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Are PPIs pro-arrhythmic drugs?

Just had a quick question re: PPIs (I'm currently on omeprazole). Can they/do they have an impact on afib? On the face of it, it would make sense that they do, given the connection between the vagal nerve, stomach and heart.

I ask as, I have afib, but was ablated in June 2017 successfully. I have also been on PPIs for gastro/reflux issues for the last 3 months.

Can't say 100% definitely but for the last 2-3 months I've been experiencing a LOT of increased PACs/PCVs/ectopics. It's actually got to the point that if I wake up through the night, or a couple of hours before my alarm I can't go back to sleep because the arrhythmia is quite pronounced sometimes and is keeping me awake.

Anybody else had issues with PPIs?

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Just wanted to add. I DO know that PPIs can deplete magnesium levels. I also take about 1500mg magnesium per day, so presumably this should negate that effect?

Or can TOO much magnesium lead to these arrhythmia too?

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Be sure and take the PPI at least 2 hours apart from your magnesium or they will interfere with each others jobs

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1500 mg of magnesium may be a bit high. I would definitely have a red blood cell test to make sure you’re not exceeding limits that can actually hurt you with your calcium phosphorus balance

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I've lowered my dose, tbh I think that too much magnesium can cause these regular ectopics as well. Can also upset an already upset stomach.

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What type of magnesium are you taking

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A 250mg tablet from Holland & Barrett. Took 1500mg a day, now down to 500mg a day

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It does not tell you what type of magnesium it is or it’s bioavailability

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Do you absolutely have to take PPIs? They are unnecessary toxic load on your body and if you can research natural ways to overcome the reason for taking them, you would probably notice a big difference.

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I have a lot of health problems at the moment, and the gastro issues worsen a lot of them so I'd been avoiding the PPI for so long but had to start a few months ago.

I'm to trial stopping them for a short while from this morning as my heart has become really irritated lately and it's unpleasant.

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It would be better to research alternative ways to deal with your problem, rather than just trying to do without them. There are many and firstly is your diet. Have you looked at that aspect? Sorry to preach but PPIs are not what you need right now.

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Hi, yeah I'm currently gluten, wheat, dairy and mostly soya free. Have been for over 6 months now. Had gastroscopy, been checked for acid in oesophagus, and manometry. All clear. Was discharged from the gastro dept. after that, so been trying to manage on PPIs.

Strangely, I've found drinking a smoothie in the evening can often help with the worst of the reflux but still always very bloated and uncomfortable etc.

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Why not just eat normal, natural organic home cooked food and not the latest bandwagon of ‘free’ this and ‘ free’ that, most of which are full of horrible additives to make up for what is missing?

Oh dear, you have got me started but honestly why do you think you need to be free of all those? Have you been tested for any? Normal unprocessed food cannot be inferior to highly processed foods. Fruit and veg? Do you get loads of those? Why when I mentioned a good diet did you think I meant manufactured? Sorry, I will go and hide but am only trying to help.

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To be quite honest, I just don't have the time. I'm off work at the moment, so I've been making more meals with natural ingredients but I simply haven't got the time to do this constantly.

Also, I've cut those things out of my diet through a process of elimination after finding that they give me a great deal of problems. I've also had some allergy tests done and they suggested that I have intolerance to all of these things as well.

I do eat a lot of fruit and veg now.

That's a topic for another day though, as I'm looking to find out what effect PPIs have on afib.

Thanks for your response.

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What can be more important than preparing proper food? It need not take more than an hour to make a good wholesome dinner starting from scratch. What else would you do with that hour that is more important? If you are working so many hours that you cannot take time to cook then you need to look at your work / life balance .

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Just read that drinking a smoothie helps. Do you mean a lovely homemade one? Well, no wonder as it is full of vitamins and minerals. Even so, you are still better off chewing the proper whole fruit and veg. Chewing food releases proper digestive enzymes, which is exactly what you need to combat acid reflux.

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Try drinking celery juice first thing in the morning

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I thought that many patients are prescribed PPI's due to post ablations problems.

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No idea about that. I am not familiar with why a digestive issue would be triggered by an ablation. Anyone else heard this? All I know is they are not what anyone should take for a long period.

