A Simple Guide to Proton Pump Inhibitors (PPIs)

02 / Aug

What are PPIs?

Proton pump inhibitors are medications that work to reduce acid production in the stomach. They are used to treat and prevent conditions caused by excess stomach acid such as indigestion, acid regurgitation, and stomach ulcers.

PPIs work by blocking the action of proton pumps, which are tiny substances in the stomach lining that produce acid. By reducing the amount of acid in the stomach, PPIs can help to relieve symptoms of acid reflux and gastro-oesophageal reflux disease (GORD), as well as promote the healing of stomach ulcers.

When taking PPIs, you should start to feel relief within an hour, with the full benefits becoming apparent after 2-3 days. However, it may take up to 4 weeks for the medication to reach its maximum effectiveness, so you may still experience some acid-related symptoms during the first month.

Other side effects may include diarrhoea, constipation, headache, and dizziness.

Conditions treated with PPIs

Proton pump inhibitors (PPIs) are commonly prescribed to treat a range of conditions related to excessive stomach acid.

Acid reflux and heartburn

PPIs effectively reduce the amount of acid produced by the stomach, providing relief from the burning sensation in the chest and sour taste often associated with heartburn and acid reflux. If these symptoms persist, it may indicate a chronic condition known as gastro-oesophageal reflux disease (GORD).

Indigestion

While indigestion is often a temporary discomfort, PPIs available over-the-counter in lower doses can help alleviate symptoms such as nausea, bloating, and wind.

Stomach ulcers

PPIs play a crucial role in both treating and preventing stomach ulcers. By significantly reducing stomach acid levels, they create an environment that promotes the natural healing of ulcers.

Zollinger-Ellison syndrome

This rare condition is characterised by excessive stomach acid production due to tumors in the pancreas or small intestine. PPIs are a key component of managing Zollinger-Ellison syndrome by controlling acid levels.

Most Common PPIs?

Several types of proton pump inhibitors (PPIs) are available to treat acid-related conditions.

Omeprazole

Lower doses of omeprazole can be purchased over-the-counter for mild indigestion and heartburn. Higher doses typically require a prescription for more severe conditions like chronic acid reflux (GORD).

Pantoprazole

Similar to omeprazole, lower-strength pantoprazole is available without a prescription for mild symptoms. Stronger doses are prescription-only. It comes in both tablet and liquid forms.

Lansoprazole

Lansoprazole is exclusively available with a prescription. It comes in various forms, including tablets, capsules, and a liquid.

Esomeprazole

Like the others, lower doses of esomeprazole can be purchased over-the-counter, while higher strengths require a prescription. It’s available in tablets, capsules, granules, and liquid form. It is not suitable for pregnant women and is not normally recommended for women who are breastfeeding.

Research suggests that most PPIs are equally effective in treating acid reflux and related conditions.

How to take Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are typically taken once a day, often in the morning. However, your doctor may prescribe a twice-daily dose for more severe symptoms.

Dosage

The specific dose will depend on the severity of your condition and the type of PPI prescribed.
Your doctor will follow guidelines from organisations like NICE when determining the appropriate dosage. You can see the regular dosages from the NHS website here

Administration

Tablets: Swallow whole with water.
Capsules: Swallow whole or open and mix the granules with water, juice, yogurt, or soft food.
Dispersible tablets: Allow to dissolve on the tongue.
Liquid: Use the provided spoon or syringe to measure the correct dose. Do not use household utensils.

Always follow the instructions provided with your medication or given by your doctor or pharmacist.

What to do if you miss a dose

If you take your PPI once a day and miss a dose, take it as soon as you remember unless it’s within 12 hours of the next dose. In that case, skip the missed dose and take the next one as scheduled.
If you take your PPI twice a day and miss a dose, take it as soon as you remember unless it’s within 4 hours of your next dose. In that case, skip the missed dose and continue as normal.

What are the Side Effects of Proton Pump Inhibitors?

Like most medications, proton pump inhibitors (PPIs) can cause side effects. However, not everyone experiences them.

Common side effects

• Headache
• Nausea
• Constipation
• Wind (gas)
• Vomiting or diarrhoea
• Stomach pain

These side effects are usually mild and tend to improve as your body adjusts to the medication. If they persist or bother you, consult your doctor.

Serious side effects

While rare, some serious side effects are possible. Seek immediate medical attention if you experience:

• Yellowing of the skin or eyes, dark urine, and fatigue (symptoms of liver problems)
• Joint pain accompanied by a red skin rash, especially in sun-exposed areas
• Worsening stomach pain
• Decreased urination, painful urination, swollen ankles, lower back pain, rash, or fever

Important: This information is not exhaustive. Always read the patient information leaflet provided with your medication for a complete list of side effects. If you have any concerns, consult your doctor or pharmacist.

It’s essential to note that long-term use of PPIs has been linked to additional potential side effects, such as bone fractures, vitamin B12 deficiency, and an increased risk of certain infections. If you have concerns about long-term use, discuss them with your healthcare provider.

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