Daily Column

July 28th, 2008

DEAR DR. GOTT:
Your advice to the woman with the distended stomach, lower back pain, aching legs, and constant tiredness in which you suspected Cushing Syndrome may very well be correct. However, there is another possibility. These are also side effects from the drug Nexium which she claimed to be taking. I had symptoms just like hers while I was taking it. I am now on generic Prilosec and my stomach is going back to normal and my tiredness is slowly lifting.

When the patent on Prilosec was about to expire the formula was “tweaked” just enough to receive a new patent which was then marketed as Nexium. This “tweaking” caused the Nexium to have some side effects that the Prilosec did not.

I would like to be off the medication but diet, exercise and over-the-counter antacids don’t work. Do you have any suggestions?

DEAR READER:
First, let’s address your concerns about Nexium and Prilosec. I am not a pharmacist and was unaware that Nexium and Prilosec (while it was still a prescription) were even made by the same manufacturer let alone were practically the same drug. After reading your letter, I went to my trusty Physician’s Desk Reference and looked up both medications. It turns out, you are at least partially correct in your assessment. From my limited knowledge of drug chemistry, it appears to me that Nexium and Prilosec are practically the same formula with only minor alterations. However, your statement that because of this “tweaking” one drug has side effects the other doesn’t is incorrect. Both medications have distended stomach, fatigue, back pain, and leg pain listed as known, but rare (occurring in less than one percent of users) side effects.

Why you are affected so severely by one and not the other is a mystery but I must congratulate you on discovering the cause of your symptoms.

Proton pump inhibitors, such as Nexium, Prilosec and others, work to block some of the stomach’s acid producers. They are prescribed for those with gastro-esophageal reflux disease, hiatal hernia and ulcers. Before medication is prescribed, physicians should recommend the patient change his or her diet, lose weight if necessary, get regular exercise and use over-the-counter medications as needed. If symptoms are still a problem, then prescription medications should be used. In some cases of hiatal hernia, symptoms still persist and surgery may be necessary to tighten the opening between the stomach and throat. Unfortunately, this only works about 50% of the time and may not be permanent.

I often recommend that acid reflux sufferers make drastic changes in their diets by avoiding all trigger foods such as fat (fried foods, greasy bacon, etc.), citrus/acidic (tomatoes, oranges, lemons, etc.) and some spices. Spicy foods are not the main culprit as many believe. In fact, I have heard many sufferers say that they don’t have a problem with spices, but rather it is milk and lettuce that are the major sources of discomfort.

If you are continuing to have difficulties, speak with your gastroenterologist about alternatives to prescription medications.

To give you related information, I am sending you a copy of my Health Report “Hiatal Hernia, Acid Reflux and Indigestion”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.