Stopping Nexium (Esomeprazole) Suddenly Can Cause Severe Heartburn

When the acid-suppressing medications known as proton pump inhibitors (PPIs) were first introduced, doctors were extremely enthusiastic. The drugs were extremely effective at treating ulcers and severe gastroesophageal reflux disease (GERD). Before long, they were being used for much less consequential conditions. Many people were prescribed these drugs for recurrent heartburn.

The FDA, along with the medical establishment, believed that these drugs were unusually safe. That is why esomeprazole, lansoprazole and omeprazole were approved for nonprescription use. Since that time, researchers have uncovered a number of side effects that concern us. Not the least of these is that stopping Nexium or similar drugs suddenly can lead to unbearable withdrawal symptoms.

Problems Stopping Nexium:

Q. I am weaning myself from 10 years of taking Nexium. I thought it would be easy. Ha!

I asked my doctor how to do this and he said just quit and if you have problems, take Zantac. I am stubborn so didn’t want to take more pills but found that I was eating Tums almost like candy. Because of my symptoms, I broke down last week and took Nexium again so I am having to start over.

Without Nexium I experience heartburn, coughing (I had no idea this was related!), waking up at night, burping, etc. I had to take Zantac today. I’m going to try the apple cider vinegar with water also to see if it helps.

A. It is hardly surprising that your doctor did not have a recommendation about how to discontinue Nexium. There is very little guidance about how to stop taking powerful acid-suppressing drugs (proton pump inhibitors or PPIs) like dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (AcipHex).

Most physicians have been led to believe that PPIs are extremely safe and could be taken indefinitely without worry. Over the last few years, however, we have learned that long-term use of such strong acid-suppressors might have unintended consequences.

Stomach acid kills unwanted germs. Without this barrier, there is fear that some bacteria might survive, creep into the lungs and lead to pneumonia. There are also data to suggest that the hard-to-treat intestinal bug C. difficile can flourish more readily and cause uncontrollable diarrhea when PPIs are on board.

Nutritional Deficiencies:

Then there is the danger of nutrient deficiencies including calcium, iron, magnesium and vitamin B12. Without adequate calcium and magnesium there may be an increased risk for fractures. Low levels of vitamin B12 can lead to symptoms such as nerve pain, confusion and memory problems, as well as blood abnormalities.

The latest concern is the discovery that acid-suppressing drugs may be linked to heart problems (Circulation, online, July 3, 2013). Researchers have found that PPIs lower levels of a natural compound called nitric oxide, which relaxes blood vessels and makes them more flexible. If drugs like Nexium lead to stiffer arteries, that could cause cardiovascular complications, especially for people with existing heart disease.

Other Nexium Side Effects:

• Headaches
• Digestive distress, nausea, stomach pain, diarrhea, pancreatitis
• Blood disorders
• Skin reactions, rash (can be life threatening; seek immediate medical attention!)
• Fractures

Stopping Nexium or Other PPIs:

So how can people like you phase off drugs like Nexium without going through hell? First, never stop suddenly! Rebound hyperacidity can cause unbearable heartburn. We know this because of a Danish study (Gastroenterology, July 2009). Researchers recruited healthy volunteers with no history of heartburn. They were randomly assigned to either Nexium or placebo. After eight weeks on Nexium, a placebo was substituted without the subjects’ knowledge. The conclusion: “PPI therapy for 8 weeks induces acid-related symptoms in healthy volunteers after withdrawal.” In other words, even normal people without heartburn can experience symptoms if the drug is stopped suddenly.

People who take PPIs for a long time can really suffer. The excess acid production can last for several weeks. That’s why gradual withdrawal over two or three months may be necessary.

Some people report that apple cider vinegar helps, even though it seems illogical:

“My doctor prescribed Nexium for me in my early 50s. My ‘reflux’ was a temporary problem noted during my annual physical, almost certainly the result of over-eating. I didn’t think my diet was bad enough to require taking daily meds for the rest of my life, but when I skipped a dose the indigestion came back with a vengeance.

“Finally I heard about apple cider vinegar to get off Nexium. I took about a tablespoon in water twice a day, and was off Nexium in two days. I had been on Nexium for about two and a half months. The apple cider vinegar was a quick fix for me.” Jim

Other people report that DGL licorice tablets can help ease withdrawal symptoms.

“Fifteen minutes before eating I would take a DGL licorice tablet. I also swallowed two digestive enzyme pills and a probiotic tablet with my meals. I gave up snacking after dinner. I still get an acid stomach once in a while, but I just take a DGL and it goes away. All this helped.” MJM

“I have had chronic GERD and gastritis since I took Nexium and had a horrible adverse experience with it. Since then I have used DGL deglicerized licorice, Aloe + L-Glutamine along with digestive enzymes. These could help you transition off your prescription medicine. Remember to not stop all at once, but to taper off slowly so you don’t get a rebound acid attack. Another old remedy is to drink boiled cabbage or spinach water between meals.” C.T.S.

Still others report success with Persimmon Tea, a traditional Korean dessert punch:

 “I must attest that my dad who have suffered from reflux for over 2-3 years and have been taking Nexium is totally off his medication ever since he started drinking persimmon tea! It’s amazing.” Shel

“I started using the persimmon tea/punch since my grocery started selling persimmons in October. I use fresh persimmons but I will find dried persimmons soon and keep them on hand.

“I mix the recommended amount of ingredients in the recipe using fresh persimmons and I leave the persimmons in the container. It takes me about 1 week to use all the tea. I drink about 3 or 4 ounces cold three times a day and before bedtime.

“I mix the morning tea with “Clear & Natural, Metamucil”. I took a sample of the tea to my doctor and he really liked it. He said he is going to give the recipe to his mother and if it works as well for her as it does for me then he will start giving the recipe to his patients.

“One more thing, I can now eat what I want; chocolate, coffee, bananas, orange juice and coffee. One morning I had a bacon & egg breakfast with buttered toast, orange juice and coffee. Not a hint of a problem! Yeah!” Ilene

For more details on how to deal with stopping strong acid-suppressing drugs, we offer our Guide to Digestive Disorders. The persimmon-ginger tea recipe is described along with tips from Tieraona Low Dog, MD, about getting off PPIs. Here is a link to our publications, including our Guide to Digestive Disorders. 

This article was updated on January 19, 2017.