How long do you give a new medicine to work?

[kat]

How long should you give a new medicine to work before giving up?
Here’s a brief history of what’s I’ve tried. Originally my doctor prescribed Protonix. It relieved my symptoms of regurgitation, but I still had pretty regular chest pains. I tried it for a month, and still had problems so my doc switched me to Aciphex. I was on Aciphex for about a year, and had very few reflux symptoms when suddenly it seemed to stop working, and I was back to pretty constant acid regurgitation.

Now my doctor’s switched me to Prevacid. It’s only been 2 days so far, but I’ve had horrible unstoppable headaches several hours after taking the medicine that’s lasted for the rest of the day, and on top of that I’m having chest pains. I know to give a PPI a couple of weeks to fully kick in for the reflux symptoms, but how long should I wait before connecting the headaches as a nasty side effect??

Thanks!

[Thistle]

If I were you, I'd go to the web site for this drug and read the disclosures re: the drug. All the known side effects will be listed. That way you'll know whether your headache is related to the drug (and whether it goes away after a few days or not) or whether it's just a coincidence.

Whenever I'm given a drug with a side effect that I don't want to live with, I give my doctor a call and ask if there is another solution.

[gmhoward]

Headache is commonly associated with PPI's. Ask your doctor for a different PPI and see if that helps. You may find a different PPI will give you less intense headaches or no headache at all.

[kat]

Thanks!
I decided to give it one more day to make sure it's not a coincidence. I'm just worried since this is the third PPI I've tried...

[gmhoward]

If you take an over the counter antacid do you get relief?

Perhaps your pain isn't from heartburn. Please describe the pain you are having.

[kat]

My doctors tell me it definietly is... I've recently been through the 24-hr pH monitoring and endoscopy. I have severe, almost constant, acid regurgitation when not on a PPI. I also have associated chest pains, but not as often as the regurgitation. Funny thing is I don't think I've ever had traditional "heartburn" a day in my life!

I've been suffering through this for probably 10 years now and I'm only 25! (My parents took me to the emergency room when I was 15 cause I was having chest pains, and when all their tests came back fine that's when they first told me it could be reflux)

I've been doing diet modification for years and I still have problems (on the days leading up to my pH monitoring I was refluxing on water!), and over the counter meds give me little relief unless I sip a bottle of malox or constantly chew on tums throughout the day :)

Hopefully I'll find something that works soon, cause I swear it keeps getting worse!

Thanks all :)

[gmhoward]

It's quite likely that your constant regurgitation is causing other problems. The PPI's may be working and doing their job all day keeping the acid at bay and the PH above 4.0.

The reason I asked you to describe the pain you are having and if you get immediate relief from OTC's is that you may be having a spasm of some type. I had them for many years and PPI's won't make them go away if your are constantly regurgitating.

If you have the pain all the time a Barium Swallow or Esophogeal Motility test will confirm the presence of spasms. The 24-Hour PH Study will tell you if you have reflux or not but will not identify a spasm. It's also quite likely that if you are having spasm's you will not have them when you take those tests.

Did your doctor tell you the results of your PH study?

Talk to your doctor about spasms and get his opinion. A quick and easy way to see if that is your problem is to get him to prescribe Nitro Glycerine for you. Take 1 pill and if the pain goes away then you know! Get ready for the headache of your life too :) Nitro in the pill formula is very short lived and the spasms will quickly come back.

If spasms are confirmed, and that can generally only be done through a process of elimination, there are a world of medicined for them. If the PPI's take care of the acid and a Nitrate, Calcium Channel Blocker, or Valium take care of the spasm's then all you have left is the constant regurgitation.

You can try a pro-motility agent for the regurgitation.

On the other hand, you could just be experiencing pain from having gastric contents in your esophogus so much of the time. Even if the PH is above four you are still going to get some discomfort or even pain. Pain from acid reflux can manifest itself in many ways.

How much pain are you in on a scale from 1 to 10 with 10 being the point at which you would pass out?

The only way you can confirm your PPI's are working properly is to take the 24-Hour PH study while you are on them. How long have you been on PPI's?

Now this is the most important thing. Even if the PPI's work, you still have reflux and that is NOT GOOD for your esophogus. Talk to your doctor about the Laparascopic Nissen Fundoplication, that is where you will likely end up anyway.

[kat]

Unfortunately I haven't found out the results of my pH monitoring yet. I had it done a little over a week ago. Hopefully I'll hear something soon.

She did call with the results of my endoscopy and biopsy and said that I had esophagitis from the years of GERD and needed to find a PPI that seemed to work for me to heal my esophagus. That was when she switched me to Prevacid.

What do esophageal spasm feel like? I often have almost a burping sensation bringing acid up into my mouth, but I've never known what to call it other than a burp but it's not really that either...

Thanks for all the info, I'm glad I found your guys!

[gmhoward]

It feels different for each person. Generally a crushing pain in the center of the chest is an indicator. Mine changed from week to week and depending on how bad they were. Sometimes I had pain in the right part of my ribs and sometimes the left, sometimes my back, sometimes my hands! Usually the pain was a crushing or pulling pain in the center of my chest and YES I did get a lot of aeropagia when I had spasm's.

[kat]

Alright, my chest pains are more of the pulling pain in the center of your chest that you describe. If it's real bad (like the night I first went to the hospital) my chest gets real tight and even breathing hurts.... but thankfully those don't happen too often.

[gmhoward]

Sounds like it might be a spasm to me. It's always a good idea to rule out any cardiac problem, especially with the associated difficulty in breathing.

[kat]

Well gmhoward, you were right....
My gastro dr called with my test results from the 24-hr pH monitoring. She said my Demeester Score was 87.5 and that I'm an ideal candidate for surgery. I have my first visit with a surgeon she reccomended tomorrow.

[gmhoward]

Please keep me posted!

It doesn't sound like you have had the pre-surgery workup yet. You will want to have an esophogeal motility test at the very least, it's not fun but you will get through it.

Be sure to ask lots of questions all along the way, especially from anyone who is going to be caring for you. It will make you feel a lot morecomfortable. DO NOT BE SHY!