? increased risk of bleeding when taking Esomeprazole

[Littlenanny25]

Hello all,

Does anyone take Apixaban with Esomeprazole. I’m not sure if there’s interactions between the two. I’ve just been prescribed Esomeprazole to replace Omeprazole.

Thanks

[BobD Volunteer]

Best speak to your pharmacists on that as they are the experts

[mjames1]

No interactions per personal experience and online drug checker. In fact, PPI's like the ones you've mentioned, are often prescribed together with NOACs to help reduuce bleeding risk in the GI track.

Jim

[Cavalierrubie]

It is quite safe to take PPI’s with anticoagulants and can prevent bleeding if you have ulcers or inflammation. Lots of us have to take them to protect the stomach lining from the anticoagulant. I think your GP would have checked that, but if you are unsure or worried ask a Pharmacist.

[Littlenanny25 in reply to Cavalierrubie]

Thanks all

[Neoneo]

Good morning Littlenanny25, I am on both and have had no problems. I never take the PPI with any other medication, leaving a couple of hours between. But that’s just me. There should be no problems for you.

[Littlenanny25 in reply to Neoneo]

Thank you

[mjames1 in reply to Neoneo]

.I never take the PPI with any other medication, leaving a couple of hours between.

In general, that's only necessary with antacids. You can take a PPI at the same time with other drugs unless specifically contraindicated by your doctor or pharmacist.

Jim

[Ppiman]

Yes and for many years. There are no issues whatsoever; indeed by protecting the gastric mucosa from erosion, ulceration and bleeding, I would say it adds to the safety.

Steve

[Littlenanny25 in reply to Ppiman]

Many thanks

[Ppiman in reply to Littlenanny25]

I would add that a few people can get problems with long term PPI drugs like esomeprazole as they can block magnesium and B12 absorption. I’ve not had this, and it is unusual, but is a reason maybe to take them for as short a time as possible. I have dreadful acid reflux so need to take them.

Steve

[Littlenanny25 in reply to Ppiman]

Thanks Steve, yes it will be long term as it’s for severe Gerd, so I’ll probably need to take extra B12. I’m already taking Magnesium Taurate. I will ask the consultant for periodic bloods to monitor levels etc

[Ppiman in reply to Littlenanny25]

That’s a good idea. A few here are very against the drugs and, in fear of them as a result of a couple of posts here, I tried hard to stop them and try alternatives - but ended in a dreadful mess for months.

I eventually saw a GI specialist who was full of praise for the good they do, despite the problems a few get. He said that problems from stomach acid, once common, were now rare thanks to PPIs. He went on to add that many of those problems were severe or intractable.

It seems to me that the problem with PPI drugs is that they work so well that if they do have to be stopped, there is no effective alternative except surgery. Taking extra magnesium won’t help as the PPI completely blocks absorption (in those cases).

Steve

[Littlenanny25 in reply to Ppiman]

Thank you to everyone who has replied, it’s been really helpful.

It’s a real balancing act I think. In my case juggling drugs for Afib with drugs for other conditions and trying to avoid the potential pitfalls with side effects and interactions. I’m a relatively fit 67 year old now having to take quite a lot of tablets every day, and they are all really necessary in order to try and avoid surgery and becoming sicker in the long term, so I’m happy to keep taking the tablets and talking to the professionals. I find this forum so helpful on a daily basis for queries that crop up.

[Ppiman in reply to Littlenanny25]

It's been a helpful thread - thanks for starting it! Acid reflux is an awful thing to deal with.

Steve

[mjames1 in reply to Ppiman]

Taking extra magnesium won’t help as the PPI completely blocks absorption (in those cases).

I'm not sure what cases you're talking about. In general, magnesium supplements will work if you're taking PPIs and need them. But before that, you can take a simple blood test to find out if they're even necessary.. B12 is also easy to supplement if necessary. I've been taking PPIs for years and never had a deficiency in either. It's also not correct that PPI's cannot be stopped. Yes, some cases there is a rebound. Period which can be taken care of with proper weaning. Then if the tissues have healed, many can go on without the ppi's.,

There are also other options besides surgery. Should PPIs. stop working.

There is also a new class of drugs that have been available in Japan for many years and now in the United States called potassium competitiveacid blockers (PCAB). Studies and personal eexperience show them to be as good if not better at acid suppression with a different side effect profile. They work for some where PPI's will not work. Hopefully, they will be available in the UK and Europe soon.

Jim

[Ppiman in reply to mjames1]

Whoops - sorry if it wasn't clear! I meant in those cases where magnesium deficiency is caused by the PPI blocking Mg absorption. I know of no proven option, aside from surgery, that will solve GERD caused by a weak sphincter (from such as a hiatus hernia, for example). Even then, the surgery is not always useful and can have its own repercussions.

I have been hoping a new class of drugs would be found so thanks for that information.

Steve

[mjames1 in reply to Ppiman]

meant in those cases where magnesium deficiency is caused by the PPI blocking Mg absorption.

From what I've read, it would be rare that magnesium supplementation would not work. but then IV magnesium would be become an option. And then you could always stop the PPI be no before.

Yes, look for the new drugs. The brand name is Voquezna.

Jim

[Ppiman in reply to mjames1]

Will do - thank you.

I could have been clearer. In PPI-induced hypomagnesemia, the PPI will need to be stopped completely, whereupon, studies show, the relevant receptor site soon returns to normal and oral magnesium of whatever kind will rapidly return levels to normal.

