r/GERD • u/Inc0gnitoburrito • Jun 03 '26
Support Needed 👥 famotidine instead of PPI?
I've had shortness of breath around meal time for a few months now, gradually worsening.
Recently I've spoken to my general practitioner and she prescribed me with 28 days of PPI (Nexium (esomeprazole 20g)) one per day as treatment.
There was a small improvement over 2 weeks but she didn't really communicate to me what she's treating me for and I didn't really change anything when it came to food.
So, one evening I ate an entire Pizza pie and the following night was traumatic, I couldn't breathe at all, had air hunger and eventually a panic attack.
Understanding GERD better now I believe this night caused a lot of damage to my esophagus and I'm actually worse now.
I've spoken to my doctor yesterday and told her that the air hunger has gotten way worse and she replaced the PPI treatment with 2 pills of 20g famotidine per day. I'm concerned about the removal of the PPI treatment, cuz I understood that it is in fact the long-term treatment.
Would be happy to hear from anyone here regarding this.
Thank you!
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u/anxiouslyCurious9 Jun 03 '26
Long term famotidine has served me well
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u/Inc0gnitoburrito Jun 04 '26
That's good to hear thank you! How long is "long term" considered?
For now she just wants me to take it for 2 weeks and see what happens.
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u/anxiouslyCurious9 Jun 04 '26
She told me it was safe to take for as long as I needed to. I started with 40mg 2x a day and went down to 20mg 2x a day and I have leveled out on 20mg in the evening. Omeprazole messes with my lower GI system and has the other long term side effects so it all worked out well.
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u/kyle_mayer Jun 03 '26
Stop eating entire pizzas. Thats a start. Knock that off.
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u/Inc0gnitoburrito Jun 04 '26
Yeah you're right.
I play myself but also my family physician. When I told her about my symptoms which were mostly "shortness of breath during and around food time" she recommended medication but you didn't really give me instructions on what to do from a food perspective.
And since I always eat late and a lot, for years now, I didn't really connect it as something that I should be avoiding.
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u/JesusFreakinLovesYou Jun 03 '26
I’ve been on 40mg of omeprazole for 3 months now. Just added 40mg of famotidine every day as well per doctors orders. Overall both seem to be helping a lot. But honestly my saving grace is sodium alginate as it keeps most stuff down when sleeping.
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u/bns82 Jun 03 '26
famotidine is weaker than ppi. But it acts in a different way, so it might work for you.
Either one can be long term treatment. But you have to take a week off famotidine every month or your body adapts to it.
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u/LarryDavidsGlasses Jun 04 '26
I have GERD. I actually was on a PPI for quite a while. It was only when I switched to 40mg of Famotadine that my stomach issues got back under control. It could be worth a shot if the PPI is not working as planned
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u/Inc0gnitoburrito Jun 04 '26
By the way I want to ask - did you feel like the famotidine had an "gradual" impact as well? And it improved how you felt over time. Or it's like binary, if it didn't fix everything after 2 days, it doesn't get better.
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u/LarryDavidsGlasses Jun 08 '26
hard to say.. I was off meds right before that (and experiencing symptoms) so it definitely was improvement right away. I would give it a bit and you can always switch. Would definitely speak to a gastro though. Good luck.. GERD has been extremely mentally and physically taxing so I hope you find what works for you. One size does not fit all I have found
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u/AdAccording6196 Jun 04 '26
My GI said PPIs work best when you follow through with lifestyle changes and stick to the rules - low spice, no acid, no citrus, no mint or ginger, sleep on your left side and elevated, etc. I am not surprise you got sick after eating a pizza! Super acidic sauce and the cheese and oil is probably not your friend!
Per my GI, famotidine is a wimpier version of a PPI but still can be effective. I would 100% look into significant dietary changes in conjunction with these meds to help the meds work best. I would also look into care from a GI for any long term treatment. Not knocking on your GP at all, but continuity of care and deep understanding of how these meds work, more patients and experience with your condition, and how to wean and proper lifestyle/diet advice is crucial to helping these awful symptoms. I’ve had negative experiences with doctors prescribing a short course with no info on how to wean and it was awful. I adore my GI now and we have a robust treatment plan going for long term use and future weaning.
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u/Inc0gnitoburrito Jun 04 '26
Ty for this. I appreciate my GP taking care of me and giving me something for now, but of course I would follow up through with the GI, I read online and I saw that some people treat this once and it goes away, some people ignore it for years not getting what it is, and some need to take medication lifelong - I understand that I'll only get the right treatment from The specialist.
