Ranitidine (Zantac) -- not my new favorite thing

[pameladean]

So I had a doctor's appointment last Wednesday, with a new doctor, who frowned at the computer screen and said, "You've been taking omeprazole since 2013? We don't really recommend it for long-term use. It can lower your calcium levels."

My patient-information sheet says that multiple daily doses, which I am not taking, can do that; but apparently they are getting more cautious because there is more information.

I accordingly stopped taking the omeprazole this morning and took a Zantac pill instead.

Urgh. Two hours of nausea. No actual barfing, but still, urgh. When that abated, I went out somewhat belatedly to take a bus over to arkuat's place to look after his cat. As I arrived at the bus stop, I felt so weird that I thought, "I'm going to have to go home again. I can't get on a bus like this." I found myself hanging onto the bench as if I might fall if I let go. Vertigo? Dizziness? No, actually. I could stand up perfectly well on my own. Things were not describing slow repeating arcs across my vision. Everything was fine and stable. Only something felt extremely weird in my head, and my brain kept deciding it was dizziness. "Woogly" is the term that I use for this feeling; it sometimes precedes a migraine. However, I had no other symptoms.

I did get on the bus, and bus and walk to Eric's, and hang out with a very loudly purring elderly orange cat, and walk a bit more and take two buses home again without untoward incident. I had a late lunch and a small dinner without incident. I even made some banana bread later in the evening. The woogliness persisted in a mild form and finally went away about an hour before I had to take my evening dose.

I had suspected that the nausea wasn't just caused by the new drug, but by my having taken it with all of my blood pressure medication, most of which also wants to be taken with food, without increasing the amount of food that I provided. I don't like eating in the morning. I took the evening dose 45 minutes ago on its own, with a substantial snack, and am not having nearly the same kind of problem. So I'll have to have a larger breakfast; or, since that's generally unpleasant, maybe take the Zantac first with some food, and follow up half an hour or so later with all the BP stuff and some more food. This makes for a more cumbersome morning, but there's no relation between the ranitidine and the BP meds, so I don't have to bolt them all at once. It's supposed to be so very healthy to eat a good breakfast, but this isn't the way I'd have chosen to do that. I also suspect that it's healthy enough for the people who like doing it but am dubious about the rest of us.

Has anybody else had this kind of experience with ranitidine? If so, how did it work out in the end?

It does seem to be controlling the acid reflux all right, but I'm not sure that I care for the trade-off if the morning effects persist.

It was a glorious spring day: forsythia and magnolia are on their way out, but flowering plum and cherry are in; tulips are in colorful bud, or blooming in warm places; there are purple and white violets in the grass. The maples are blooming so hard that they look as if they have come out in leaves. Lilac and spirea and honeysuckle really have come out in leaves. Raphael saw a juvenile yellow-bellied sapsucker in the neighbors' yard. So this medication nonsense needs to settle itself.

Pamela

Comments

[ritaxis.livejournal.com]

I don't think that I had a reaction like that to ranitidine but it doesn't make me feel good and I'm back to the omeprazole. I don't worry much about calcium. I get sun, I eat a lot of dark green leafies and also dairy and some other calcium-rich foods, and I always had dense bones before. I may be required to worry about it in the future as I'll be on hormone blockers, but not now. Calcium levels can be tested, right?

[pameladean]

Yes, they can be tested. However, taking omeprazole can also lower magnesium levels, especially in conjunction with a diuretic (which I also take, so I was looking in to this) and, specifically in the case of the magnesium, levels can't be increased by supplementation; you have to stop the omeprazole and then levels rebound. IF this is the case with calcium, which I can't in a quick search find any support for, that would be an issue.

All the information I could find still mentions multiple daily doses for the most part, though.

P.

[lcohen]

meep. i hope the food adjustments do the trick!

[pameladean]

Thanks! I was okay last night with just the Zantac and my nice snack. It's annoying to have to come up with something solid enough to eat at a particular time of the evening, but I've done it before with a BP med, so I guess I can adjust.

Currently eating leftover brown rice with soy sauce and making "behave" motions at the Zantac.

P.

[rachelmanija.livejournal.com]

My experience with Zantac is useless to you because it had no effect on me whatsoever, for good or ill. In general, I find that other people's experiences with medication have no predictive effect for mine, because I tend toward unusual reactions.

However, what I have learned recently is that I tend to have consistent responses to all medication in certain ways. So if you're similar, you may be able to predict what Zantac will do to you based on your own previous experiences. For example, if a drug gives me a side effect, it either goes away after a few days or never goes away - it won't linger for a week or two, then wear off. This is true of virtually all drugs for me. So if you also respond consistently to drugs and you're still getting that effect after three days (even with breakfast), it probably won't ever go away and that's not a good med for you. However, some people find that side effects go away after a longer period of time, so if you're more like that, you might want to give it a week or so.

[pameladean]

Thank you, that is very useful. As a rule, if I have side effects, they level off slowly. This is very annoying in the short run but good to know in the longer one.

P.

