedtime)

I've noticed that the past few days, my acid reflux (rebound?) has calmed down a lot. I'm so thankful. I was on the fence for some time about about whether to continue with the taper method or asking GI doc to go back to taking 40mg every day.

I'm continuing to ensure that I follow non-medication methods to control my acid reflux. (ex. avoiding triggers).
Posted 10/23/2017 12:40 AM (GMT 0)
Hello, you are going about it the right way. I have taken Nexium 20 mg/day for years.

I tried to quit several times. The first time I quit (January of this year), I did it cold turkey, and it actually worked! I went through 2 weeks of hell, followed by a little bit more time of discomfort that wasn't too bad, and then I was off of it completely. This lasted about 3 months. I was feeling great, jogging, etc. I then eventually went back on it.

I didn't have the burning symptoms, but maybe more of the nausea/dyspepsia (I wish I tried natural supps or H2's before going back on them). I tried to justify going back on, by just taking every other day, but I eventually went back to taking them every day. Since then, I tried cold turkey again, but couldn't do it.

The reason why I think I was successful the first time was because my esophagus was in a great state after being on PPI's for so long. When I tried to quit again, I'm pretty sure I had esophagitis, and so every little bit of acid was hurting me that much more. I believe that if you want to quit, you need to make sure that your esophagus is in a healed state/condition.
Posted 10/23/2017 12:51 AM (GMT 0)
As far as right now, I'm trying to take my 20mg two days on, one day off; maybe one day on, one day off, if I can. What I do wholly depends on how I feel. If I have trouble on a certain day, I will take some of the granules from the inside of the pill, and swallow with some water. I will then wait half an hour to see how I feel; if I'm still having issues, then I take a little bit more, all with the goal of not taking a whole pill.

It's very important to minimize esophagus pain, and/or esophagitis, for the simple reason that it will make your rebound acid symptoms even worse, and make it that much harder to quit.

Regarding your case, you might try going on 20mg per day, and then if you have bad symptoms, just take the second 20 mg dose...or, you can break open one of the pills and swallow some of the granules with water; wait a while and see how you feel. If you don't feel great yet, maybe take a little bit more, or try to supplement with H2's, again, with the goal of not taking a whole pill.

Regardless of what you do, it seems like you're on the right track.
Posted 10/24/2017 12:00 AM (GMT 0)
Thanks for your feedback.

I'm currently alternating between 40mg and 20mg of Pantoprazole each day. I don't see my GI doctor again till mid-December at which point, I'm sure he will evaluate my progress.

Assuming everything is good, I'm sure he will continue the taper process to 20mg every day. (like you wrote in your post).

I'm also taking Pepcid 40mg at bedtime. (which my GI doc has not touched since prescribing it to me)

I also do the best I can (w/ non med solutions), such as avoiding triggers, not lying down right after eating, not eating w/in 3 hours of bedtime.
Posted 11/3/2017 1:43 AM (GMT 0)
I just wanted to post an update as to how I'm doing with the taper. I'm still alternating between the 40mg and 20mg doses of the Pantoprazole. (I see GI in Dec at which point we will evaluate progress)

I'm still taking my Pepcid 40mg every night at bedtime.

I'm feeling pretty good overall. I have some mild reflux once in a while, but nothing I can't handle.

I continue to make sure that I follow the lifestyle modifications.

Since I am also lactose intolerant, I make sure to stay away from dairy particularly. (I drink almond milk, avoid dairy products, although, I do have some dairy from time to time (either the amount needed for cooking or the occasional mac n' cheese). I've noticed that since I stopped/reduced eating/drinking as much dairy, my reflux has calmed down with it.

I also continue to make sure I follow other modifications, such as not lying down after I eat, and make sure I don't eat w/in 3 hours of bed.
Posted 12/15/2017 1:47 AM (GMT 0)
I just went to my GI doctor on Monday.

I told him how well everything has been going with the 40mg/20mg alternate doses of the Pantoprazole. He was pleased with my progress and told me to start taking 20mg every day. I'm still continuing the Pepcid 40mg at bedtime.

These past few days since the lowered dosage, I've not had any rebound pain, nausea, regurgitation, heartburn, etc.

I'm still doing the lifestyle modifications.

I feel pretty good right now.
Posted 12/23/2017 5:36 AM (GMT 0)
Hi Netsavvy. I've been diagnosed with Grade A GERD due to weak LES and hiatal hernia. Doc put me on PPI (40 mg Esomeprazole) for a month. Most symptoms vanished with the exception of occasional discomfort I'm chest. I tried to come off PPIs, but all the symptoms came back. I back to taking PPIs. I can't imagine being on PPIs for years. How are you managing to avoid the PPI side effects.
Posted 12/24/2017 1:42 AM (GMT 0)
Well in my last post, I mentioned that I had to taper the dosage (as per GI doc instruction) from 40mg/20mg alternate dose to 20mg every day.

At the time of my last post (Thursday 12/14), I didn't have any rebound pain from the lower dose. Unfortunately that next day (Friday 12/15) I did have a reflux episode. (mainly nausea). It did settle down after that though.

I think what is helping to reduce issues with the PPI is that we are reducing the dose slowly over a long period of time. We only change the dosage once every 3 months. I've noticed that every time we do reduce the dose, I have issues the first few days and some reflux still lasts up to a month.

I am also continuing to take the Pepcid 40mg at bedtime so maybe the Pepcid is helping somewhat too.

I've also learned since having to lower my dosage some of my triggers, like dairy (being lactose intolerant). I also make sure to follow other lifestyle modifications, like not eating too close to bed time.

I hope this helps.
Posted 7/8/2023 10:42 PM (GMT 0)
Hey I was just wondering if you're on this forum and how you did, I'm trying to wean off of Pantoprazole and started with the same 80mg dose a day. Doc lowered me immediately to 40mg per day and that went reasonably well. Then he said to do every other day 40mg and I was thinking really? But okay, I tried and ran into some hyperacidity issues and am back to daily 40mg for a time until I stabilize. I'm going to try that strategy of alternating between 20mg and 40mg since the doc approved it, but haven't started yet.
Posted 7/11/2023 8:55 AM (GMT 0)
Here's a video to look at https://youtu.be/px5hfs7pblo
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