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After my ablation they put me on a poi. Only took a few doses because read about the cons of taking them!!

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Has often been written of here by post ablation patients.

This is one of many medical reports.

uspharmacist.com/article/ga...

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After my ablation my Dr Ordered poi to take for 3 mths. I only took them abot a week or so cause ppi's have a lot of negative issues too.

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I have found ppis Impact adversely on me in that I get ectopics badly so have stopped the ppis. Every time I try them I get ectopics so for me it's clear they are a trigger. I am taking ranitidine instead which doesn't appear to give the same ectopic issue. I too have dreadful gastric issues and in themselves they set my heart off. Best wishes.

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Thanks meadfoot.

I'm trying to come off them today and see how I manage without. Really don't need the ectopics on top of everything else right now.

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Hi Dave,

I'm in the same boat as you as far as taking ppi's. . I have to take them right now because I have a large hiatal hernia and ibs. My medication has inflamed my stomach. For years I've eaten the necessary way to avoid reflux. No processed, spicy, fried foods. No tomatoes, citrus fruits etc. Only eat small meals. I've put 5 inch blocks under the head of my bed. No lying down or even bending over for 2 hours past meals. No eating 3 hours before bed. No caffeine or alcohol.

All was great for 4 years, then came Sotolol! My cardiologist won't change it and I've been in hell with constant stomach pain. Had to go on ppi's but intend for them to be temporary if I can do any thing about it. Was on them before and my Vitamin D and calcium was depleted. You have to wean off them very carefully or you get rebound effect and there's more acid than before. Mine are 20 mg. so I just got recently a prescription for 10 mg. I intend to alternate for a couple of weeks between 10 and 20 daily and then try just the 10. Then after a short time of that will go to Zantac or similar.

A natural remedy for protection of stomach lining is DGL.

It's deglycyrrhizinated licorice in chewable form. It's not expensive and a lot of people say it works well. I want to try it but need to check to see if any interaction with sotolol.

I think ppi's are terrible to be on. I've asked 4 doctors and they all say they're just fine indefinitely.

They didn't believe me when I said my vitamin D dropped extremely low while on them. So much for docs!

Lynda

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Do not just arbitrarily stop your PPI without discussing with your prescriber. If your reflux is severe, PPI is protecting your esophagus. The chronic burning of your stomach acid on your esophagus can lead to bad problems.

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Indeed i had barretts because of hyetus hernia, and have to take ppi. But i am permanant af.

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Yes Barretts esophagus is a very serious thing . Sorry you have to deal with that and a fib.

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That’s what my GP and the allergist who finally diagnosed my GERD which had been misdiagnosed and mistreated as asthma for many years. If I was 40 I’d try like heck to leave PPI behind . But I’m 73 and both docs say risking injury to esophagus is a bad idea.

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The problem with PPIs as I preach regularly is that the should never be taken long term. I found two to three weeks absolute tops.

The reason is simple. The lower sphincter in the stomach needs an acid environment to open and pass food down into the gut. Take away that acid and the food sits there idly wondering what to do and actual increases the chance of reflux especially when laying down or bending. Why on earth these drugs are so widely used is beyond me. I found the result many years ago without understanding why when I ran out over a bank holiday weekend and felt so much better. Subsequent research found the reason.

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To be truthful, I actually work with gastro nurses and doctors, and whenever I mention the dangers of being on PPI's for a long time they tell me that it's fine.

However, I've read all kinds of awful things about the damage they can do long term. So either they're refusing to accept that as evidence, or they are simply unaware of it.

I was concerned to start them in the first place, but I have found that a 20mg tablet in the morning helps. However, I'm trying to work out what has caused this uptake in ectopics in the past few months and it coincided with me starting to take PPI's again a few months ago, so..

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Nurses and doctors are trained to believe in the drugs they prescribe and rarely have time to look at studies that show otherwise. If they did not believe in what they were prescribing, the NHS would collapse, like a pack of cards. The NHS nowadays is in thrall to Big Pharma and new medications are introduced to doctors at jolly jamborees on lovely holidays. Any thought of people being cured by eating the right food and living the right lifestyle is long gone....

