Proton pump inhibitors (PPIs)
Tablets that turn down stomach acid. Brilliant for reflux and ulcers. Less brilliant as a lifelong habit nobody remembers starting.
At a glance
- For
- Reflux (GORD) and heartburn, stomach and duodenal ulcers, H. pylori (with antibiotics), protecting the stomach on anti-inflammatories
- Works
- Reflux damage to the oesophagus: about 8 in 10 heal within 8 weeks. Heartburn: most people with true reflux improve. Stronger than older acid tablets
- Cost
- Under the $25 PBS co-payment, about $21–23 a script for generics (brand premium extra); $7.70 concession. Small packs sold in pharmacies without a script
- Kicks in
- Some relief in a day or two; full acid control in a few days; healing takes 4–8 weeks
- Taken for
- Usually 4–8 weeks, then step down or stop. Long term only for some (e.g. Barrett’s oesophagus, ongoing anti-inflammatories)
- Watch for
- Headache, tummy pain, diarrhoea, constipation, wind, nausea
Take it 30–60 minutes before breakfast. Swallowing it after the bacon and eggs is like turning on the sprinklers once the kitchen’s already alight.
Brand names
- Esomeprazole: Nexium, plus generics
- Pantoprazole: Somac, plus generics
- Omeprazole: Losec, Acimax, plus generics
- Rabeprazole: Pariet; lansoprazole: Zoton
- Pharmacy packs (no script, short-term heartburn): e.g. Nexium 24HR, Somac Heartburn Relief
How it works
PPIs switch off the “proton pumps” in the stomach lining that make acid. Less acid means less burning and gives a damaged oesophagus or ulcer time to heal.
Used for
- Reflux (GORD) and reflux oesophagitis
- Stomach and duodenal ulcers
- Clearing H. pylori, together with antibiotics
- Preventing ulcers in people taking anti-inflammatories or aspirin who are at risk
- Barrett’s oesophagus and rare acid conditions (Zollinger-Ellison syndrome)
- Short-term heartburn relief, up to 14 days (pharmacy packs)
Side effects
Full side-effect list (from the product information)
How often, from the omeprazole product information (other PPIs are similar). Bold = serious.
Common 1 in 10 to 1 in 100
- Headache
- Tummy pain, wind, nausea, vomiting
- Diarrhoea, constipation
- Harmless stomach polyps (fundic gland polyps)
Uncommon 1 in 100 to 1 in 1,000
- Poor sleep, dizziness, drowsiness, tingling
- Rash, itch, hives
- Raised liver enzymes
- Hip, wrist or spine fractures (with high doses or long-term use)
- Swollen ankles, feeling unwell
Rare 1 in 1,000 to 1 in 10,000
- Low sodium
- Low white cells or platelets
- Allergic reactions, including anaphylaxis
- Confusion, agitation, low mood
- Taste changes, blurred vision, dry mouth
- Hepatitis
- Kidney inflammation (interstitial nephritis)
- Joint or muscle aches, hair loss, sun sensitivity
Very rare fewer than 1 in 10,000
- Severe skin reactions
- Liver failure
- Very low blood counts
- Hallucinations, aggression
- Breast enlargement in men
Frequency not known reported, rate unclear
- Low magnesium (can cause cramps, tremor, irregular heartbeat)
- Microscopic colitis (watery diarrhoea)
- Skin lupus
Get help urgently if
- Trouble or pain swallowing, vomiting blood, black tarry poo, or unexplained weight loss. These aren’t side effects: they’re red flags a PPI can hide, so get checked promptly
- Severe or bloody diarrhoea, especially after antibiotics
- Swelling of the face or throat, trouble breathing, or a blistering rash
Good to know
- Stopping: after weeks of use, stopping suddenly can cause a few weeks of rebound acid. Step down instead: lower dose, then every second day or only when needed.
- Long-term use is linked (mostly in observational studies) with low magnesium and B12, gut infections such as C. difficile, and fractures. Worth a yearly “do I still need this?” chat.
- Interactions: omeprazole and esomeprazole can weaken clopidogrel; pantoprazole is usually preferred. PPIs can also reduce absorption of some HIV and cancer medicines.
- Heartburn that keeps coming back, or new symptoms when you’re older, needs a proper check, not an endless supply of pharmacy packs.
Common questions
Can I take a PPI long term?
Some people need to, such as those with Barrett’s oesophagus, severe oesophagitis or ongoing anti-inflammatory use. For most, the aim is the lowest dose for the shortest time, with a yearly review.
How do I stop a PPI?
Step down rather than stopping suddenly: halve the dose, then take it every second day or only when needed. Rebound heartburn for a couple of weeks is common and usually settles.
When should I take my PPI?
30 to 60 minutes before breakfast (or before your evening meal if twice a day). PPIs work best when the stomach is about to switch on acid production.
Are pharmacy PPIs the same as prescription ones?
Same medicines, in smaller packs and usually lower doses, for short-term heartburn of up to 14 days. If you need them longer, see your GP.
Information only. Not a recommendation or endorsement of any product. Whether a medicine suits you depends on your health and other medicines, so talk to your doctor or pharmacist. In an emergency, call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
More information
- NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults
- PBS: Pantoprazole 40 mg
- PBS: Esomeprazole 20 mg
- Healthdirect: Medicines information
maladywise.com/medicines/ppis/