Gastroenterologist Questions Gastroenterologist

Long-term GERD sufferer?

I just wonder whether 80mg of Protonix daily for my GERD is scientifically speaking really as effective as taking only 40mg? I read some papers online, and the effectiveness is comparable according to these papers. My intuition would tell me, that more do more. Is that just not the case? I've read some conflicting stuff about that.

I am a long-time GERD sufferer and will get surgery for the second time this year probably. Right now I am managing by taking Protonix in the morning, 40mg, and using H2 Blockers (Famotidine, up to 80mg) in the evening. I have symptoms that affect even my nose and upper throat. The full program, sadly...I had to stop taking my meds for a long while and now I am struggling with constant throat pains and mild heartburn and on top of that a lot of swallowing up and breathing problems like a completely clogged nose. Night and day...I want to speed up the healing process and at least and regain some life quality as soon as possible by taking 80mg of Protonix daily. Is that sensible? I had my magnesium levels and so forth checked a while ago and I am taking some supplements by now to prevent any deficiencies. I had some hairline fracture in my right foot a while ago, so I and my doctors were worried about my bone density, but it turned out, that's just fine...So bottom line: Is taking 80mg of Pantoprazol (Protonix) in the morning and additionally taking 80mg of Famotidine in the evening before going to bed already overkill? Thank you.

Btw my doctors leave me some leeway in dosage and combining meds, since I am rather sophisticated, let's say, informed about what I do, what a proton pump inhibitor actually is and blah... Yet, I wanna have some other and real expert, e.g. doctor, give me an opinion from time to time.

Male | 31 years old
Complaint duration: 2 Months
Medications: Protonix, Famotidine
Conditions: GERD, Hernia

2 Answers

The usual dosing is 40 mg twice a day rather then 80 mg once daily (because the half life of PPIs is very short), but to answer your question, 80 mg will control more acid than 40 mg. In general, though 40 mg once per day is enough to heal any injury that might result from acid reflux. It is very rare for anyone to need an 80 mg dose.
Other than PPI/H2B therapy, I also suggest doing the following:

1) LOSE WEIGHT!!!!!!!!!!!--if you are overweight--mainly by exercising/staying active and also by avoiding JUNK FOOD and anything "white or tan" and contains SUGAR or FLOUR (including potatoes, bread, pasta, dairy/ice cream, cookies, cakes, etc. (if you are very overweight, consider bariatric surgery).
2) Elevate the head of your bed by 6"--takes advantage of gravity at night
3) Avoid FATTY or FRIED foods, and also avoid ALCOHOL and anything SPICY or TART or acidic tasting--fruit juices, tomato sauce (from CITRIC ACID and its ACIDIC EFFECT on the stomach/esophagus
4) Don't eat after about 6pm at night so the stomach is EMPTY when you go to bed
5) Avoid any medications that worsen reflux or exacerbate gastric sx (especially NSAIDS, many BP meds, and many meds for mental health therapy)
6) Avoid CARBONATED beverages, especially SOFT DRINKS
7) Consider TRYING OTHER PPIs--Nexium, lanzoprazol
8) Keep LIQUID ANTACIDS easily available--as taking a "swig" of this medicine like MYLANTA a few times a day may quickly relieve reflux sx

Good luck!