Actually, there is a ray of hope, now that diabetics are found to lose their diabetes if they lose weight and exercise.

And if you could find the time to eat natural home cooked food, you would soon not need a PPI. Trust me, I am not a doctor but I am sure of that.

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I make all my meals from scratch but it's much more complicated than that.

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I agree that it depends on what one is actually cooking and eating but generally people who cook their own food have an interest in what they are putting in their stomachs, are knowledgeable about what not to eat and use the best natural ingredients, without being drawn into the current nonsense of excluding perfectly healthy foods, because manufacturers have spotted a gap in the market and are producing foul “pretend” food to fill it e.g. the madness of packets of highly processed, gluten free non-food for people who somehow think it is healthy. I could go on and on...better not to start!

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My last GP had been taking PPI's since they first came on to the market but he used to come off them when going to 'Mucky countries' on holiday as he wanted the stomach acid to deal with bugs. He relied on Bisodol and Gaviscon then.

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Finding doctors or nurses who are well informed about the dangers of many prescribed drugs is like looking for a needle in a haystack. I expect they were saying the same about Vioxx right up to the moment it was pulled off the market.

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Thanks, Bob. I thought I was the only one here who wished to discredit PPIs. It is another Big Pharma ploy, I am afraid and GPs probably get points for prescribing them, as they also do for statins.

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It is an easy fix to prescribe pills with your head in the sand.

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I cured my reflux by cutting out all fats, vinegar and magnesium tablets. Be aware that a lot of thing's you wouldn't suspect, have vinegar hidden in them such as baked beans.I also raised the head of my bed by putting blocks under the legs.

Eating a banana if my stomach hurt helped too.

I haven't had any symptoms now for a few years, but am still wary of eating anything too fatty.

PPI's can have such nasty side effects.

Jean

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What do you think it was about the magnesium that was encouraging the reflux?

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I now know through trial and error that I have a sensitive stomach and I have to take my Warfarin mid breakfast, or else that makes my stomach sore too if taken later in the day as most people do. The magnesium, well it took me months to realise it was that. I was taking it way before I had AF, which I've now had for 14 years. I tried taking it again a few years ago and it had the same effect. I'm now settled on putting it in my bath and using an oil spray.

I think the lady who is expert on magnesium is called Caroline Dean (not sure,) but think it was her that suggested if that happened then dissolve tablets in water and sip it throughout the day. Unfortunately it still made my stomach sore. I have no idea what it was about the magnesium that caused reflux. Probably just my sensitive stomach, as others appear to be able to take it.

Jean

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Sounds like it's a lot of trial/error when it comes to these sorts of supplements. I'm going to try to reduce the doses of some of my supplements and see how it helps.

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My mother in law who had gastric ulcers taught me never to drink a cup of tea without a biscuit - sometimes the most surprising things cause reflux 😮 PPIs gave me diarrhoea and I was told to stop immediately and go back to Ranitidine but too late, I had diverticulitis and spent a week in hospital so I wouldn't want to take a chance on taking them again. Another tip is to eat fruit or salad separately from other food as they pass through quicker and can cause bloating while 'waiting' for other food to pass - sounds ridiculous I know but it seems to work.

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Hello Buffafly please research celery juice, and drinking it first thing in the morning good luck

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Thanks for the suggestion - unfortunately I'm intolerant to celery 😬

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PS To answer your question, PPIs cause flatulence and as gastric issues affect AF etc that is probably the link.

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Definitely noticed this tbh.

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Have you been tested for helicobacter Pilori ? a nasty little bug that can cause a while array of gastric problems.

It May help a little if you read up on conditions called roemheld syndrome and Candida Albicans…...the stomach is known as the bodies second brain.

drsanjayguptacardiologist.c...

Certain probiotics and manuka honey although expensive has a very beneficial effect on gastro issues all worth researching and reading into.

A gastro Doctor I know keeps bees and imports manuka plants from New Zealand for his bees.

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A remedy for heartburn and reflux is to take two desert spoonful’s of Manuka Honey before meals to put a coating on your oesophagus. I tried it for a couple of months many years ago and it really helped but was expensive. Then I had annual blood tests and my GP asked how long I had been diabetic as my blood glucose was 18 mmol/L or 325 mg/dl.

