Medications Used for Treating Heartburn

Antacids and Proton Pump Inhibitors for Heartburn Symptoms

Treating heartburn isn't an exact science; sometimes you'll need to try different options—some with medication and some without—to find the treatment that works best for you.

When starting the trial-and-error period that can lead to relief, your doctor will probably want to implement the "no medication" approach, which is preferred but more difficult because it involves lifestyle modifications and dietary changes. There are also home remedies that do not rely on pharmaceuticals to treat their heartburn, and some of those may work for you.

When It's Time to Turn to Heartburn Meds

If you cannot find relief with any of these methods, you can discuss with your doctor the various types of medications that may treat your symptoms. Antacids, H2 blockers, and proton pump inhibitors (PPIs) are all types of heartburn medication, each relieving the burn in different ways.

Which type of medication you use will depend on several factors, including the severity of your symptoms.

Many heartburn medications are now available over-the-counter (OTC) but don't let this fool you into thinking that they are not very effective. In fact, when Prilosec first came out, it could only be prescribed by physicians who specialized in digestive diseases, and then, for only a short duration. Side effects are not common, though they do occur at times. What is important to understand is that untreated and undertreated heartburn can result in several serious complications, and effective treatment, sometimes with only medications available over-the-counter, may decrease these risks.

It's also important to realize that many of these medications are available as both over-the-counter and prescription formulations. Often times the prescription dose is higher, but not always. In addition, many of these medications are marketed under both brand names and generic names. This can be confusing and it is not uncommon for people to find out they have been using two medications with different names, one prescription and one over-the-counter, or one generic and one brand name, that have the same action. Not only is this ineffective but may expose you to an excess dose of medication.

Meet the Heartburn Medicines

Antacids

Antacids are a commonly used heartburn medications, and you've likely seen commercials touting their effectiveness. What these commercials advertise is true; antacids may relieve occasional heartburn and indigestion. The active ingredients in antacids neutralize stomach acid, which is what is causing the pain.

Antacids are sold under the following brand names:

Note that different antacid preparations may have the same or different ingredients.

Antacids should are not meant for long-time use. If you're taking antacids for longer than two weeks, then the heartburn may be caused by a more serious medical problem. Consult your doctor for a further evaluation. You should see your doctor even sooner if you're experiencing any symptoms severe enough to interfere with your lifestyle.

Side effects from using antacids are more likely to occur when taken for longer periods or at higher doses than recommended. However, because side effects may occur, it's important to know what they are and when you should discuss your symptoms with your doctor.

Side effects that usually do not require medical attention unless they continue or become bothersome are:

  • Constipation
  • Stomach gas

 Report to your doctor immediately if you experience:

  • A skin rash, itching or hives, swelling of the face, lips, or tongue (indicates an allergic reaction)
  • Confusion
  • Headache
  • Irritability
  • Nausea or vomiting
  • Unexplained weakness or tiredness

H2 Blockers

H2 blockers (also called H2-receptor antagonists) are medicines that reduce the amount of acid the stomach produces by blocking one important producer of acid: histamine-2. Cells in the stomach lining, called parietal cells, produce acid. One of the ways these cells are stimulated to produce acid is with histamine. H2 Blockers reduce acid production by blocking signals from the histamine that tell the stomach to make acid.

H2 blockers are sold as the following brands:

Side effects when taking H2 blockers are rare. Most people tolerate H2 blockers well when they are taken as directed. Other medical conditions or medications could increase the odds of experiencing side effects. 

Side effects that you should report to your doctor or health care professional:

  • Allergic reactions like a skin rash, itching or hives, swelling of the face, lips, or tongue
  • Agitation, nervousness, depression, hallucinations
  • Breast swelling, tenderness
  • Redness, blistering, or peeling of the skin, including inside the mouth
  • Dark urine
  • Diarrhea
  • Headache
  • Nausea or vomiting
  • Yellowing of the skin or whites of the eyes

Proton Pump Inhibitors (PPIs)

The proton pump inhibitors (PPIs) work by completely blocking the production of stomach acid. They do this by shutting down a system in the stomach known as the proton pump.

The proton pump is a molecule in certain cells that "pumps" acid into the stomach. It takes a non-acidic potassium ion out of the stomach and replaces it with an acidic hydrogen ion. This hydrogen ion is what makes things acidic. By stopping the action of the pump, acid secretion into the stomach is stopped.

Doctors prescribe PPIs to treat people with gastroesophageal reflux disease (GERD), peptic ulcer disease, or other digestive disorders that may cause excess stomach acid.

Proton pump inhibitors are sold under the following brand names:

  • Prilosec (omeprazole)
  • Prevacid (lansoprazole)
  • Protonix (pantoprazole)
  • Nexium (esomeprazole)
  • Aciphex (rabeprazole)
  • Dexilant (dexlansoprazole)

PPIs as a class of medicine are meant to be taken under a doctor's supervision and only for a limited amount of time. Chronic use of PPIs has been associated with heart attacks, kidney disease, and bone fractures.

Side effects of taking PPIs may occur. See your doctor if you experience any of these possible side effects:

  • Headache
  • Diarrhea
  • Constipation
  • Upset stomach
  • Vomiting
  • Stomach pain
  • Cough
  • Cold symptoms
  • Dizziness
  • Mild rash

Report to your doctor immediately if you experience:

  • Severe skin rash with swelling or peeling
  • Hives
  • Swelling of the face, mouth, lips, or tongue
  • Swelling of hands, feet, or ankles
  • Severe diarrhea
  • Hoarseness

Sources:

Boardman, H., Delaney, B., and S. Haag. Partnership in Optimizing Management of Reflux Symptoms: A Treatment Algorithm for Over-The-Counter Proton-Pump Inhibitors. Current Medical Research and Opinion. 2015. 31(7):1309-18.

Scarpignato, C., Gatta, L., Zullo, A. et al. Effective and Safe Proton Pump Inhibitor Therapy in Acid-Related Diseases – A Position Paper Addressing Benefits and Potential Harms of Acid Suppression. BMC Medicine. 2016. 14(1):17.

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