Seeking prescription-strength heartburn relief is your next step under the following conditions:
- OTC products, such as antacids (Tums [calcium carbonate]), H2 blockers (Tagamet HB [cimetidine] and Pepcid AC [famotidine]), bring little or no relief.
- You still need antacids or H2 blockers after 14 days.
- You must repeat the preventive, two-week course of Prilosec OTC (omeprazole) more often than every 4 months.
Fifty million Americans suffer from frequent heartburn (symptoms occurring two or more days a week) that may require a doctor's care. For 17 million, heartburn is a symptom of gastroesophageal reflux disease (GERD), a disorder in which stomach acids and the enzyme pepsin back up from the stomach in to the esophagus. A much less-severe occurrence, called "GER," affects almost all of us at some point. Both happen because the lower esophageal sphincter (LES) spontaneously opens, releasing stomach juices in to the esophagus.
After questioning you about your symptoms and general health, performing a series of tests and making a diagnosis, your doctor may recommend one or more medications, including:
Prescription-Strength Versions of OTC medications. Higher doses of OTC medications that reduce acid production may be prescribed, but don't double up on your drugstore remedies without your doctor's advice. Higher doses multiply the risk of side effects, ranging from constipation to kidney problems.
Prescription H2 blockers. In prescription form, the H2 blockers can usually lessen heartburn symptoms and treat GERD. Although the H2 blockers are useful for improving heartburn, they may be less effective for treating inflammation of the esophagus resulting from GERD. Examples of prescription H2 blockers include: Axid (nizatidine), Pepcid (famotidine), Tagamet (cimetidine), and Zantac (ranitidine).
Prescription proton pump inhibitors (PPIs). The PPIs are the most commonly prescribed medications for the treatment of heartburn and GERD. These medications block acid production in the stomach more effectively than the H2 blockers. Examples of PPIs include: Aciphex (rabeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), Prilosec (omeprazole), and Protonix (pantoprazole).
Prokinetics. Prescription drugs that strengthen the LES and improve digestion. An example of a prokinetic medication is Reglan (metoclopramide), which may have serious side effects, including depression and anxiety. This medication is not commonly used because of its side effects.
To make sure you get the best care, ask your doctor the following questions:
- What is the active ingredient in my medication, and what are its side effects?
- How and when do I need to take this drug?
- If it doesn't help my symptoms, what should I do?
- Are there possible interactions with any other medications I'm taking?
- What do I do if I miss a dose?
- Is there any other information I should have about this drug?
Seeing a Doctor Can Be Important
Most people (that is, about 90%) who have GERD improve with medication. The consequences of not treating GERD can include esophageal injury, leading to difficulty swallowing or even cancer, and damage to the stomach lining, which can result in an ulcer.
It's also critical to seek help for GERD symptoms, because they can signal that you already have a more serious illness, such as esophageal hypersensitivity, ulcers or cancer.
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"Heartburn." gastro.org. Apr. 2008. American Gastroenterological Association. 16 Jan. 2009 <http://www.gastro.org/wmspage.cfm?parm1=848#Controlling%20Heartburn>.
"Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)." digestive.niddk.nih. May 2007. National Institutes of Health. 16 Jan. 2009 <http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/>.
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