Reflux 101 (Part II) What You Should Know About Acid Reflux Medications

While drug treatment can lessen heartburn and other annoying tell-tale signs of acid reflux, there are some troublesome side effects that you need to know about. Before you read any further, please note: you should never change your reflux medications without consulting your doctor. There can be consequences to abruptly stopping or changing treatments.


Reflux Meds: Antacids, H2 Blockers & PPIs

Last week in the Reflux 101 post, we talked about acid reflux, GERD and how lifestyle changes are the first line of defense in relieving your acid reflux symptoms. The next course of action often involves over the counter (OTC) and prescription medications recommended by your doctor.

Over-the-counter medications include antacids such as Tums, certain H2 blockers like Zantac, and lower dose Proton Pump Inhibitors (PPI) like Prilosec OTC . If symptoms persist, then your doctor may prescribe stronger medications – either an H2 blocker or one of the many PPIs – which can be the same brand as the OTC version but with a higher dosage.

Let’s take a look at each category of medications – antacids, H2 blockers and Proton Pump Inhibitors (PPI) – for a better understanding of what they are and how they work. 

What’s an Antacid? 

An antacid has over 100 different formulations that contain a key ingredient to neutralize stomach acid. Most contain at least one of these ingredients: calcium carbonate, magnesium hydroxide, aluminum hydroxide or sodium bicarbonate. While all these ingredients work to  neutralize your stomach’s acid, it’s important to choose one that makes sense for you and avoid possible reactions.

Consider the following common antacids with different formulas and their side effects : 

  • Sodium bicarbonate antacids, such as Alka-Seltzer and Bromo Seltzer, contain baking soda. These antacids should be avoided if you have high blood pressure or are on a salt-restricted diet. Alka-Seltzer contains aspirin, which is linked to Reye syndrome, a rare but serious illness in children. 
  • Calcium carbonate antacids, such as Tums and Alka-Mints, are sometimes used as calcium supplements. These products may cause constipation. 
  • Aluminum-based antacids, like Amphojel, are less potent and work more slowly than other products do. They may also cause constipation. Some may cause calcium loss and should not be taken by women who are past menopause. If you have kidney problems, check with your doctor before using aluminum-based antacids. 
  • Magnesium compounds, such as Phillips’ Milk of Magnesia, may cause diarrhea. Aluminum-magnesium antacids are less likely to cause constipation or diarrhea than the aluminum-only or magnesium-only antacids. Examples include Maalox, Mylanta, and Riopan. Many of these types of antacids contain simethicone to help break down gas bubbles in your stomach. 
  • Antacids with alginic acid, like Gaviscon, contain a foaming agent that floats on top of the stomach contents. This may help keep acid from coming in contact with your esophagus. 

How do H2 Blockers work? 

Histamine H2-receptor antagonists, also known as H2 blockers, can help relieve acid reflux by decreasing the amount of acid produced by the stomach . Signals that tell the stomach to make acid are blocked which makes the stomach contents less acidic and, therefore, less bothersome to the esophagus . H2 blockers are available both over-the-counter (OTC) and with your doctor’s prescription. 

Common H2-Blockers and their OTC counterparts: 

  • Axid/Axid AR 
  • Pepcid/Pepcid AC 
  • Tagamet/Tagamet HB 
  • Zantac/Zantac 75 and Zantac 150 

H2 blockers, which have been used since the 1960s, are said to have nominal side effects including headaches, dizziness, diarrhea, constipation, nausea and vomiting. While H2 blockers have been found to help acid reflux symptoms, relief for GERD sufferers is not always a given. Studies show that for people taking H2 blockers, more than 5 out of 10 people still have some GERD symptoms. 

What’s a PPI? 

Proton pump inhibitors (PPIs) work by reducing the production of acid in the stomach. Then, if stomach contents leak back into the esophagus,the irritation is less because the acidity isn’t as strong . Available as both prescription and over-the-counter (OTC) medications, PPIs have received negative press lately because of significant side effects that may occur with prolonged treatment. 

Common prescription PPIs:

  • Nexium
  • Dexilant
  • Prilosec
  • Zegerid
  • Prevacid
  • Protonix
  • AcipHex
  • Vimovo (contains a PPI and naproxen)

Common over-the-counter PPIs:

  • Prilosec OTC
  • Zegerid OTC
  • Prevacid 24HR

Over the past few years, multiple studies have raised concerns over possible side effects of long-term PPI use. These side effects include higher risk of hip, wrist, and spine fracture as well as bacterial infections such as clostridium difficile. Specific to bone weakening, the United States Food and Drug Administration (FDA) states, “Patients taking prescription PPI’s should understand the possibility of increased fracture risk… those using over-the-counter PPIs to treat heartburn should be cautioned not to take these drugs for more than 14 consecutive days and not to take more than three, 14-day treatment courses in one year.”

In 2009, based on health claims data, over 20 million people filled PPI prescriptions in the United States and, on average, continued with their prescription for about 6 months. As this was prior to the FDA’s warning, hopefully the trend is towards shorter courses of treatment. But are the possible side effects worth it? More than 5 out of 10 people taking PPIs still have GERD symptoms so it’s in your best interest to research your options, carefully weigh the facts and determine – along with your doctor – what makes the most sense for you. 

Considering the possibility of serious side effects linked to acid reflux medications and the lack of effectiveness for many, it’s important to give lifestyle changes a fighting chance. Make sure you’re not turning to acid reflux medications in lieu of changing habits that will increase your health all around. Eat smaller meals, avoid trigger foods and try sleeping with a MedCline reflux relief system to relieve your acid reflux naturally. And always talk to your doctor before making any changes to your medications.

References

1. Heartburn: Antacids, http://www.heartburn.com/ReliefAndManagement/Antac...

2. WebMD Medical Reference from Healthwise, Nonprescription Medicines and Products: Antacids and Acid

Reducers, http://www.webmd.com/a-to-z-guides/nonprescription...reducers (December 15th, 2010).

3. Micromedex, Histamine H2 Antagonist (Oral Route, Injection Route, Intravenous Route), http://www.mayoclinic.com/health/drug-information/... (March 10th, 2012)

4. Heartburn/GERD Health Center, H2 Blockers (Acid Reducers) for Gastroesophageal Reflux Disease (GERD), www.mayoclinic.com/health/drug-information/DR60190... (March 16th, 2010)

5. Kahrilas, PJ (2008). Gastroesophageal reflux disease. New England Journal of Medicine, 359(16): 1700-1707.

6. Heartburn/GERD Health Center, Proton Pump Inhibitors for Gastroesophageal Reflux Disease (GERD), http://www.webmd.com/heartburn-gerd/proton-pump-in... (March 16th, 2010)

7. FDA US Food and Drug Administration, Possible Increased Risk of Bone Fractures With Certain Antacid Drugs, http://www.fda.gov/ForConsumers/ConsumerUpdates/uc... (May 25, 2010)

8. SDI, Vector One®: Total Patient Tracker (TPT). 2002-2009. Data extracted 3-24-10.

9. IMS Health, IMS Health Plan Claims Database

10. Yang YX, et al. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296(24): 2947–2953.