Over-the-Counter Medications for Heartburn
By Aaron Syring, Pharm.D.
Almost everyone has heartburn sometimes. Heartburn is a painful burning feeling in
your chest or throat. It happens when stomach acid backs up into your esophagus, the
tube that carries food from your mouth to your stomach. Heartburn usually occurs after
eating and may occur at night, and is often worse when lying down. If you have
heartburn more than twice a week, you may have gastroesophageal reflux disease
(GERD). With GERD, the muscles at the end of your esophagus do not close tightly
enough. This allows contents of the stomach to back up, or reflux, into the esophagus
and irritate it. If you have other symptoms such as crushing chest pain, it could be a
heart attack. Get help immediately.
Heartburn is triggered by a number of things including pregnancy, certain foods often
acidic or spicy, alcohol, coffee, and some medications. Treating heartburn is important
because over time reflux can damage the esophagus. Over-the-counter medicines may
help. If the heartburn continues, you may need prescription medications or surgery.
Over-the-counter Treatment Options
There are three main categories of medicines available without a prescription to help
with heartburn.
1. Antacids
a. Common brand names: Tums, Maalox, Mylanta, Gaviscon, Alka Seltzer,
and Rolaids
b. Common Ingredients: Calcium Carbonate, aluminum hydroxide, and/or
magnesium
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The above article is general information that is in no way intended to treat, diagnose, or cure any medical condition. Further it is not
intended, nor recommended, that this information be used without the supervision of your medical provider.
c. Antacids work to neutralize the stomach acid. The advantage to this class
of medicines is they tend to work quickly. Some of the products also
include simethicone, an anti-gas medication, to help with bloating.
Further, the calcium containing products such as Tums can be used as a
calcium supplement to get to your recommended daily intake for bone
health.
2. H2 (Histamine) Blockers
a. Common brand names: Zantac, Pepcid
b. Common ingredients: ranitidine, famotidine
c. This class of medicine used to be exclusively prescription only; some
strengths are now available over the counter while other dosages are still
Rx only. Histamine plays a role in the production of stomach acid along
with other substances in the body. Blocking the histamine receptor on
parietal cells, which are responsible for stomach acid production, reduces
the amount of acid produced. This class of medicine is a good choice if
antacids haven’t provided enough relief in the past. It is safe to use
antacids with Zantac/Pepcid, in fact there is actually a product called
Pepcid Complete, which has both in one tablet.
3. Proton Pump Inhibitors (PPI’s)
a. Common Brand Names: Prilosec OTC, Prevacid 24HR
b. Common ingredients: omeprazole, lansoprazole
c. This class also has a mixed availability; some strengths/forms are
available OTC and some still remain Rx Only. In fact, omeprazole was the
11th most dispensed drug in 2009 with over 38 Million prescriptions.
PPI’s are the most effective at reducing acid in the stomach because they
block the last step in the production cycle. As shown in the graphic
below, the Histamine blockers only block one part of the acid production
cycle where the PPI’s stop the final step. Generally, PPI’s are the
something to try if you haven’t received sufficient relief from H2 blockers
or antacids.
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The above article is general information that is in no way intended to treat, diagnose, or cure any medical condition. Further it is not
intended, nor recommended, that this information be used without the supervision of your medical provider.
When using these medicines it is important to follow the package labeling very carefully.
The key point here is that the over-the-counter versions of these medicines are meant
to treat heartburn on an intermittent basis. The intent of the labeling is to give patients
options to treat intermittent heartburn, while giving guidance to see a doctor if you
have chronic heartburn since there may be other issues that need to be dealt with.
Further, many of this general class of drugs can interact with other medicines you may
be taking. One interaction that isn’t currently on the labeling for Prilosec OTC is a
conflict with Plavix, blood thinning type drug. Please don’t hesitate to ask your Island
Drug/LaConner Drug pharmacist for guidance in selecting the right heartburn remedy
for you.
Lifestyle and home remedies from the Mayo Clinic
You may find heartburn relief by making small changes. Consider trying to:
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Maintain a healthy weight. Excess pounds put pressure on your abdomen,
pushing up your stomach and causing acid to back up into your esophagus. If
your weight is healthy, work to maintain it. If you are overweight or obese, work
to slowly lose weight — no more than 1 or 2 pounds (0.5 to 1 kilogram) a week.
Ask your doctor for help devising a weight-loss strategy that will work for you.
Avoid tightfitting clothing. Clothes that fit tightly around your waist put pressure
on your abdomen and the lower esophageal sphincter.
Avoid foods and drinks that trigger heartburn. Everyone has specific triggers,
such as alcohol or tomato sauce. Avoid foods you know will trigger your
heartburn.
Eat smaller meals. Avoid overeating by eating smaller meals.
Delay lying down after a meal. Wait at least two to three hours after eating
before lying down or going to bed.
Elevate the head of your bed. An elevation of about six to nine inches puts
gravity to work for you. Place wood or cement blocks under the feet of your bed
at the head end. If it's not possible to elevate your bed, you can insert a wedge
between your mattress and box spring to elevate your body from the waist up.
Wedges are available in our Home Medical Equipment Department.
Stop smoking. Smoking decreases the lower esophageal sphincter's ability to
function properly.
For more information on some homeopathic treatment options, please see an earlier
podcast by our Natural Health Specialist Dr. Karen Carbone;
http://islanddrug.com/podcasts.aspx?c=3#heartburnandgerd
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The above article is general information that is in no way intended to treat, diagnose, or cure any medical condition. Further it is not
intended, nor recommended, that this information be used without the supervision of your medical provider.
As mentioned above, our pharmacists are here for you and will help you make the best
selection and check your profile for any drug interactions at the same time. We hope
this information was helpful and thank you for tuning in to this Island Drug Podcast.
References
 http://www.mayoclinic.com/health/heartburn-gerd/DS00095/METHOD=print
 http://www.astrazeneca.com.ph/1027897/1027901/522976?itemId=1517321
 http://www.nlm.nih.gov/medlineplus/heartburn.html#cat3
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The above article is general information that is in no way intended to treat, diagnose, or cure any medical condition. Further it is not
intended, nor recommended, that this information be used without the supervision of your medical provider.