Thanks to Pooka, I was able to find some of the posts that I lost due to the stupid hacker, and I am going to repost a few after doing a little editing and updating. Here's the first:

To help clear up the confusion, I thought I would give you all a more scientific explanation behind why, when taking an enteric-coated PPI such as Prevacid Solutabs, Prevacid capsules, Prilosec capsules or Prilosec OTC tablets, it is best to take them on an empty stomach and then have a meal 30 minutes or so later. Some of this I have explained elsewhere as well, so forgive me for repeating myself.

PPIs or Proton Pump Inhibitors work to reduce acid production in the stomach by blocking (or "inhibiting") the proton pumps which make the acid. However, they are only able to block those pumps that are in an active (acid producing) state. So the best way to block the most pumps and best reduce the acid level is to have as many of these pumps in the active state as possible when the drug reaches them. The primary means of activating the pumps is by raising the pH level in the stomach (ie, making the fluids less acidic and more alkaline). The primary means of raising the pH level in the stomach is by eating a meal, since most foods are much less acidic than the stomach’s fluids.

Now here's the tricky part with PPIs. They are what is known as a pro-drug which means that they need to be chemically modified in order to become active. The way that PPIs are activated is by being placed in an acidic environment (such as found in the stomach). However, they also have a very very short half-life (1-2 hours), which means that once they are activated, they only stay activated for a very short period of time. The other trick is that they only work by reaching the proton pumps through the blood stream. So they must be taken orally, then absorbed into the blood stream, then come to the proton pumps though the blood in the stomach lining in order to do their job.

The problem is, if they are exposed to the stomach acid right away, they will be degraded by the acid and never be absorbed or passed on to the proton pumps, thereby being completely ineffective. In order to get around this problem, most PPIs are given an enteric coating that will only be dissolved in a high pH environment. This coating protects the drug from the acid while it is in the stomach until it can pass into the first section of the small intestine known as the duodenum. In the more alkaline environment of the duodenum, the enteric coating is dissolved and the drug is absorbed into the blood stream and is carried to the proton pumps in the stomach lining where it begins to block the proton pumps.

This whole process takes approximately 30 minutes. As you can see, with this form of PPI, timing is everything. What you are aiming for is to have the medicing reach the pumps right about the time that the meal is turning them all on, so the maximum number can be turned off. That is why you must have the meal as close as you can to 30 minutes after having taken the enteric-coated PPI on an empty stomach. The reason that it must be taken on an empty stomach is that taking it along with food dramatically reduces the absorption of the drug into the blood stream, which means that less drug gets to the proton pumps.

Even more detailed explanations and illustrations of this process can be found at the PPIKnow website on this page.

As I have explained elsewhere, Zegerid is the only FDA approved form of PPI which is not enteric-coated and which is absorbed immediately in the stomach and you do not have to wait 30 minutes after taking it before eating a meal - it can be given without regard to a meal.

If you have any questions about this post or other related topics, please email: info@marci-kids.com

Thanks for the info

I just spoke to our Gi yesterday and she said you need to wait 1/3hr with
prevacid but prilosec/nexium 1 hr
I've never heard this before?
I wish all the docs would get on the same page...

Kim

I'm cracking up here, LMAO!

It makes me so mad that so many doctors out there are just talking out of their you-know-whats and telling folks these things so confidently when they just aren't true! It really makes me wonder just how much they really do know sometimes. 

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