From anecdotal experience I've seen from other people, PPIs have more "individual quirks" than H2 blockers. The latter work more universally, but with PPIs you have to pick one that's "you-friendly".

A couple of things spring to mind...

Firstly different meds work better for different people. It takes experimentation to find which H2 blocker or ppi (or combination) works best for you.

Secondly ppi's require an acidic environment to work. They are activated by acid. So taking a dose a couple of hours after a first dose may be pointless because the stomach is no longer acidic enough to activate the second ppi.

Zantac does not require an acidic environment to be activated.

I did a lot of reading last night & made some notes about the actions & quirks etc of H2 blockers & ppi's. I will attempt to share this on a post later.

Thanks. I am at my wit's end trying to find a combination that works. I now have severe reflux symptoms for the first time, even on 40 mg Nexium and 300 mg Zantac. Things seem to be getting worse, not better. I feel like I'm even coughing up acid now.

I don't know whether to switch PPIs, or increase the dose, or what. I don't understand why i can't get this under control somehow.

did you quit nexium recently by any chance cold turkey? Thats what happens to me when I took nexium, it wiped out all my acid 100% but when I came off of it cold turkey the acid rebound along with reflux made my throat bleed and I never had reflu before nexium and I still deal with it but its gotten a lot better not the rebound but the reflux, a couple of months ago i was able to have 0 reflux and sleep normally but since I took antiacid again (zantac/pepcid) and quit again cold turkey I got reflux last week so bad i damaged my esophagus but its gotten a lot better now 1 week with no antiacids.

I remember when I had the first rebound on nexium, not even omeprazole or zantac could calm it down the first week, so i just stopped using antiacids completely back then and waited for it to go away.

However, you could do the oppossite, wait for the nexium to kick in or use another PPI to calm the rebound again (assuming its rebound if you quit before or reduce your dosage drastically). I'll probably get on PPI in a week or two but this time im going to wean off slowly, you should to, no matter how long you took the PPI: Never get off of it cold turkey or too fast!

Gusko - I did try and go down to 20 mg of Nexium, after being on 40 mg (but I was only on 40 for a week). Anyway, things got much worse so maybe it was rebound? I would love to get off PPIs entirely but I don't know how to do that - as it is, I can't eat anything, not even rice.

How long did it take for your rebound to go away when you waited it out?

Oh so you maybe have rebound, I was on nexium for 2 weeks for H pylori and that was enough to destroy my throat and give me sore throat.

The worst part was the first week. The rebound started after day 3 of quitting nexium, anything I ate caused me to reflux bad but it took 3 months for the whole mess to go away but after the first week it was bearable/manageable but i think thats because my gastritis was better back then.

If your gastritis is really bad + you are dealing with reflux, the reflux will be really really bad because you cant digest food as good which makes reflux even worse. Luckily my gastritis wasnt so bad back then so my reflux was bearable.

Talk to your doctor about it. I don't know what to advice you and don't want to hurt you either.

3 days delay for rebound sounds about right...
I reckon that's exactly what happened to you - not too bad gastritis, rebound = massive gastritis and more..

Ugh. I just don't understand how I could have had such a bad rebound when I was only on 40 mg for a week before trying to reduce it to 20 mg.

I also don't understand why 40 mg no longer works - I guess maybe I did even more damage. My gastritis was very bad before I started Nexium, but it is now worse after this rebound episode or whatever it was.

I should probably just stay on it, and hope for the best. Maybe it needs to be increased.

A friend was on it for 3 days his reflux/rebound lasted severeal months but it wasnt bad he didnt have gastritis he took PPIs for another problem (the hospital forced him to, i think it was some surgery). These drugs are dangerous because they can cause reflux or other side effects because they work so good, they wipe out all the acid. The problem comes when quitting them, you gotta be real smart when doin that. Get a good doctor, one that knows to deal with the rebound if possible. I think mine is good, he takes care good care of his patients and didn't want me on nexium before doing tons of tests.

Pyrrha - read up on this: http://www.refluxmd.com/connect/physician-expert-blogs/2256/rebound-acid-secretion-what-expect-if-you-reduce-your-ppi-use

I suspect that you had rebound and this furthered your damage, now it seems like Nexium no longer works. It works. You're just hurting real bad... I'm sorry it's happening to you...it will get better, but it takes time.

Thanks Pho...after reading Andy's post about moving after eating, I'm now wondering whether the problem is that I'm not absorbing the pills when I swallow them, since my stomach is so inflamed. I had a *lot* more relief when I was given a dose of PPI intravenously.

Pyrrha, if you're having problems like me, I found that dissolving the tablet in a little bit of water then swallowing that worked much better for me. If you have capsules you can open them up and take too. As long as you don't chew them you'll be ok.

I've done lots of reading on absorption & mechanism of ppi's recently. I'm working on creating a straightforward post about this without too much pharmacokinetic jargon...

In the meantime I can say it's a miracle that ppi's work for any of us considering their quirks. They do work extremely well when they reach the right cells, but there are SO many things that can make them not work properly. No wonder it takes a lot of trial & error.

Zantac is a much simpler drug & there are much less constraints & requirements to get it to work "properly". They do need a strict time schedule though - to maintain consistent acid suppression.

smile, I would be very interested to read it. I actually find Zantac really makes a difference for me, even though im on PPI, which tells me that my PPI is probably not doing its job perfectly for me, but I sure can notice the difference when I stop it!

I've certainly had the phenomenon of randomly at times feeling as if I haven't taken any PPI, when in fact I have. Over the months I have managed to figure out some of the things that caused it, like the whole tablet thing, which I still dont understand, but glad I figured it out!