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Using Over-the-Counter Medicines for Heartburn When is Heartburn Just Heartburn? Is Your Heartburn Medicine Working? Night Pains: Is Heartburn Keeping You Up?

Digestive Health

Medication Strategies for Heartburn

Summary & Participants

Choosing heartburn medicines is easier if you know how they work against acid. In this program, experts explain the difference among common treatments.

Medically Reviewed On: July 01, 2008

Webcast Transcript

STUART SPECHLER, MD: I think one of the best ways to use the H2 blockers, if you're going to a situation where you know you're going to get heartburn unless you do something about it, that's a really good way to use the H2 blockers. So if you know that you're going to eat a pizza tonight and you know that it always gives you heartburn, take that H2 blocker half an hour or an hour before you go to the restaurant, and you may well get relief that way.

ANNOUNCER: There are four H2 blockers available over-the counter. The name-brand versions are Pepcid, Tagamet, Zantac, and Axid.

ANNOUNCER: There's also a combination technique in treating simple heartburn.

STUART SPECHLER, MD: The combination, using antacids along with H2 blockers, is something that had been done for many years. We would tell patients, "Gee, if you get heartburn, take an antacid, and if you want to prevent it, take the H2 blocker." So we often did that. Now there certainly is a medication today that combines the two. Pepcid complete has both antacid and an H2 blocker.

ANNOUNCER: H2 blockers prevent one of the messenger signals from getting to the parietal cell. There's another class of drugs that attack acid formation at another stage in the process, at structures in the parietal cells called proton pumps. The drugs are called Proton Pump Inhibitors, or PPI's.

STEVEN PEIKIN, MD: The PPIs, the so-called PPIs, work because they block the final pathway that makes acid. All the three different mechanisms: histamine, gastrin and acetylcholine work through the proton pump. It pumps up an acid ion into the stomach and brings back potassium into the cell. This pump that pumps acid into the stomach is blocked by the proton pump inhibitors.

So the PPIs, like Aciphex, Protonix, Nexium and Prilosec, these are drugs that bind and knockout the proton pump.

HASHEM EL-SERAG, MD: The onset of action of a proton pump inhibitor is also delayed, so it doesn't start working 'till approximately one hour after ingestion. But once you take it, it blocks the acid production for really extended periods of time, anywhere from 10 to 16 hours.

ANNOUNCER: Consumers have many choices in heartburn medicines. But when should they seek the advice of a doctor?

STEVE PEIKIN, MD: If somebody has trouble swallowing, burning in their esophagus when they swallow, somebody who is choking at nighttime, somebody who has frequent coughing at nighttime, somebody who has black, tarry stools -- those are alarm symptoms. That person needs to see their doctor and be evaluated.

Without those alarm symptoms, and when symptoms don't last longer than a month, doctors say a world of relief is available on supermarket shelves and at the corner drug store.

HASHEM EL-SERAG, MD: Over-the-counter medications are generally effective for dealing with heartburn. The majority of sufferers of heartburn are those who suffer from infrequent, episodic heartburn, they know hat brings it on and they know what relieves it. For those patients, over-the-counter medications are usually effective.

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