Withdrawal symptoms from omeprazole
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Withdrawal Symptoms from Omeprazole: A Comprehensive Overview
Introduction to Omeprazole Withdrawal
Omeprazole, a proton pump inhibitor (PPI), is widely used to treat acid-peptic disorders such as gastroesophageal reflux disease (GERD) and peptic ulcers. While effective in managing these conditions, sudden discontinuation of omeprazole can lead to significant withdrawal symptoms and adverse effects.
Rebound Acid Hypersecretion
Increased Gastric Acid Production
One of the primary withdrawal symptoms from omeprazole is rebound acid hypersecretion. Studies have shown that patients who abruptly stop long-term omeprazole therapy experience a significant increase in basal acid output. For instance, in a study involving patients with resistant reflux oesophagitis, basal acid output increased markedly from 0 to 1.95 mmol/h within ten days of stopping omeprazole treatment1. This rapid increase in gastric acid production can exacerbate symptoms of acid reflux and oesophagitis.
Recurrence of Reflux Symptoms
The same study also noted that all patients exhibited endoscopic and symptomatic evidence of recurrent oesophagitis within ten days of omeprazole withdrawal1. This suggests that the sudden cessation of omeprazole can lead to a quick return of reflux symptoms, making it crucial for patients to manage the discontinuation process carefully.
Changes in Serum Gastrin Levels
Elevated Gastrin During Treatment
During omeprazole therapy, serum gastrin levels are typically elevated due to the suppression of gastric acid production. This is a compensatory mechanism where the body increases gastrin secretion to stimulate acid production in response to the reduced acidity.
Normalization Post-Withdrawal
Upon discontinuation of omeprazole, serum gastrin levels decrease significantly. In the aforementioned study, median serum gastrin levels dropped from 166 ng/l to 42 ng/l within ten days of stopping the medication1. This normalization of gastrin levels coincides with the rebound increase in gastric acid production, contributing to the recurrence of reflux symptoms.
Potential Adverse Effects
Acute Interstitial Nephritis (AIN)
Although not directly related to withdrawal, it is important to note that omeprazole has been associated with serious adverse effects such as acute interstitial nephritis (AIN). AIN is an inflammatory condition of the kidneys that can lead to renal failure. Symptoms of AIN include fatigue, fever, anorexia, and nausea, and it has been reported to occur after an average of 2.7 months of omeprazole therapy2. Management typically involves discontinuation of omeprazole and, in some cases, corticosteroid therapy.
Conclusion
Sudden withdrawal from omeprazole can lead to significant rebound acid hypersecretion, resulting in increased gastric acid production and recurrence of reflux symptoms. Additionally, serum gastrin levels, which are elevated during treatment, normalize rapidly after discontinuation. While omeprazole is generally well-tolerated, it is also associated with serious adverse effects such as acute interstitial nephritis. Patients discontinuing omeprazole should do so under medical supervision to manage these potential withdrawal symptoms effectively.
Sources and full results
Most relevant research papers on this topic
Temporary cessation of long-term maintenance treatment with omeprazole in patients with H2-receptor-antagonist-resistant reflux oesophagitis. Effects on symptoms, endoscopy, serum gastrin, and gastric acid output.
Stopping long-term maintenance treatment with omeprazole in patients with H2-receptor-antagonist-resistant reflux oesophagitis leads to rapid normalization of serum gastrin levels and recurrence of reflux symptoms and oesophagitis within 10 days.
Non-RCTAcute interstitial nephritis due to omeprazole
Omeprazole use can cause acute interstitial nephritis, with most patients recovering normal renal function after withdrawal and corticosteroid therapy.
Case Report
Highly CitedWithdrawal symptoms after gabapentin discontinuation.
Discontinuing gabapentin therapy can cause withdrawal symptoms, which resolve completely when reintroducing the medication.
Case ReportOmeprazole or ranitidine in long-term treatment of reflux esophagitis. The Scandinavian Clinics for United Research Group.
Omeprazole (20 or 10 mg once daily) is superior to ranitidine (150 mg twice daily) in maintaining remission in patients with erosive reflux esophagitis over a 12-month period.
RCT
Large Human TrialHighly CitedDeath attributed to severe anaphylactic reaction due to omeprazole
Omeprazole can cause severe anaphylactic reactions, leading to death in a 61-year-old female patient.
Case ReportContinued (5-year) followup of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease.
Antireflux surgery is more effective than omeprazole in controlling gastroesophageal reflux disease, but when doses are adjusted for relapse, the two therapies show similar efficacy.
RCTLarge Human TrialHighly CitedA Prospective, Placebo‐Controlled Pilot Evaluation of the Effect of Omeprazole on Serum Calcium, Magnesium, Cobalamin, Gastrin Concentrations, and Bone in Cats
Prolonged proton pump inhibitor treatment in cats leads to hypergastrinemia and abrupt withdrawal may result in rebound acid hypersecretion.
RCT
Animal StudyErythema nodosum caused by omeprazole.
Omeprazole should be added to the list of medications known to cause erythema nodosum, as it was the cause in this case study.
Case ReportIn vivo and in vitro protective effects of omeprazole against neuropathic pain
Omeprazole reduces neuropathic pain and protects against chronic constriction injury-induced damage by preventing proinflammatory cytokine release, enhancing anti-oxidant defense, and maintaining nerve integrity.
Non-RCTAnimal StudyComparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis.
Antireflux surgery is superior to omeprazole in controlling overall GERD symptoms, but post-fundoplication complaints continue after surgery.
RCTLarge Human TrialHighly Cited