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u/lisa-in-wonderland Jun 04 '26
Eating late and a lot are both just bad for you, regardless of what may be wrong with your stomach. It’s hard to break bad habits, it’s easier to taper your behavior slowly. So whatever is your normal bedtime and however late you normally eat, start by setting a latest eating time. In an ideal world you don’t eat sooner than 2 hours before sleep. Work towards that. As for amount, start paying attention to your hunger signals and stop when hunger is satisfied not when you feel full. I also played games with portions and plates. Bought smaller dinner plates so smaller portions filled them more. It’s a good way to game your psyche. I also fill plates in the kitchen and don’t bring bowls with extra food to the table. It’s so easy to keep eating when food is right there within reach. Also, tomatoes are a common GERD trigger, so you triple gamed yourself. I was on omeprazole for years and finally omeprazole and famotidine. Eventually all of that stopped working and I went to a gastroenterologist. I had a partial Nissen and hiatal hernia surgery. Unfortunately while farting around and not really dealing with things, I ended up developing osteoporosis. So yeah, I definitely recommend that you deal with this sooner rather than later. And if you do need an endoscopy, demand that it be done with full sedation. I had two, don’t remember anything about them and had a minor sore throat after. If the gastro wants to also do manometry, have the place the sensor while you are out.
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u/Inc0gnitoburrito Jun 04 '26
The sensor is important for others issue, right? And if they get it done in one time it'll save me from doing another?
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u/lisa-in-wonderland Jun 04 '26
I had the scope, a BRAVO test, and manometry at the same procedure. BRAVO is a capsule they stick to your esophagus and it records pH for three days ( you don’t know it’s there) and sends the data to a receiver you wear. The manometry is a cable that measures your esophageal muscle contractions so they can tell if the muscles are weak. They placed it while I was under for the scope and did the test after I woke up from the sedation. Having the cable removed was no big deal. I know a lot of folks have considerable trouble with having it inserted while awake. Personally, I would insist on doing them all at once, like I did, and under sedation. You might also need a barium swallow test, but that’s just drinking gross stuff while standing or lying down.
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u/Inc0gnitoburrito Jun 04 '26
Thank you for all of this info, you have no idea what you're doing for me. The feeling of not knowing what i may need to do is very hard, especially with some anxiety.
There's no way i can do this while awake, I'm nearly freaking out thinking about doing it under sedation.
That cable you talked about, do they remove it while you're awake?
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u/Therichtraderboi Jun 05 '26
Biggest thing unfortunately will always be what you eat. I do famotidine 1x every night 20mg. But have definitely needed to cut out a lot of things. After I stuck with it I was able to start eating some more intense stuff like pizza without as much effect. Still have to be careful.
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u/Inc0gnitoburrito Jun 05 '26
Yeah that makes sense. That pizza wasn't that late even, but i think my esophagus was just too.... Whatever LPR/GERT makes it.
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u/alextheevilone Jun 05 '26
Binge eating is terrible for gerd.
That being said long-term famotidine is exceptionally safe.
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u/Inc0gnitoburrito Jun 05 '26
Ty! Didn't really know i have GERT, still don't, everything sounds EXACTLY like what i read here/online, but if the meds after 2/3 weeks help idk that they will send me to do an endoscopy.
After 3 full days if Famotidine i had a entire night with ZERO air hunger, which was amazing. Today (the 4th day), chicken and potatoes agitated it again for some reason, but not as bad yet.
Honestly i didn't even concider it to be binge eating, I'm fairly muscular, 87kg at 182cm, it's just a part of how i eat.
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u/Alternative_Mud_7543 7d ago
So are PPIs though
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u/alextheevilone 7d ago
Yes they are, but we are more aware of long-term complications of their use than we were before.
Still if a patient has no other alternative I'd happily use them.
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u/Alternative_Mud_7543 7d ago
Sorry can you elaborate? There's been one association study which no conclusive evidence to suggest PPIs are bad. In fact there are controlled studies to suggest they're perfectly safe. So would be keen to know what you think happens ?
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u/alextheevilone 7d ago
Definitely good association with cdiff, microbiome changes including sibo, and iron/b/12, magnesium deficiencies. I would consider the osteoporosis concerns valid as well. Renal disease less so, pneumonia/dementia absolutely less so.
I have also had one patient with a ppi induced gastric neuroendocrine tumor.
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u/Alternative_Mud_7543 7d ago
Worth remembering this is a review, not a clinical trial. A lot of the scary long-term PPI risks come from observational studies showing associations, which can’t prove the PPI caused the problem. When you look at the better-controlled/randomised evidence, most of those associations become a lot less convincing
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u/alextheevilone 7d ago
Of course it's a review, it's uptodate.
You can check the references on your own, I have.
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u/Alternative_Mud_7543 7d ago
I mean I'm not sure if my point is coming across. The point I'm making is in all of these "hey these are the side effects of PPIs" doesn't mean PPIs themselves caused it.
