Do You Still Need Your Heartburn Medication? A Pharmacist's Honest Look at PPIs

Hi, it's Nelo — pharmacist, compounder, and the one usually behind the counter at Opal Wellness. Pull up a chair.

Here's a question I ask at the counter more often than almost any other: "How long have you been taking this?" And when the medication is a proton pump inhibitor — omeprazole, pantoprazole, esomeprazole, one of that family — the answer is very often "oh... years?" followed by a pause, because nobody quite remembers why it started.

If that's you, or someone you love, this one's for you. PPIs are genuinely excellent medications — and they're also among the most common medications Canadians stay on longer than they need to, refill after refill, without anyone stopping to ask whether they're still doing a job. Let's talk about when they're essential, when it's worth a second look, and how to have that conversation safely.

As always: this is general education, not medical advice. Never change or stop a prescription on your own — that goes double for this class of medication, for reasons you'll see below.

What are PPIs, and what do they treat?

Proton pump inhibitors reduce the amount of acid your stomach produces. In Canada, the family includes omeprazole, pantoprazole, lansoprazole, dexlansoprazole, rabeprazole, and esomeprazole — and together they're among the most prescribed medications in the country.

They're prescribed for good reasons:

• GERD (gastroesophageal reflux disease)
• Stomach and duodenal ulcers, and healing the damage they cause
• Protecting the stomach from NSAIDs like naproxen or ibuprofen in higher-risk patients
• H. pylori infections, as part of combination therapy
• Frequent heartburn and indigestion

For these, PPIs work — often remarkably well. They relieve symptoms, heal the lining of the stomach and esophagus, and prevent damage from coming back. When a PPI is the right tool, it's the gold-standard tool.

So what's the concern?

Not the medication — the autopilot.

Over the past fifteen years, PPI prescriptions in Canada have more than doubled. Nearly one in three Canadian seniors takes one, and studies estimate that somewhere between a quarter and half of long-term PPI use may no longer be clinically necessary. That's a lot of people taking a daily medication that no one has reviewed in years.

From behind the counter, I can tell you exactly how it happens, because the pattern repeats:

• A PPI gets started in hospital — often appropriately — and simply never gets stopped after discharge
• It's prescribed for general "heartburn" and works so well that nobody revisits it
• Refills renew automatically, year after year, without a re-evaluation
• Symptoms are long gone, but there's hesitation to rock the boat — if it's not broken, why touch it?
• Or it never involved a prescriber at all: over-the-counter PPIs, bought and re-bought, quietly becoming a daily habit

None of this is anyone's fault. It's just what happens when a medication works quietly in the background — it stops getting questioned.

What are the risks of long-term PPI use?

Let me say the reassuring part first, because it's true: for most people, these risks are small, and for people with a clear ongoing medical need, staying on a PPI is the right call. This is not a "throw out your omeprazole" article.

But stomach acid isn't a design flaw — it helps you absorb nutrients and defends against certain infections. Suppressing it for years, without a clear reason, has been associated with:

• Vitamin and mineral deficiencies, particularly B12, magnesium, and iron
• Increased risk of bone fractures, especially in older adults
• Kidney concerns, including chronic kidney disease and acute kidney injury
• Gut infections, including C. difficile
• Rebound acid hypersecretion — a surge of acid if the medication is stopped abruptly, which can feel worse than the original problem

Individually, these risks are modest. The reason they matter is scale: when millions of people take a medication longer than needed, small risks add up to real harm across the population — harm that a simple medication review can often prevent.

When a PPI is exactly the right medication

Worth repeating clearly, because I never want an article like this to scare someone off a medication they genuinely need. PPIs remain essential — the standard of care — for:

• Healing stomach and duodenal ulcers
• Managing serious or frequent GERD
• Preventing gastrointestinal bleeding in higher-risk patients, such as some people on long-term NSAIDs

Long-term use can be entirely appropriate. It just deserves what every long-term medication deserves: periodic review. The problem was never the PPI — it's the years without a check-in.

How to tell if it's time for a review

If you've been on a PPI for longer than about 8 to 12 weeks, these are the questions worth asking — yourself, and then your pharmacist:

• Do I still have the symptoms this was started for?
• Was I ever actually diagnosed with GERD, an ulcer, or another condition that needs ongoing acid suppression?
• Could a lower dose, an "as-needed" approach, or a gradual taper make sense for me?
• Are there lifestyle changes — meal timing, trigger foods, weight, alcohol, smoking — that could reduce my symptoms at the source?

And one rule that is not optional: never stop a PPI suddenly. Because of rebound acid, quitting cold turkey can bring your heartburn roaring back worse than before — which convinces many people they still "need" the drug, when what they actually needed was a proper taper. Coming off a PPI, when appropriate, is a planned, gradual process — and it's one we help patients with regularly.

How your pharmacist fits in

Your pharmacist is usually the most accessible professional on your care team — no appointment needed. For PPIs and digestive health, here's what we can do:

• Review how long you've actually been on your PPI and why it was started
• Work with you and your prescriber on whether continuing, stepping down, or tapering makes sense
• Build a gradual tapering plan so rebound acid doesn't ambush you
• Recommend good-quality over-the-counter options for occasional symptoms — antacids or other short-acting products matched to your situation and medication list
• Check your other prescriptions and supplements for anything aggravating your reflux, or anything affected by long-term acid suppression
• Keep your prescriber in the loop, so nothing changes without the whole team on board

And when you fill your prescriptions with us, one-on-one time with a pharmacist comes with the territory. That includes a MedsCheck — a medication review, publicly funded for eligible Ontario patients — where we sit down together and go through everything you take, how it's working, and whether each medication is still earning its place. A years-old PPI is exactly the kind of thing a MedsCheck is designed to catch.

Start with a conversation — wherever you are in Ontario

Your treatment plan should evolve with you. The medication that was right after your hospital stay, or during a rough stretch of reflux five years ago, may not be what your body needs today — and finding that out is a conversation, not a leap.

If you're wondering about your PPI — or any medication that's been quietly refilling itself for years — talk to us at Opal Wellness Pharmacy. We serve patients across Ottawa and throughout Ontario — visit, call, or ask about transferring your prescriptions, and we'll book that MedsCheck together. No pressure, no sales pitch — just a proper conversation about what makes sense for you.

Take good care of yourself — and remember, the counter's always open.

— Nelo

Chinelo Uddoh, RPh — Pharmacist, Compounder & Owner, Opal Wellness Pharmacy, Ottawa

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This article is for general education and does not replace advice from your physician, nurse practitioner, or pharmacist. Always consult a health professional about your individual situation.