Medication Options

What can I take to relieve chest pain?

Heartburn is a common cause of chest pain, but severe or chronic chest pain could also signify a more serious condition such as a heart attack. If you have any chest pain that lasts for more than a few minutes — or any warning signs of a heart attack — seek immediate medical attention. Warning signs include such things as pain occurring with exertion, pain radiating to the arms or jaw, pain associated with shortness of breath or pain associated with lightheadedness or dizziness. Risk factors for heart disease include high blood pressure, diabetes, high cholesterol and family history of heart disease

What is the best treatment for heartburn?

Various factors should be reviewed when choosing an appropriate treatment, such as other medications you are taking, health problems you may have, the frequency and severity of your attacks and your own personal triggers. Your health care professional can help you to choose a product that fits your needs.

How do I choose the right medication for my heartburn?

Heartburn is a common ailment that affects 60 million American adults at least once a month. Caused when acidic stomach juices reflux, or flow backward, into the esophagus, heartburn sufferers generally describe symptoms that include a burning mid-chest pain, a feeling that food or liquid is coming back into the mouth or throat, an acid or bitter taste at the back of the throat, or an increase in severity of pain behind the breastbone when lying down or bending over. While heartburn symptoms will vary from patient to patient, there are general treatment guidelines, based on frequency of heartburn, to direct individuals to the most appropriate and effective medication options.

Episodic or occasional heartburn is a common type of heartburn. These infrequent bouts of heartburn are often predictable and are usually manageable in the short-term by avoiding certain foods or activities that cause heartburn, or with traditional over-the-counter (OTC) treatments (e.g., antacids, H2 antagonists, also known as H2-blockers). Antacids neutralize existing stomach acid and provide relatively rapid but short-term relief of heartburn symptoms lasting one to two hours. H2 blockers partially block production of acid in the stomach. The effect of H2 blockers generally lasts six to 12 hours.

Frequent heartburn is heartburn that occurs two or more days a week. Frequent heartburn sufferers may also be those whose heartburn does not respond to dietary and/or lifestyle changes alone, and/or who medicate heartburn symptoms two or more days a week. Some individuals engage in compensatory behaviors to offset heartburn discomfort, such as avoiding certain foods, beverages or physical activities for fear of resulting heartburn, sleeping with the head of their bed elevated or avoiding wearing close-fitting clothes and/or belts. Because they do not always feel the pain, these individuals may not identify themselves as frequent sufferers.

It is estimated that more than 50 million adult Americans suffer from frequent heartburn (2003 National Heartburn Alliance Survey). Frequent heartburn sufferers now have an OTC option that they did not have before.

The proton pump inhibitor (PPI) Prilosec OTC is the only OTC medication indicated specifically for frequent heartburn. Prilosec OTC provides 24-hour treatment of frequent heartburn with one daily pill when taken as directed for 14 days. PPIs, powerful inhibitors of stomach acid production, virtually shut down the acid pumps in the cells of the stomach, leaving enough acid for normal digestion of food. Although frequent heartburn symptoms can be reduced with traditional OTC medications, the OTC proton pump inhibitor is the only one specifically indicated for frequent heartburn.

Those who suffer from severe or persistent heartburn, despite treatment and changes in diet, could be experiencing early warning signs of gastroesophageal reflux disease (GERD). These individuals should receive prompt medical evaluation to confirm the presence or absence of GERD and determine the appropriate course of treatment for their heartburn symptoms.

Evaluating the type of heartburn you are suffering and knowing the relative value of OTC medications available are key to determining the best course of treatment for you. If you have not found a remedy that effectively manages your heartburn, talk to your health care professional and seek assistance to find the best treatment for you. Even frequent heartburn sufferers can now treat their symptoms effectively with an OTC medication.

Are there questions I should ask my health care professional about the medication he or she recommends?

The following are questions to ask your health care professional:

What is the name of the heartburn medication you are recommending and what is the active ingredient?
Do my symptoms indicate I have episodic, frequent or severe heartburn?
Are there OTC medications available to treat my heartburn?
How does OTC medication compare in cost to prescription medication to treat heartburn?
How and when should I take this medication?
For how long should I take this medication?
What should I do if my heartburn comes back or my symptoms are not relieved while taking this medication?
What are the most frequent side effects with this medication?
Could this medication interact with other medications I am taking?
What should I do if I miss a dose?
Is there any other information about this medication of which I should be aware?

What prescription medications are available for heartburn associated with GERD?

The two most common types of medications prescribed for heartburn associated with GERD are H2 antagonists (also known as H2 blockers), which reduce acid production in the stomach and proton pump inhibitors (PPIs), which offer the most complete suppression of acid production among prescription medications.

