The annoyance of reflux: it can turn a normal evening into a disaster.
It was a fine dinner, but as you lie down the burning starts. Perhaps there’s a metallic taste at the back of your throat. Perhaps you cough for no reason or wake at 2 am, sensing that your meal has somehow gone up your nose.
An antacid will help if the burning is occasional, but if it’s a regular occurrence then you may be facing gastroesophageal reflux disease (or GERD), for which medications such as Dexilant were developed.
Dexilant isn’t a rapid-acting medication to help heartburn that has already started. It acts further back in the process, lowering the amount of acid that the stomach produces.
What is Dexilant?
Dexilant is a registered trademark for dexlansoprazole, a proton pump inhibitor (PPI). Other PPIs are omeprazole, lansoprazole and pantoprazole.
The lining of the stomach contains numerous tiny acid pumps. Dexilant switches many of these off, which results in the stomach producing less acid. The normal amount of acid is required for digestion, but reducing it considerably helps to lessen the sting of reflux and allows inflamed esophageal tissue to heal.
The indications for Dexilant are erosive esophagitis, maintenance after healing of erosive esophagitis, and heartburn due to non-erosive GERD. It is approved for use in adults and adolescents aged 12 years or older.
The capsules are available in 30 mg and 60 mg strengths. The 60 mg dose is commonly used for patients requiring short-term healing of erosive esophagitis, while the 30 mg dose is generally indicated for patients with uncomplicated GERD or requiring maintenance after healing of erosive esophagitis.
A 60 mg capsule is not necessarily the “better” option. Once healing of the esophagus has been achieved, extended suppression of gastric acid may not be required.
The unusual ingredient is hidden in the capsule
Many PPIs have stringent instructions, such as taking omeprazole 30-60 minutes before breakfast. There is a sound reason for this: they are most effective when the acid pumps are about to kick in due to a mealtime surge in acid production.
Dexilant is a bit more relaxed about timing. The granules inside the Dexilant capsule are specially designed to release dexlansoprazole in two doses, one earlier and one later. This allows for more acid control throughout the day.
It can also be taken with or without food.
This flexibility is handy for someone whose mornings consist of never knowing what awaits them: a nurse switching shifts, a driver who is lucky to get a meal in when the road allows, or someone who has repeatedly forgotten to take their “before breakfast” medication may find Dexilant a breeze.
Being easier doesn’t necessarily mean it’s stronger. Many people manage well on a generic PPI, but Dexilant often comes into play for people who have been less successful with another PPI or whose lifestyle makes the timing of PPIs difficult. It can also be a good option if symptoms continue to flare up despite apparently “correct” treatment for GERD.
It won’t perform like an antacid
A patient swallows the first dose during a bad episode of reflux and then has burning pain 20 minutes later, and rightly expects faster results.
Dexilant is not Tums. It doesn’t neutralize existing acid in the stomach, but instead reduces the production of new acid and this results from regular dosing.
Some people notice an improvement on the first day, but others need several days’ dosing before it becomes apparent. Healing of erosions in the esophagus may take weeks.
Taking a second dose is not a good way to speed up treatment. Stick to the prescribed dose and allow it time to do the job it was designed to do.
The capsule should be swallowed whole. It can be opened and the contents sprinkled onto a spoonful of applesauce if you have difficulty swallowing the capsule, but it should be swallowed immediately without chewing. The tiny granules contained in the capsule have a special coating to control the release of the drug; this will be lost if they are chewed.
If “reflux” can be something else
Not every sharp pain in the middle of your chest is coming from the stomach.
Heart pain can cause a burning, pressure-like sensation in the chest, which may be mistaken for indigestion. Any new chest pain associated with sweating, breathlessness, nausea, or pain that radiates into the arm, back or jaw should be seen by a doctor as soon as possible.
Other symptoms also warrant a trip to the doctor instead of waiting for a repeat prescription. Food sticking on the way down, burning on swallowing, vomiting of blood or black-colored stools, incessant vomiting, unexplained weight loss or anemia can suggest something more serious.
And if Dexilant isn’t helping at all, the dose is not necessarily too low. The cause of the symptoms may be non-acid reflux, a swallowing disorder, soreness of the esophagus, gallstones, asthma or something unconnected to digestion.
A favorable response to treatment is useful; an unfavorable response is also useful.
Side effects are usually mild, but not imaginary either
Most people experience little trouble while taking Dexilant. Headache, nausea, stomach discomfort, gas and diarrhea are common side effects.
Persistent watery diarrhea should be reported to a doctor, especially if it follows antibiotic treatment or a hospital stay. Reduced stomach acidity may predispose to infection with organisms such as C. difficile.
PPIs are also associated with reduced magnesium, vitamin B12 deficiency, increased risk of bone fractures and kidney inflammation, particularly with long-term use. The online forums can make it sound as though everyone who takes a PPI will inevitably get all of these complications. And for people with severe reflux, Barrett’s esophagus or a history of bleeding ulcers, the risks of long-term therapy may be worth considering.
But it makes little sense to continue a prescription for years simply because nobody has reviewed it.
The sensible questions are whether you still need to take a PPI, whether this is the lowest dose necessary to control your symptoms, and whether anything has changed.
Dexilant should not be taken with medications that contain rilpivirine due to the risk of reduced absorption of the HIV medication; a pharmacist should check other prescription medicines, vitamins and supplements for potential drug interactions.
Stopping can lead to brief worsening of symptoms
A patient feels well for months, stops Dexilant on a Friday and wakes up with heartburn on Sunday night. It’s as if the medication caused a dependency.
What probably happened is that the patient experienced rebound acid secretion. Stopping a PPI after long-term use can cause a temporary increase in acid secretion.
This doesn’t mean that everyone should continue on a PPI indefinitely. Some patients can reduce the dose, move to intermittent dosing or switch to another medication with a physician’s advice; others genuinely need continued treatment.
Lifestyle modifications can help, but you don’t need to punish yourself with a bland diet just because your generic reflux list said tomatoes were forbidden.
Avoid lying down after a large meal, and if nighttime reflux is an issue then raising the head of the bed is a better alternative to stacking soft pillows on your chest. Losing excess weight can help to reduce pressure on the stomach, and smoking, heavy alcohol consumption and late meals are common aggravating factors, but not every cup of coffee has to be a medical emergency.
Dexilant can be an excellent reflux medication for people who need to suppress acid for a longer period of time without having to plan breakfast around the dose. It is not necessarily the best PPI for everyone and shouldn’t become a permanent part of the morning ritual without a good reason. But when the diagnosis is correct, the improvement it can make to a patient’s life is wonderfully normal: that is, dinner stays where it belongs and the night is not interrupted by the taste of acid.
