Reducing Your PPI Medication: A Patient Guide

This information is for patients who have had six or more prescriptions of a Proton Pump Inhibitor (PPI) in the last year.

Common PPIs include Omeprazole, Lansoprazole, Pantoprazole, and Esomeprazole. 

While these medicines are excellent for treating acid-related conditions, many people continue taking them long after they are no longer needed. This guide explains why you might consider "deprescribing" (reducing or stopping) your medication and how to do it safely.

Why should I think about stopping?

PPIs are generally safe, but when used for a long time (years), they can sometimes lead to side effects or interact with other medications. Potential long-term risks include: 

  • Weakened bones: An increased risk of fractures, especially in the hip or wrist. 
  • Nutrient deficiencies: Difficulty absorbing Vitamin B12, magnesium, and iron. 
  • Infections: A slightly higher risk of stomach infections like C. diff or pneumonia. 
  • Kidney health: Possible impact on kidney function over many years. 

If your symptoms have been well-controlled for several months, your stomach may have healed, and you might no longer need a high daily dose—or any dose at all. 

Can everyone stop taking PPIs?

No. Some people must stay on PPIs long-term. Do not stop or reduce your dose if you have: 

  • Barrett’s Oesophagus (a pre-cancerous condition). 
  • Severe Oesophagitis (grade C or D). 
  • A history of bleeding stomach ulcers. 
  • A high risk of bleeding while taking blood thinners or high-dose anti-inflammatories (such as aspirin, naproxen, meloxicam etc). 

How to reduce your medication

If you decide it is time to try reducing your PPI, do not stop "cold turkey." This can cause rebound acid hypersecretion, where your stomach overproduces acid temporarily, making your symptoms return worse than before. 

The "Step-Down" Approach:

  1. Lower the dose: If you take 20mg, try 10mg daily for 2 weeks. 
  2. Space it out: Try taking your dose every other day for 2 weeks. 
  3. On-demand use: Take a tablet only when you feel symptoms, rather than every morning. 
PPI Medication Available Strengths
Omeprazole 10 mg, 20 mg, 40 mg
Lansoprazole 15 mg, 30 mg
Esomeprazole 20 mg, 40 mg
Pantoprazole 20 mg, 40 mg
Rabeprazole 10 mg, 20 mg

If you require a lower strength of your medication, please request here.

Managing "Rebound" Symptoms 

It is common to feel a little indigestion or heartburn in the first 1–2 weeks of reducing your dose. This is usually temporary. You can manage this by: 

  • Using over-the-counter antacids (like Gaviscon or Rennie) for immediate relief. 
  • Eating smaller, more frequent meals. 
  • Avoiding "trigger foods" (e.g., spicy food, caffeine, alcohol, or chocolate). 
  • Not eating within 3 hours of going to bed. 

Lifestyle advice

Eating habits

  • Eat smaller, more frequent meals instead of large portions
  • Avoid trigger foods (these vary, but common ones include):
  •  Spicy foods
  •  Fatty or fried foods
  •  Chocolate
  •  Citrus fruits
  •  Tomatoes
  •  Caffeine and alcohol
  • Think about keeping a food/symptom diary to identify your personal triggers
  • Don’t lie down after eating - wait at least 2–3 hours
  • Eat slowly and avoid overeating

Body position & sleep

  • Raise the head of your bed by ~15–20 cm (using blocks or a wedge pillow)
  • Sleeping on your left side may reduce reflux symptoms
  • Avoid late-night snacks

Weight & clothing

  • If applicable, losing even a small amount of weight can reduce pressure on your stomach
  • Avoid tight clothing around your waist (it increases abdominal pressure)

Lifestyle factors

  • Stop smoking (nicotine relaxes the valve that keeps stomach acid down)
  • Limit alcohol - it can worsen symptoms

Adjusting your medication

If your symptoms return after reducing or stopping your PPI, You can try the following:

  • Restart your PPI at the previous dose that controlled your symptoms, or
  • Increase your dose again if you are currently reducing it

Our aim is to have you on the lowest dose that controls your symptoms.

To discuss adjusting your medication, please request a routine telephone appointment with our practice pharmacist.

When to contact us urgently

Please seek urgent medical advice if you develop any of the following “alarm” symptoms: 

  • difficulty swallowing, food sticking, or pain on swallowing 
  • vomiting blood or black stools 
  • unexplained weight loss 
  • persistent vomiting 
  • severe or worsening chest/upper abdominal pain