I told him about the Manuka honey and a liking for Butterscotch after having stopped smoking. I stopped them and the next check had me down to border line high and a diagnosis of glucose intolerant. Later came a letter saying that glucose intolerance had been deleted from the medical vocabulary and I now had to be T2..... spoil sports.

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I've had a look at this, saw it advertised at Holland and Barrett. It's very expensive but may be worth a try, as opposed to omeprazole.

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In japan helicobactor pilori is called the gastric worm it’s very common in Japan and one of the most common cancers in Japan is stomach cancer

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Hallo,

there are a few newer papers about PPIs blocking the Mg-adsorption. So in my opinion you can take as many Mg you want but the PPI will block the adsorption anyway already on a cellular level. The inhibitory action blocks the capacity of Mg to "dock" .

Am I wrong?

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Not sure if you're wrong, but that certainly makes sense GeneralLee.

I know it has an adverse affect on magnesium levels but hadn't thought about it this way. I may well have been throwing expensive magnesium tablets 'down the drain', effectively.

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Good Morning, I have been on omerprazole forever and flecanide for probably three years and haven’t had any problems. Are you on any other medication? I was told not to take any extra magnesium as there is some aReady in a lot of tablets.

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That could be the magnesium stearate that is used as an anti caulking agent in the manufacturing process and is not a food supplement.

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I'm not, just omeprazole and ramipril for high BP. Also started sertraline a few days ago.

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What’s PPL ?

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Proton Pump Inhibitors - stop your stomach producing acid, usually name ending in 'azole'. Which means your digestion is interfered with and bugs aren't killed - hence link with c.diff infection.

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Many thanks for your detailed reply 🙌

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Lol do you think big Pharma is telling people who are taking these things something by the last part of the medicines name ( azole)

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😂

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hehehe! good point.

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Thank you for all of your comments re Omeprazol. I was prescribed these and looking back I can see that my gastric problems appear to have started at about the same time although it was my understanding that I was taking these to help! I have to be careful what I eat and drink as anything can start me off being sick. No rhyme or reason; I can eat something one day and be fine and the next day it will make me sick. I too have diverticulitis and have just had gallstones diagnosed which on tip of my heart issues makes me very low. Time to investigate further!

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A year ago when my heart first started acting wonky, with fast beats and chest pain, my cardiologist prescribed omeprazole 20, believing that my problem was acid reflux. The issue seemed to go away for a few months, then came into full afib following an undiagnosed bout of pneumonia. I asked about going off the PPI, since we then knew it was a heart issue, afib, but the cardiologist said to stay on the PPI and not mess with anything while we figured out the heart situation. I had an ablation a few months later but am still on the PPI. My GP just told me to go off of it this June when I return from vacation, since we don't even know if I ever really needed it or not. I have now been on it for a year, so will go through the weaning process, as I have heard that many people get really sick if you just quit taking it, with acid flooding the stomach. Twenty years ago, while practicing law as a public defender and under incredible stress, I was prescribed Ranitidine for reflux that was causing me to lose my voice. After I left that job, I quit Ranitidine cold turkey and the acid issues were gone for a decade. So, next month I will wean from PPI and see what happens. I also developed very bad PVCs, at the same time the afib kicked in, so I don't know if it is due to the PPI or not, but I still can't get off of the Flecainide post-ablation due to the PVCs. I will make a fourth attempt to get off of the Flecainide after I am well over the PPI withdrawal.

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You re right. I came off them cold turkey and had bigger problems than before. I m better now, but it took weeks

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I came off yesterday and a few hours after eating lunch I felt really 'full', though that feeling was in my chest. Got some sort of lump in throat sensation and had to take one later in the day. I may need to substitute ranitidine in next time I try and have a look at something like manuka honey to wean myself off them. Only been on them 3 months.

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I am going to conservatively try going a week at half dose, then half dose every other day for a week, then have Ranitidine and Tums ready and try to stop altogether, but drink lots of water and eat lightly, lots of crackers and broth and smoothies. Hoping that if I do that diet another week I can be finished with it. Ridiculous that millions of people are given that drug whether needed or not, sold over the counter (at least in America), and once you are on it you are stuck unless you make Herculean efforts to get off.