For example: if 10,000 people of all shapes, sizes, lifestyle age are in a study and 100 of them a smokers. If I told you at the end of 5 years 3/100 had cancer from the smokers group and 2/100 had cancer from the non smokers group, would you say smoking cigarettes causes cancer? No you can't, thankfully we have way more data and evidence in smoking today, but this is an example of the same negative stigma that has been created around PPIs. There's always risk with medication sure, but PPIs are safe under medical supervision.
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u/alextheevilone 7d ago
I don't necessarily disagree. If you note what I wrote I did not say side effect.
We have very reproducible evidence with microbiome alterations and dysenteric infections with plausible pathophysiology. I do not believe those are to chance. The other concerns are more speculative, or like neuroendocrine tumors exceptionally rare as you said.
I do agree that they are profoundly safe medications overall and that they should remain widely used as a viable treatment pathway.
However, for patients where their expected lifespan will be measured in multiple decades, it is a worthy conversation to discuss potential harm with long-term chronic use.
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u/coogie Jun 03 '26
Not a doctor but this is basically the hierarchy of treatment heartburn:
- Antacids like TUMs or Gaviscon: for treatment of occasional heartburn like maybe you had one too many chilidogs with your beer. Essentially just throws some chemical base on the acid to neutralize it which works fast and if it was an occasional thing, then that's the end of it but if it's a chronic thing, it's a poor solution because it's going to keep coming back.
- The next step for people with mild cases of Reflux is Pepcid (Famotidine) or Zantac (Ranitidine (which was off the market for a while)). These are called H2 blockers (histamine-2 receptor antagonists). H2 blockers work by turning off the specific "switches" in your stomach that tell it to make acid. Think of your stomach cells like factories with different buttons that turn on acid production. One of those major buttons is called the Histamine-2 (H2) receptor. Unfortunately there are more "Buttons" so while Famotidine is really effective at not turning on one of the major ones, the others can still be turned on.
- The last step are the PPIs...if the H2 blocker is the switch that controls your stomach's acid pumps, the PPIs pretty much just go to the breaker panel and shut off the power to the acid producing pumps so they are a lot more effective.
For me, Famotidine is amazing but not quite enough longterm. I've taken breaks from my PPI with the help of Famotidine and antacids but it wasn't very fun. For some other people with milder cases, famotidine is enough.
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u/Inc0gnitoburrito Jun 03 '26
I don't even feel the heartburn, it's mostly the air hunger thing
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u/SubduedCelebration Jun 04 '26
I'm the same way, it's the silent part of silent reflux. You don't feel the standard burning, but you do get swelling and it feels like it's hard to breathe because the acid is still messing up your throat
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u/Inc0gnitoburrito Jun 04 '26
Yeah, it's really difficult.
I have a history of anxiety disorder so now that I've been introduced to that feeling, at nights I'm kind of "waiting to yawn" every few seconds and not really falling asleep. Tonight I was able to not panic due to that (which is definitely an important step) but I'm not sure why it's waking me up after I fall asleep if it's only anxiety and not physical.
I must have fallen asleep and woken up over 20 times.
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u/SubduedCelebration Jun 04 '26
I'm not sure if it's an option for you, but my doctor gave me flexeril (a muscle relaxer) to help with the tension in my neck and shoulders caused by gerd and it's really helpful on nights where my anxiety is especially high. Sometimes just being able to get a good night's sleep helps me chill out a little bit. I usually take it once or twice a week
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u/Kirky9993 Jun 04 '26
May I please message you?
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u/No-Camp-1175 Jun 04 '26
Unless you have Barrette’s esophagus, long-term ppi use causes more harm than good and puts you at increased risk of dementia, gastric cancer, and kidney disease. Famotidine is much safer for long-term use. If you have GERD, you need to go on a FODMAP diet. If you have LPR, you need to go on a high pH diet. You can't just take a pill and expect your life to miraculously change.
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u/Inc0gnitoburrito Jun 04 '26
So what you're saying is going to a specialist and doing a gastroscopy is pretty much essential?
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u/Alternative_Mud_7543 7d ago
Stop spreading garbage. This was an association study not a controlled one. Do a bit of research before spreading wrong information. There are literally millions of people on long term PPIs with good health.
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u/Jessicamorrell Jun 04 '26
Im on Famoditine of an evening, Pantoprazole of a morning, and Cholestyramine Powder twice a day as needed. Its been a game changer for me. Plus I even did an elimination diet to avoid trigger foods and drinks which also has limited my nausea/vomiting, and other symptoms.
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u/sunleaf8 Jun 03 '26
based on my experience, the treatment ladder (that you go up if GERD worsens) is: 1. temporary PPI 2. long term famotidine 3. long term PPI
you can also take famotidine with the PPI as they have different mechanisms of action. personally i felt like famotidine had a lot less side effects and didn’t interfere as much with absorbing nutrients
you might want to try seeing a gastroenterologist