Richard John Torrens Reflux disease
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Experiments with Omeprazole PPI dosage

Contents, this page

• Experiments with dosage and timing
• Summary: PPI Dosage and timing
• Bile reflux
• Microdosing with PPIs
• Final experiment and quitting PPIs
• PPI tolerance?
• Afterword 25th January, 2020
• Afterword 11th of December, 2020

Experiments with dosage and timing

I was put om 40mG omeprazole once per day. 6 weeks later at a second endoscopy to check progress on the ulcers (not much!) I was told, by the consultant endoscopist "That's not enough - 40mG lasts about 20 hours. You need to take two of those a day." Which I did for some time - about 5 months. But then I thought If 40mG lasts 20 hours, can I take one every 16 hours?

Regime 1 (40mG every 16 hours): so I'd take 40mG at 8 in the morning on getting up, another at around midnight before going to sleep, and a third around 4pm the next day. Then back to 8:am the next day. This worked fine. But see 20mg every 16 hours

But then I thought If 40mG lasts 20 hours, this 16 hour regime is still a bit of an overdose. Let me try 20mg. Maybe it would enable me to do an 8 hour regime:

Regime 2: (20mG or 10mG every 8 hours) 8 am. 4 p.m and midnight. Slightly easier for me to do than regime 1.

So I tested - exactly how long would 20mG last? I was fortunate in this respect as I regurgitated stomach fluid easily, so could tell when it was starting to get acid. I was a little surprised to find that with a 20mG dose, acidity doesn't start until between 17 and 18 hours later! Drugs such as PPIs have a half-life - the time it takes for half the dose to be metabolised. See my list of references on PPIs - their half life.

So in fact 20mG every 16 hours (Regime 1) works as well as 40mG every 16 hours!

Having discovered the half-life effect, I was naturally curious. How long would 10mG last. Experiments showed it lasted about 15 hours. So 10mG every 12 hours (regime 3) is as effective for me as 40mG every 16 hours. Your timing may be slightly different - absorption and clearance (by the liver) can vary slightly from one person to another.

Regime 3: 10mG 8 am and a second at 8 p.m.

Summary: PPI Dosage and timing

Note that 5mG doses are not available as this seems to be too low a dose to be effective

Bile reflux

• PPIs would work, no detectable side-effects.
• As the dose expired I would at first experience a tickly cough. This is due to irritation of the oesophageal cough receptors, which I have found are sensitive to bile and acid.
• The refluxed gastric juice would start to taste of bile.
• Only after that would the refluxed gastric juice start to taste acid.

Bile reflux was something I had not experienced before except on rare occasions such as serious vomiting. So I knew the taste of bile (very unpleasant - far, far worse than acid reflux). It was extremely concerning. See My life with gastro-oesophageal reflux for more comments! My page on bile may help you determine if your problems are acid or bile related.

Bile reflux is also extremely dangerous: see my list of references regarding bile

Microdosing with PPIs

I experienced these nocturnal reflux events:

• 37 days after reducing to 5mG x 4, bad nocturnal bile reflux
• 52 days - same again
• 90 days - very bad nocturnal bile after eating a curry
• 108 days - very bad nocturnal bile after eating guacamole & taramasalata.

Microdosing may have an effect on acid levels but, looking back on the notes I made at the time, the effect is unclear. Presumably this is why 5mG doses are not available. I had done the experiment by opening a capsule and taking half the grains therein. h

PPIs work by poisoning a particular enzyme in the the cells that produce acid. See my list of references to how PPIs work

Final experiment and quitting PPIs

At this time, I had an almost permanent tickly cough. I had also lost weight so regurgitating stomach fluid to taste was no longer easy. What symptom would I notice first?

The tickly cough stopped! That was enough - I have never taken another PPI (Proton-Pump Inhibitor).

But there was a heavy price to pay: as had happened when I reduced to 5mG doses, I again experienced a very severe and unpleasant series of nocturnal bile reflux events.

• 49 days after the final dose of omeprazole.
• 59 days later.
• 104 days later, triggered by a meat-rich Brazilian meal in a restaurant in Prague.

PPI tolerance?

PPIs are metabolised by the liver. They are a chemical that the liver thinks should not be present - see my references to Liver metabolism of PPIs. In general with time the liver gradually learns to metabolises such xenotoxins more efficiently, so with time the minimum effective dose may well increase. Or with time, PPIs may well become less effective.

As yet, I have found no technical papers to confirm or contradict this.

Afterword 25th January 2020

I've not noted all of these bile/pepsin reflux events carefully, but now, after being off PPIs for over 4 years, I have a distinct feeling that these pepsin attacks have been less common recently. But I'm now logging them. I never had these attacks before taking PPIs and they were a definite problem on the two occasions I effectively stopped PPIs. See my Microdosing and Quitting with PPIs.

However this continuing series of bile reflux events implies that my gall bladder, though apparently operating normally most of the time, is going into occasional spasms and therefore its operation had been permanently damaged by the PPIs.

So I still have a hiatal hernia, so I have reflux. But I've lost weight and can cope with the symptoms I have. My symptoms are fewer without PPIs and the papers I have found give me adequate evidence that I am maximising my chances of a long and healthy life.

Afterword 11th of December, 2020

I know, during my early experiments, the sequence was - a tickly cough, bile taste, acid taste. So has the tickly cough always been caused by a trace of bile? When last I used to have the tickle I wondered why the acid reflux sometimes came without the tickly cough. If I am correct it has taken nearly 9 years for the effects on by gall bladder caused by 4 years on omeprazole to fully wear off!

I would add that I am now 77 yars old. It is possible that these changes are related to aging. But I strongly suspect that has nothing to do with the effect. Though a younger gall bladder might indeed recover more quickly.

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