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Definitely were for me ☘️

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A straightforward answer to my question.

Thanks!

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I was on omeprazole for about 4 weeks and didn’t notice any of its effects on AF. I am currently on a maximum dose of Sotalol maybe it helped

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Thanks, it appears that it could give some issues, others none.

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You could try ranitidine I do not think they are as bad as omeprazole and lansoprozol. I am taking the latter but I now have one every other day and have ranitidine inbetween.

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I think I'm going to try that, actually.

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I have been on them for ages and never had an issue ? But everyone is different.

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When you say ages, how long do you mean, years or months? I'm on them 2 years. I'd like to come off them but when I've tried, reflux kicks in again big time.

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About a year now

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I have been on 20mg Nexium for past 5 years - cutting tablets in half for the past 6 months - no problems or side affects!!! I hope to eliminate in the near future.

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It depends what one is using PPI to stand for.

I worked for 7 years at Cape Canaveral, and it is a NASA acronym for Pulse Position Indicator.

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Hilarious. Maybe take the sarcasm to another board. It's specified immediately after I first use the abbreviation that I'm referring to omeprazole. A proton-pump inhibitor.

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I had the same issue with H2 inhibitors (Zantac - Tagamet etc..) that when I had to start taking it again I had much more noticeable SVTs and a horrible feeling of anxiety in my chest. I felt it was linked to the Zantac even though my cardiologist was positive that it was not a side effect of the Zantac. I read that it seems for some PPIs are even worse. I looked around online and found a guy who claims that medical industry is backwards and the issue for many people is too low acid production creating too many bad bacteria in the gut, this leads to poor digestion and creates too much pressure inside the gut that causes the stomach acid to come up into the throat. His solution is to take digestive enzymes and betaine hydrochloric acid with pepsin to increase acid and aid digestion. I have tried this and after 2 weeks I do not take antacids except for a half a Tums right before bed just in case so I don't wake up in the middle of the night with acid in my throat. This link is to an extensive article on his beliefs. Chris Kresser How to Cure GERD without Medication --> chriskresser.com/how-to-cur...

I tend to be a full on skeptic of internet wackos, especially on health issues, but read through the whole article which there are 4-5 sections and at the end instead of asking for money for his solution he simply links to the supplements that he recommends (and he says he would get a small cut of the purchase) I Followed his directions and there were a couple days I did have severe acid reflux trying to find my personal dosage, (you have to take more and more of the HCL until you find your maximum and then you back down to what works for you) but now I would say I am 95% good and have even had some spicy Mexican tacos to test it out. And with out taking the Zantac my heart issues feel much better and are much easier to live with. I have a follow up with my Cardiologist and would be interested to wear a holter monitor again to see if it shows a real change in my arrhythmia

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Thank you. I've had that weird anxious feeling in my chest too. It's bizarre. Got it when I was on fluoxetine too.

I'm literally on 20mg in the mornings at the moment and it really helped for about 4-6 weeks but recently my AF has been playing up (not full afib, but many ectopics) and it's only the omeprazole I can think it may be at this point, having had all kinds of actual medical tests.

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I saw that there is a 10mg dose available, though can't get it over the counter. Since I have capsules, I may ask my dr. to prescribe the 10s to make reduced dosing easier.

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First off, I commend you for taking such good care of yourself and for questioning the PPI's! You're already thinking outside the box, and that's when you'll begin to find effective solutions. In the spirit of continuing that journey, I give you the following links:

naturalmedicinejournal.com/...

drhyman.com/blog/2010/07/17...

I have an adult son with AF who has also experienced significant struggles with GI issues and he has been helped greatly by the zinc carnosine mentioned in both articles as well as the DGL licorice. I'm writing from the U.S. and both of these supplements are available on amazon.com

Best of luck to you!

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One more quick link:

drhoffman.com/article/the-7...

