From the Guidelines
The primary purpose of switching from Proton Pump Inhibitors (PPI) to H2 receptor antagonists (H2 blockers) is to manage upper GI symptoms that may occur after PPI withdrawal, as evidenced by the 2022 study by Reimer et al 1. When considering the switch, it's essential to note that PPI withdrawal can lead to a higher incidence of upper GI symptoms compared to continued PPI use. The study suggests that using as-needed H2-receptor antagonists and/or contact antacids for symptom control after PPI withdrawal is a reasonable approach. Some key points to consider when switching from PPI to H2 blockers include:
- The anticipated duration of rebound acid hypersecretion (RAHS) after PPI withdrawal is not well characterized, but physiologic studies suggest that enterochromaffin-like cells and parietal cell mass can still be present 8 weeks after PPI withdrawal, although they have usually regressed by 6 months after withdrawal 1.
- Approximately one-half of all patients with uncomplicated GERD who discontinued PPI were able to remain off PPIs 6 months later, and three-quarters of those who successfully discontinued PPIs were using H2-receptor antagonists or over-the-counter antacids for symptom control 1.
- Using PPIs on demand in place of continuous PPIs provides effective symptom control and could also be considered as a partial de-prescribing strategy 1. The use of on-demand PPIs, histamine type-2 receptor antagonists, or neutralizing antacids on an as-needed basis may be helpful for controlling symptoms in the short term without committing to continuous PPI therapy. Severe persistent symptoms lasting more than 2 months after PPI discontinuation may suggest the presence of a continuing indication for PPI therapy on a non–acid-mediated cause of symptoms 1.
From the FDA Drug Label
The provided drug labels do not contain information directly related to the purpose of switching from Proton Pump Inhibitors (PPI) to H2 receptor antagonists (H2 blockers).
The FDA drug label does not answer the question.
From the Research
Purpose of Switching from Proton Pump Inhibitors (PPI) to H2 Receptor Antagonists
The purpose of switching from Proton Pump Inhibitors (PPI) to H2 receptor antagonists (H2 blockers) is to reduce the adverse effects associated with long-term use of PPIs. Some of the adverse effects include:
- Bone fractures 2, 3
- Renal disorders, such as acute interstitial nephritis, acute kidney injury, chronic kidney disease, and end-stage renal disease 4
- Cardiovascular risks, including major adverse cardiovascular events, myocardial infarction, stent thrombosis, and stroke 4
- Infections, such as Clostridium difficile infection, community-acquired pneumonia, and Coronavirus disease 2019 2, 4
- Micronutrient deficiencies, including hypomagnesemia, anemia, vitamin B12 deficiency, hypocalcemia, and hypokalemia 4
Recommendations for Switching to H2 Blockers
According to the American Gastroenterological Association, H2 blockers can be used to lessen gastrointestinal symptoms of gastroesophageal reflux disease, and PPIs should only be used if there is a definitive indication 4. Additionally, the association recommends deprescribing PPIs when there is no clear indication for therapy 4.
Considerations for Long-Term PPI Use
Long-term use of PPIs should be carefully considered, especially in patients who are at high risk for adverse effects, such as older adults 2, 5. The dose of long-term PPIs should be periodically reevaluated to ensure that the lowest effective dose is being used 6. Patients taking PPIs for long-term should be monitored for adverse effects, and alternative treatments, such as H2 blockers, should be considered if necessary 4.