Heartburn:Choose the Right Medicine

Heartburn: Choose the Right Medicine to Calm the Fire

Arryn Shelton, PharmD Candidate 2010

Bernard J, Dunn School of Pharmacy, Shenandoah University

Prepared during Consumer Health Information Corporation Clerkship
McLean, VA

Have you ever had a burning feeling in your chest? Or noticed a sour or bitter taste at the back of your throat? If so, you are probably one of the estimated 20-40% of American adults who has heartburn at least once a month. There are many choices for over-the-counter relief of heartburn. This article will help you pick the medicine that is right for you and your symptoms.

What is Heartburn? Heartburn is a burning feeling that starts in the lower chest and can move up to the throat or esophagus. The esophagus is a tube that food moves through to reach the stomach. Heartburn occurs when stomach acid leaks back into the esophagus. It can disrupt your meal and sleep patterns. Heartburn can also lead to serious problems like esophageal cancer if not treated.

Heartburn can sometimes be confused with a heart attack, because it affects the chest area. However, if you have symptoms of a heart attack, don’t pass it off as heartburn. Call 911 immediately. Symptoms include chest pain with sweating, pain radiating to the shoulder, or shortness of breath.

What are the different types of heartburn medicine? How should they be taken?

Antacids: These drugs work by causing stomach acid to be less active. They work within 5 minutes.

You might have to take them several times a day because they only last for 20-30 minutes.
If taken 1 hour after a meal, antacids will work longer (up to 3 hours).
There are many antacids available, including Tums®, Rolaids®, Mylanta®, Maalox®, and Alka Seltzer®.
Always read the label of each antacid for correct dosing. Never take more than the maximum daily amount. The maximum daily amount is different for each product.

Many antacid brands have several products with different ingredients. Always read the active ingredients and warnings on the label to help choose the best product for you. For example, the Food and Drug Administration (FDA) recently stated a warning about Maalox liquid products. Consumers were accidentally taking Maalox® Total Relief instead of the usual antacids Maalox® Advanced Regular Strength and Maalox® Advanced Maximum Strength. Maalox® Total Relief is used for diarrhea. It can cause problems in heartburn patients who are on certain medicines or have a history of bleeding or ulcers.

It is also important to check the amount of sodium, calcium, or aluminum in antacids to make sure you are not taking more than the daily limit. This is very important if you have kidney or heart problems.

Histamine Blockers: These drugs work by reducing the amount of acid that the stomach makes.

These medicines are taken with a full glass of water up to 2 times a day.
For prevention, these medicines are taken before eating food or drinking beverages that may cause heartburn. Some can be taken right before meals, and some need more time to work. Read the label for specific directions.
For relief, these medicines are taken when you have symptoms.
If you have daytime heartburn, you may find the most benefit when you take these medicines in the morning. If you have nighttime heartburn, it is recommended to take these medicines in the evening.
There are 4 histamine blockers available: Tagamet®, Axid®, Pepcid®, and Zantac®.
Always read the label of each product for dosing. The maximum daily amount is different for each product.

Read the ingredients and warnings on the label to help choose the best product for you. For example, there is a regular Pepcid® and a Pepcid® Complete. The Pepcid® Complete contains both a histamine blocker and an antacid. This product is for patients who already have heartburn because they did not take medicine before a meal to prevent it. Pepcid® Complete will provide both immediate and longer-lasting relief than a histamine blocker or antacid alone. It will have different warnings and drug interactions than regular Pepcid®.

Proton Pump Inhibitors: These drugs work by reducing the amount of acid that the stomach makes.

These medicines are taken once a day with a glass of water. You will get the greatest effect if you take the medicine 30-60 minutes before breakfast.
They are the strongest heartburn medications.
They usually begin to work within 2-3 hours.
If you are taking one of these drugs for the first time, it may take 1 to 4 days for complete relief.
There are 2 proton pump inhibitors available over the counter: Prilosec® and Prevacid®.The FDA just approved Zegerid® for over-the-counter use. It should be on shelves in the next few months.
Always read the label for each product to find the correct dose, maximum daily amount, and warnings.

Which heartburn medicine is right for me?

See a doctor before beginning any heartburn medicine if you have any of the following:

Heartburn that keeps you up at night

Difficult or painful swallowing

Black or bloody vomit or stool

Unusual weight loss

Constant wheezing

Constant nausea, vomiting, diarrhea

Drug Interactions: All heartburn medicines can interact with other medicines, including prescription, over-the-counter, and natural remedies. If you bring a list of your current medicines, the pharmacist can tell you which heartburn medicines are safe to take.

Heartburn that happens less than 2 days a week:

If your symptoms are mild:

An antacid might help. Remember to take it with a meal so that it lasts longer.
If an antacid does not relieve your symptoms or last long enough, consider a histamine blocker.
If you are taking an antacid more than 2 days a week or regularly for 2 weeks, a histamine blocker would be another option.

If your symptoms are more severe:

A histamine blocker might help.
If you know when to expect heartburn, take the drug in advance to avoid symptoms. If you cannot predict heartburn, take the drug when you start to have symptoms.
If you are taking a histamine blocker more than 2 days a week or regularly for 2 weeks, your body may stop responding to it.. A proton pump inhibitor would be another option.

Heartburn that happens more than 2 days a week:

For all symptoms:

A proton pump inhibitor might help.
Since these drugs take up to 4 days to stop symptoms completely, you can take an antacid for immediate relief for the first few days.
Zegerid® contains an antacid, so you do not need another antacid with this medication. Another antacid would not add more relief, but could increase side effects.
Over-the-counter proton pump inhibitors should not be taken more than 14 days in a row. You should not take more than a 14-day course within a 4 month period. You should see a doctor before taking more than the suggested amount.
If you are taking Prevacid or Prilosec for more than 4 days without relief, you can see a doctor for more options.

Which proton pump inhibitor is the best choice?.

Some studies have shown that there is not a major difference between Prilosec® and Prevacid® in how well they stop heartburn. However, you could still have more relief with one over the other. Prices are similar for 14 capsules of each.

Your Next Step:

Choosing a heartburn medicine is not easy. This article should help to lead you in the right direction. Always read labels because they have information about dosing, warnings, and drug interactions. If you have any questions, always ask the pharmacist. The pharmacist can tell you any possible side effects. Take control of heartburn before it takes control of you. Get the right medicine the first time, and find the relief that you deserve.



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