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Ye s I’ve just stopped taking them , they were making the arriythmia worse I think , I didn’t really need to take them , so came off last week , feeling much better Dave ! Having my ablation on the 20th for svt 🤞

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Thanks - I feel like I need something for the reflux and gastric issues so I may have to try something other than the omeprazole!

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It sounds like a lot of people use ranitidine.

It didn’t work well for me, but it’s worth a shot if you haven’t tried.

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Definitely going to give it a go again. Started on ranitidine but had to see my doctor for something stronger, i.e. omeprazole..

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PPI s reduce vit B12 absorbtion from the stomach as well. I was only on them 6 weeks to get to low B12. I was only on the Ppi just in case Pradaxa gAve me reflux , which it did not so I put the lasoprazxole in the bin and recovered. Low B12 gives you anemia. I went for the blood test owing to tiredness followi g my second ablation.

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Hmmmmmm. . .

Shortly after I had my first afib episode, I found that An episode would stop quickly after taking Prilosec.

Whenever an episode would start, I would take take one and my episode would be cut short. I actually found reports from other people who have experienced this online.

I don’t take PPIs often, but this was an interesting development for me.

I tend to think that my afib may have something to do with my esophagus.

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I think my vagal nerve, stomach, oesophagus and neck are all associated with my afib in some way. Seems way more sensitive lately.

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When I was first diagnosed, I was amazed how little information anyone had to offer on the subject of afib.

I have come to believe that part of the reason for this is that it isn’t very well understood.

One of the nurses told me that everyone’s afib is different, and that you have to learn about your own particular situation.

I have noticed that a lot of people have ectopics after eating, which has been common for me too.

I have been eating smaller meals to hopefully avoid that problem.

The esophagus is in very close proximity to the pulmonary vein, and I suspect that this may be an important factor in my afib.

But PPIs seem to possibly prevent or shorten my arrhythmias, and it sounds like they increase them for you.

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To be honest I'm not all that sure if they do. Just trying to find out whether other people have had the same issue. I'm going to gradually ween myself off them, maybe see if I can get by on Ranitidine.

So much irritates my afib nowadays.

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There are a lot of interesting articles about the esophagus/afib connection.

One is at https:/academic.oup.com/europace/article/19/1/16/2952312

I suspect that I am in the small percentage that has issues with the esophagus/PV proximity.

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I've had long expetience with PPI s and AF and haven't found any connection.

Whilst I agree that there are many who would be better off adjusting their lifestyles before taking PPI s, there are also a considerable number to whom this doesn't relate and to those these drugs are a ' life saver'. Do take notice of what Hoski has said about PPI s protecting your oesophagus from chronic burns of stomach acid.

I find that not eating after 6pm when at all possible ( and never a heavy meal ) and not lying on RIGHT side in bed helps considerably. Plus magnesium supplements.

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Exactly. Sometimes the drugs are all many people have.

I've made a number of changes to my diet, tried to eat much better, and have stopped a large number of things such as caffeine, energy drinks, chocolate, alcohol. It's made little difference. So sometimes lifestyle changes aren't the only way forward.

I do try to eat before 6:30 myself to be honest. I've also started having a larger meal at lunch (although, I know we shouldn't really eat too large meals) and a smaller one in the evening time.

Right side causes me issues too. Left side also, some times as well.

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I also try to have larger meals at breakfast or lunch, and small meals in the evening.

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Yes Dave....while many prefer to sleep on right side due to cardiac issues, if you suffer from reflux this is not a good idea. Back sleeping is probably best but left side sleeping is supposed to keep the junction between the stomach and oesophagus above the level of gastric acid. On the right side the oesophagus opens onto the stomach at an angle.

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I didn't know this, could also have something to do with why our hearts get irritated when lying on our right side.

Will definitely bear this in mind tho, Jalia

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Hi DaveT81 my doctor took me off omerprazole as it is known to reduce magnesium which is needed for the heart. When I was checked I needed magnesium intravenously as it was very low when I had dvt. So they changed my PPI to ranitidine

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Was it easy for you to switch, or did you have to wean off the ppi? How long were you on ppi before switching to Ranitidine?

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It was easy they both do the same job

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Dr Sanjay Gupta has a informative video on Magnesium well worth

a look.

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