The point that underlay my post was perhaps not well made, but it was that it is always deep problematic to stop a PPI drug since the cardiac sphincter remains inefficient added to which there will a rebound surge of acid following withdrawal. IV magnesium provides a temporary solution only, I gather.

Steve

[Ppiman in reply to Ppiman]

I forgot to add that I can find no source that shows oral Mg supplementation works where PPIs are the cause of hypomagnesaemia.

There are online doctors who suggest that oral Mg is useful for arrhythmia patients but the science differs from such a view. It seems that some of them are either ignorant of the science or hoping to to sell expensive Mg salts...

Steve

[mjames1 in reply to Ppiman]

I'm not trying to minimize the issues with PPI's and frankly I'd prefer not taking any. Medications. Alas, if only possible! But the fact remains that PPI's are a lifesaver for so many -- which is probably hard for those that had never severe GERD to understand.

So for those of us who have tried all the diet and lifestyle interventions, etc, we should be grateful they exist. And not be turned away based on opinions here that have a little basis in fact. By the way, not referring to you at all.

Jim

[Ppiman in reply to mjames1]

Yes, Jim, for sure. I’m surprised you feel the need to say that to me since that has always been my stance on this forum - and, indeed, is partly what is behind my posts on this thread. Even my monicker here is “Ppiman”.

Steve

[mjames1 in reply to Ppiman]

No I wasn't referring to you at all. But I was referring to some of the others that you had alluded to who seem to be on an anti-PPI crusade. I do understand that we're basically on the same page.

Jim

[Ppiman in reply to mjames1]

Well - I hope I'll be on a different page at some point following your telling me of this new drug! Thanks again.

Steve

[Auriculaire in reply to Ppiman]

Perhaps transdermal magnesium would be a solution.

[Ppiman in reply to Auriculaire]

That's a good thought and I seem to recall reading some studies on it now you mention it showing that magnesium is slightly absorbed through the skin.

Luckily, so far, my electrolyte level remain normal (if only I always felt normal!!).

Steve

[GoodHearty in reply to Ppiman]

As alternative view, check out Dr Berg (and some others) on YT who professes GERD/acid reflex is a consequence of NOT having enough acid (low ph) in the stomach so that food does not get properly broken done initially and passed onto digestive track. The valve that controls opening/shutting to stop food going back up doesn’t work effectively as a consequence of higher ph therefore causing unpleasant symptoms of acidity/ reflux, which is paradoxically confused with excess stomach acid being the cause. PPI then would exacerbate the problem. Worth finding out more at least of this view.

[Ppiman in reply to GoodHearty]

Thanks for that - I shall look that doctor up. It seems to be an area of health that fails to receive its due attention, partly, I suspect because PPI drugs are so very effective and most people cope well with them. I did try various dietary measures in the early days of having this and that didn't achieve much success at all. I also found the Gaviscon types of treatment totally ineffective. The worry is that if stomach acid is allowed to enter the unprotected areas of the oesophagus then eventually ulceration and worse can result.

Steve

[GoodHearty in reply to Ppiman]

Check this out, covers several things about likely cause of palpitations including stomach acidity.

youtu.be/6IwNcN1RN8o?si=ZYn...(Not working as expected?)

[Ppiman in reply to GoodHearty]

Hi - I look forward to watching that. Thanks you!

My own experimentation has been interesting, I find that bodily movement alone can cause my PACs to start. At the times when I am prone to ectopic beats, quite often these days, even stretching my chest area by lifting my arms, say as I walk up stairs, or lean forwards over a table, then PACs will start. Similarly crouching down does the same, say to wash the car wheels.

Very many years ago, a cardiologist did explain this to me while checking me for palpitations and strange chest "clicking" sounds. He showed me an X ray of my chest and stomach that showed how gas had pushed it up against the diaphragm and onto the heart. He explained this can happen from swallowed gas, made worse and into a vicious circle, by anxiety over the PACs, also food, drink, intestinal gas or constipation and set of PACs. He didn't mention stretching!

Steve

[GoodHearty in reply to Ppiman]

That is quite interesting, as for me, it also started couple of years back while bending over to pick ball up playing golf, would you believe? I first thought it must be the filtered coffee from McD I was drinking just before playing, cut that out, but it still continued every week but only while playing golf (and then gardening chores). Started my research, learned about POTS, asked GP but she just said learn to stand up (!!). Anyway, with plenty more research and without any meds, I have it under control, get rare AFib episode but only mild that lasts 20 mins thankfully. I was never going to give up golf🥰

[Ppiman in reply to GoodHearty]

The POTS things was interesting to read about. Good for you for controlling it. I have thought I had it under control a few times but time has proven me wrong eventually. It's such a variable condition but does seem gradually to become ever more present.

Like you, I press on regardless when I can despite ectopic beats and AF, coping well enough. Being able to do so has brought me to wonder how much of what AF causes is fear related. That said, separating the physical from the psychological in any condition is very hard to do.

A current change I am noticing is worsening bradycardia (caused, I suppose, because I also have a bundle block - LBBB). I don't know where that will lead but, so far, it's none too symptomatic.

Steve

[mhoam]

Hi, Yes I have taken both Apixaban and Esomeprazole for some time with no problem.

I asked my Gastric Consultant why he preferred Esomeprazole over Omeprazole and he told me that it is basically the same active ingredient but that Esomeprazole is the "cleaner" version of that active ingredient so less likely to cause unwanted side effects.

Good luck

[Littlenanny25]

Oh good thanks

[Buffafly]

It is worth reading the NHS information re omeprazole (although the same information is probably included on the packet leaflet) as some of it contradicts or modifies the information/opinions given in some replies ☺️