Drugs

[lsanderson.livejournal.com]

There's been some more recent articles as well about proton pump inhibitors:.

http://mobile.nytimes.com/blogs/well/2015/10/15/ask-well-taking-heartburn-drugs-long-term/?referer=

http://well.blogs.nytimes.com/2016/02/17/heartburn-drugs-tied-to-dementia-risk/?_r=0

(I emailed you the two stories from the links above.)

[pameladean]

Holy shit, that is very disturbing! I see why your email subject included "TMI". Thank you very much. I am actually more concerned about the dementia than the bone stuff.

There's also an article that I have lost track of that talks about some speculative research assuming that omeprazole affects proton pumps IN OSTEOBLASTS, fundamentally disrupting the process of bone turnover. Yikes.

P.

[kore]

I take two Prilosec a day, as that's the only thing that controls my terrible GERD, but YIKES. Maybe I should try Pepcid instead, it seems to work okay.

some speculative research assuming that omeprazole affects proton pumps IN OSTEOBLASTS, fundamentally disrupting the process of bone turnover

EEK

[pameladean]

Terrible GERD is pretty terrible too. The dementia research sounds preliminary to me, but the bone stuff has been kicked around for much longer and it's obviously percolated down to actual practice. So if Pepcid does work, yeah, it might be as well to switch to it.

I used to give Pepcid to my elderly cat. He didn't like it.

P.

[sartorias.livejournal.com]

Oh, I hope it settles fast. Spring sounds so lovely there!

[pameladean]

Thank you! I hope we have a beautiful June for you.

P.

[inlaterdays.livejournal.com]

I do hope you get your meds issue sorted out quickly. Feeling like that sounds scary and not fun at all. But spring sounds lovely. I adore violets and lilac especially.

[pameladean]

I wish I could show you my yard! We have Canada violets (the big white one with a splash of pinkish purple on the back of the flower) all over, also the standard purple, plus a deep violet version and a lovely spotted purple and white that a friend gave me. Maybe I can get some good photos and put them here or on Twitter.

The lilacs already have little leaves and are working on their flower stalks. I think they'll probably bloom early this year, but it depends. There's a complicated equation about daytime and nighttime temperatures that allows you to predict when they'll bloom, but I haven't seen anybody doing it this year.

P.

[inlaterdays.livejournal.com]

Oh, the violets sound beautiful!

The town where I grew up had an annual lilac festival and they always had trouble fixing the dates of it every year. Your explanation makes a lot of sense - they would aim for peak bloom and sometimes miss.

[swan-tower.livejournal.com]

No nausea, but my husband took Zantac and promptly spent about 18 of the next 24 hours asleep.

[pameladean]

That's really what I expected. I mean, it's an antihistimine.

P.

[swan-tower.livejournal.com]

There's antihistimine levels of sleepy, and then there's what happened to my husband. He was incapable of staying awake, and that isn't normally how he reacts.

[pameladean]

Sorry, my comment was seriously over-compressed. I expected the Zantac to do that to me because that's how I used to react to Benedryl. I would find it surprising in most people. I hope they found something else for his symptoms.

P.

[lblanchard.livejournal.com]

Blerg. Here's hoping it settles down for you soon.

[pameladean]

Thanks. It's definitely better today.

P.

[17catherines.livejournal.com]

Sounds scary! I am glad things are improving today.

[pameladean]

Thank you. It's one of the few times I've been glad to know what a migraine feels like, though, or I'd have been far more freaked out.

P.

[carbonel]

I think I told you my woes with Zantac (ranitidine) and omeprazole, but if I did, I have an update.

I had had occasional reflux at night, and Zantac helped with that.

Then something happened a couple of years ago. I had a few days of serious abdominal pain, and went to the ER (per the advice of the HMO nurse). They did a bunch of tests, and found nothing wrong. And the pain eventually went away. But after that, I started having daytime reflux, and pain when I ate. (First thing my mother asked when I told her that was, "So have you lost any weight?" Bah.)

My NP put me on omeprazole, and it worked like a charm for a couple of months. Then she said it wasn't good to stay on long term, and put me on a high dose of Zantac. Which didn't do a thing for my reflux. No nasty side effects, but no help, either.

I just went for an EGD, which showed some inflammation, but nothing serious. And no Barrett's esophagus, which is good.

So I don't know about staying on the omeprazole long term, but I have a three-month scrip for now.

Stupid bodies.

[pameladean]

NOOO, "HAVE YOU LOST WEIGHT?" IN THAT CONTEXT IS SERIOUSLY INAPPROPRIATE WTF.

Ahem.

I wonder if there is some fundamental difference between day- and night-time reflux. I don't know what it would be, though.

Omeprazole allegedly actually heals things up, so maybe they hope the Zantac will work again after that? Is there anything except for Zantac and Prilosec?

P.

[carbonel]

> Is there anything except for Zantac and Prilosec?

Other than antacids like Maalox and Pepto-Bismol, not much that I see.

After the current three months of Omeprazole are done, I will try seeing if Zantac alone will help.