Tapering is the best policy when stopping heartburn medications

I am a 61-yearold woman in fairly good health except I have been taking prescription omeprazole once a day for heartburn for at least 10 years, if not more. I’ve read articles that say this isn’t good long term, like I’ve been doing. When I’ve tried to stop by using famotidine instead, I still suffer from heartburn. I’ve raised my bed and tried sleeping in an upright position. Your thoughts, please. — O.D.S.

DEAR READER » It certainly

is a good idea to periodically review with your doctor all the medications you take, to decide whether they are still necessary. At times people take medications for unclear reasons, and the person who is prescribing it does so without thinking about whether benefits outweigh risks, especially as people get older and may have acquired new conditions or had medication changes.

Proton pump inhibitors like omeprazole frequently are prescribed for shortterm use but end up being continued for years. Except in people who absolutely need it (such as people with Barrett’s esophagus), I agree with a trial of stopping and using H2 blockers like famotidine on an asneeded basis. I recommend a taper, not a sudden stop.

Proton pump inhibitors are likely to increase the risk of infection, such as pneumonia and intestinal infections; may possibly increase the risk of osteoporosis; and probably reduce vitamin B-12 and iron absorption. Although there have been reports of increased risk of kidney disease and dementia, I doubt the actual clinical risk is significant. Still, there are enough possible adverse effects that it is worth balancing risks against benefits of reducing symptoms.

I am glad you tried some nondrug therapies, as we doctors often do not emphasize how important they are. In addition to raising the head of the bed, losing weight for those who would benefit, avoiding tobacco and alcohol, and not eating three hours before bedtime make drugs unnecessary for many. Some people benefit from eliminating certain foods, especially caffeine, chocolate and fatty or spicy foods.