Proton Pump Inhibitors (PPI) - Swallow them whole

 In previous post, I mentioned about the importance of not chewing some capsules or tablets. Instead , swallow them.


One of the most common examples I want to talk about today is those medicines come under the class, called proton pumps inhibitors (PPI) .

PPIs are frequently prescribed worldwide, for instance, omeprazole, pantoprazole, lansoprazole; and also esomeprazole and dexlansoprazole.PPIs are used to lower the gastric acid level in the stomach, relieving the symptoms of indigestion and heartburn. PPIs act by inhibiting the proton pumps of the parietal cells, stopping the release of acid into the stomach , thereby suppressing the acid level in the stomach. It's not surprising at all that a lot of people nowadays, suffering from indigestion or heartburn. In fact, these are one of the most common disorders observed from day-to-day life.This is probably due to the modern lifestyle of the people nowadays - skipping meals, rushing their meals, taking meals at irregular times, overeating, under stress all the time, binging...

PPIs are not the first line of the treatment for indigestion and heartburn. Usually , antacids and alginates (eg Gaviscon) are the first line for mild symptoms of heartburn or indigestion, followed by H2 antagonist (eg Zantac [ranitidine]).

PPIs are prescribed for those who have moderate to severe indigestion or heartburn when antacids, alginates or H2 antagonists do not work well.

                                                                           


Your doctor or pharmacist should have told you to SWALLOW the capsule whole 30 minutes before breakfast (or meals).

However, I found out that some of the people are not or not being able to follow the instruction, especially for those elderly people or those who have difficulty in swallowing the capsule.

PPI is an enteric coated capsule with granules inside the capsule, storing the active drug.

Let me briefly explain why we should swallow this capsule (PPI) whole instead of chewing them into pieces.  PPI is produced as a capsule containing enteric-coated granules , which means it is designed in a formulation that the granules are not broken down in the stomach. This is because omeprazole(the active drug) is acid labile - once it is released into the acidic environment in the stomach,  it will be quickly inactivated. So, you wont be able to get rid of the symptoms as quickly as desired or need a higher dosage to relieve the burning sensation, nausea and even vomiting resultant off heartburn or indigestion, even after you take the medicine! Simply it is because the medicine is not absorbed into your body.

Why should we take before meal (or breakfast)?

The same reason as above. When we eat,  the food mix with the acid in the stomach , rendering the pH of the stomach higher (becomes less acidic). The enteric coated tablet is designed to dissolves at a higher pH environment - above pH6 ( which is the small intestine) for absorption. However, if the pH in the stomach is increased, the enteric coated will dissolve in the stomach before reaching the small intestine for absorption. Again, once the active drugs are exposed to the acidic environment, they will be rapidly deactivated by the acid in the stomach.

Well then, what could we do or how can we help those elderly, kids or those who have problems in swallowing the capsule?

Here is the simple way -  you can open the capsules and empty the granules inside the capsule into the acidic food o drinks. For instance place the granules into the yogurt, mixing them and swallow the much smaller granules without chewing them. Or you can swallow the granules with acidic drinks such as orange or lime juice. Easy? :) (Doing all these steps are to protect the granules from exposing to the acidic environment).

The alternative is that you can ask the doctor or pharmacist to prepare the omeprazole suspension for you.  :) Or worse case, administer through nasogastric and jejunostomy tubes.

In summary,
****SWALLOW the capsule (PPI) whole 30 minutes before breakfast (or meals).*******
Follow the instruction and get the most benefit out of this medicine. :)

P/S: Even you're taking the medicine to relieve your symptoms, remember that changing your lifestyle is the way to get rid of these annoying symptoms.

- Take your meals on regular basis, eat slowly and don't skip meals.
- Avoid too much fatty or spicy foods and reduce the amounts of alcohol and caffeine intake.
- Do exercises to lose weight.

Suggestion on further info about PPI :

http://patient.info/health/proton-pump-inhibitors