Optimize PPI dose, timing, and drug¹⁸

¹⁸ Traditional delayed-release PPIs should be administered 30-60 min ac for max pH control [S/M]; newer PPIs may offer dosing flexibility relative to mealtime [C/M]. Optimize PPI: increase PPI dosing to bid or consider a switch to a different PPI [C/L]. If nocturnal sx, sleep disturbance, and/or variable schedules: consider dose-timing adjustment and/or bid dosing [S/L]. Bedtime H2RA tx can be added prn to daytime PPI tx in pts w/ nighttime sx, but tachyphylaxis may occur after several wks of use [C/L]. If PPI side-effects: switch PPIs [C/L]. PPI switching is common in practice; there are limited data to support this; no data to support switching PPIs ≥1x in partial/nonresponders. Meta-analyses fail to show significant efficacy difference for sx relief between PPIs. <br><br>¹⁹ Traditional delayed-release PPIs should be administered 30-60 min ac for max pH control [S/M]; newer PPIs may offer dosing flexibility relative to mealtime [C/M]. <br><br>
²⁰ PPI switching is common in practice; there are limited data to support this; no data to support switching PPIs ≥1x in partial/nonresponders. Meta-analyses fail to show significant efficacy difference for sx relief between PPIs.