Antacids are available over the counter for heartburn, but are not indicated for heartburn associated with GERD.

How do the various OTC heartburn medications work?

Antacids neutralize some existing stomach acid and provide relatively rapid but short-term relief that lasts up to two hours.
H2 blockers or acid reducers partially block production of acid in the stomach. The effect of H2 blockers varies, depending on the specific product or brand used. One dose of an H2 blocker can last from six to 12 hours.
A proton pump inhibitor (PPI) is the only medicine that virtually shuts down active acid pumps at the source of stomach acid production. Prilosec OTC, the only PPI available over-the-counter, can treat frequent heartburn symptoms in most patients for up to 24 hours with one pill a day, when taken as directed for 14 days.

If you are prescribed a proton pump inhibitor for GERD, will you have to take it for the rest of your life or is there a specific time frame involved?

A standard course of PPI treatment for GERD is 8-12 weeks. Most physicians will try to reduce the dose and or the frequency of medication after completion of a standard course of PPI therapy. Some people can get along without prescription medication — restarting drug therapy if and when symptoms return. However, since GERD is a chronic condition some people will require long-term continuous treatment.

Are there any herbal therapies that effectively relieve heartburn?

The Web site wholehealthmd.com lists aloe vera juice as a natural remedy for heartburn. You may want to check the site for other natural remedies. The NHBA does not endorse or recommend this site. Keep in mind that herbal therapies are nutritional supplements that have rarely undergone objective clinical evaluation and have no FDA-approved medical use as a treatment for heartburn.

Is it dangerous to take heartburn medications all the time?

In general heartburn medications are safe. As with any medication, it is important to follow the directions on the label or take as directed by a pharmacist or doctor.

All over-the-counter medications are intended for short-term use. Unless taken under the supervision of a health care professional, they should not be used long term.

Never take more medication than is recommended or for a longer period of time than indicated on the label or as directed by your health care professional. If you are taking a medication and find that you are still experiencing heartburn symptoms, be sure to let your pharmacist or health care professional know so that he or she can evaluate your condition and suggest possible alternatives.

If you experience severe or persistent heartburn, you should seek the advice of a health care professional because you may have a more serious condition called gastroesophageal reflux disease (GERD). Both heartburn and other symptoms of GERD can be treated and complications avoided with proper monitoring by a physician.

Can some medications contribute to heartburn?

Some medications can contribute to heartburn. Frequent users of nonsteroidal anti-inflammatory drugs (NSAIDs) such as apsirin, ibuprofen and naproxen may experience heartburn as a side effect of the NSAID. Other medications that may contribute to heartburn include calcium channel blockers (used to treat high blood pressure and angina); anticholinergics (used in drugs that treat urinary tract disorders, allergies and glaucoma); beta adrenergic agonists (used for asthma and obstructive lung diseases); bisphosphonates (used to treat osteoporosis).

Certain antibiotics, antidepressants, sedatives and narcotics may also contribute to heartburn. Potassium or iron pills and pre-natal vitamins may be irritating to the stomach and may also contribute to heartburn.

Talk with your health care professional if you think a medication is contributing to your heartburn. Ask about alternatives but never stop taking any prescription medication without checking with your health care professional first.

Will heartburn medications induce side effects that will influence my ability to exercise?

Heartburn medications are generally safe and can reduce heartburn, making exercise more enjoyable.

I've heard in the news that there is a connection between heartburn medications and a disease that causes diarrhea. Should I be concerned?

The results of a recent study that showed H-2 blockers and PPIs are related to an increased risk of Clostridium difficile-associated disease (CDAD), or diarrhea, are inconclusive and do not show a direct correlation between the treatment and illness. The illness has many other risk factors including antibiotic use and increased age.

Talk to your health care professional if you have any additional questions or concerns.

Are prescription PPIs (Nexium, Prevacid) and those sold over-the-counter (Prilosec OTC) still safe to take?

Prescription heartburn medications and those sold over-the-counter have proven records of safety and efficacy and should be taken as directed by your physician or as indicated on the label. If you still have concerns, please contact your health care professional.

If I am having issues with diarrhea, can I take my heartburn medication?

Prescription medications and those sold over-the-counter are proven to be safe and effective when used as directed. If you are concerned about the effects of H-2 blockers and PPIs or about your current condition, please contact your health care professional.

If I am at high risk for CDAD (one who is elderly or heavily uses antibiotics), does using heartburn medication increase my risks of developing diarrhea?

The use of H-2 blockers and PPIs has not been definitively related to the increase of CDAD. If your heartburn medication is used as directed, the treatment is safe and effective. If you have additional concerns regarding CDAD, please contact your health care professional.