Can I safely taper off Nexium (esomeprazole) after this final week, given my history of gastritis and recent recurrence of symptoms, including sourness, bloatedness, and dizziness after eating, which resolved with Nexium 40 mg daily treatment?

Can You Taper Off Nexium After This Final Week?

Yes, you can attempt to taper or stop Nexium after this final week since you have gastritis without documented erosive esophagitis, but expect transient rebound symptoms for several days that should be managed with on-demand antacids or H2-blockers rather than immediately restarting continuous PPI therapy. 1

Understanding Your Situation

Your diagnosis of gastritis without endoscopic confirmation means you likely have non-erosive disease, which has different management implications than erosive esophagitis:

• Patients with gastritis or GERD symptoms without documented erosive esophagitis can successfully use on-demand PPI therapy rather than continuous daily dosing 2
• The primary goal in non-erosive disease is symptom control, not mucosal healing, since there's no erosive damage to maintain 2
• Your symptom recurrence during the flu likely represented temporary physiologic stress rather than treatment failure, especially since symptoms resolved again with bland diet 1

How to Stop Your Nexium

You have two equally effective options:

Option 1: Abrupt Discontinuation

• Simply stop taking Nexium after your final dose 1
• Clinical trials show 31% of patients remain symptom-free at 6 months with this approach 1

Option 2: Gradual Taper

• Take Nexium every other day for 2-3 weeks, then stop 1
• Clinical trials show 22% of patients remain symptom-free at 6 months with this approach 1
• Neither approach is superior—choose whichever feels more comfortable to you 1

What to Expect: Rebound Acid Hypersecretion

You will likely experience temporary upper GI symptoms within the first few days after stopping, lasting 3-7 days, with complete resolution taking 2-6 months 1:

• This occurs because chronic PPI use causes compensatory parietal cell hyperplasia that takes months to regress 1
• These rebound symptoms do NOT mean you need to immediately restart continuous PPI therapy 1
• This is a normal physiologic response, not disease recurrence 1

Managing Breakthrough Symptoms

When symptoms occur after stopping:

• Use on-demand H2-receptor antagonists (like famotidine 20 mg) or over-the-counter antacids for symptom control 1, 3, 4
• Take these medications only when symptoms occur, not on a scheduled basis 1
• Famotidine is particularly effective for gastritis symptoms and provides acid suppression without the rebound effect of PPIs 3, 4
• You can also use on-demand Nexium (taking it only when symptoms occur) as a partial de-prescribing strategy 1

When to Seek Further Evaluation

Return to your doctor if:

• Severe persistent symptoms last more than 2 months after discontinuation—this suggests either a continuing indication for PPI therapy or non-acid-mediated pathology requiring evaluation 1, 5
• You develop alarm features: unintentional weight loss, difficulty swallowing, persistent vomiting, evidence of GI bleeding, or severe pain 6
• The FDA label recommends seeking medical attention if you need to take the product for more than 14 days or need more than one course of treatment every 4 months 7

Critical Pitfalls to Avoid

• Do not immediately restart continuous PPI therapy at the first sign of symptoms after stopping—distinguish between temporary rebound hypersecretion (expected and self-limited) versus true disease recurrence (persistent beyond 2 months) 1
• Do not assume you need lifelong PPI therapy based on a 2.5-week course for gastritis—many patients with non-erosive disease do not require long-term continuous therapy 2
• If you were taking NSAIDs regularly, you would need different management, but this doesn't appear to be your situation 6

Bottom Line for Your Specific Case

Since you responded quickly to Nexium, your symptoms resolved with bland diet alone during the flu, and you have no documented erosive esophagitis, you are an ideal candidate for PPI discontinuation 2. The recurrence during your flu illness was likely stress-related and temporary, not treatment failure 1. After completing this final week, stop the Nexium and manage any rebound symptoms with on-demand famotidine or antacids for the next few weeks 1, 3.