If you suffer from regular heartburn you may be tempted to pick up an over-the-counter PPI (proton pump inhibitor), such as Prilosec OTC, Prevacid 24HR, or a newer product, Nexium 24HR. But that’s probably not a good idea for several reasons, according to a Consumer Reports Best Buy Drugs report on heartburn drugs.
OTC PPIs all are similar-strength versions of prescription medications and are approved to treat heartburn that occurs several times a week. But they are potent medications and more appropriate for treating a serious condition called GERD, or gastroesophageal reflux disease, according to Consumer Reports Best Buy Drugs.
GERD occurs when acid from your stomach backs up, or refluxes, into your esophagus, the tube that leads from your throat to your stomach. If it isn’t treated, over time, the acid reflux can inflame or erode the lining of the esophagus. But while heartburn is a symptom of GERD, not everyone with heartburn needs a PPI. In fact, research has found that up to 70 percent of people taking PPIs might not need such strong medication.
For occasional heartburn or flare-ups that occur after a heavy meal, try an antacid, such as Maalox, Mylanta, Rolaids, or Tums, or an over-the-counter H2 blocker, such as famotidine (Pepcid AC) or ranitidine (Zantac 75). Even if you have a period of time—say a couple of weeks—in which you get heartburn fairly regularly, you may not need anything stronger than those drugs. Consider making changes to your diet and lifestyle, too, suggest our medical experts, such as eating smaller meals, not lying down for at least 3 hours after eating, and cutting out trigger foods and drinks, such as citrus fruit, garlic, onions, fried foods, caffeine, and alcoholic beverages.
In addition to the potential for overmedicating, PPIs come with side effects, including headaches and diarrhea. They can also increase your risk for serious infections such as pneumonia and a bacterial infection called C. diff (clostridium difficile) that can cause severe diarrhea, fever, and, in rare cases, death. The risk for those infections might be higher if you have asthma, lung disease, decreased immunity, or are older.
And taking PPIs long term—for a year or longer—has been linked to an increased risk for bone fractures, and depleted magnesium levels, which can trigger muscle spasms, an irregular heartbeat, and convulsions. Some research suggests PPIs also can deplete vitamin B12 levels, and a study published in January 2015 in the journal JAMA Internal Medicine linked the drugs to an increased risk for kidney disease.
"PPIs were never meant to be taken forever," says Marvin M. Lipman, M.D., Consumer Reports chief medical adviser. "You should periodically consult with your doctor about reducing dosage or switching to a less potent acid blocker in combination with dietary modifications."
What If It's More Than Heartburn?
If you have heartburn at least twice a week for weeks or months on end, have frequent regurgitation of food into your throat or mouth (with or without heartburn), or if antacids or H2 blockers do not relieve your symptoms, you may have GERD. For that, our medical advisors urge that it's time to see your doctor about it.
If you are diagnosed with GERD, your doctor may recommend you take a PPI to reduce the acid in your stomach and allow any irritation or ulcers in your throat to heal. For that problem, our Best Buy Drugs report recommends discussing two over-the-counter generic PPIs with your doctor as your best first option: generic omeprazole OTC and generic lansoprazole OTC. You should know that, although effective, the drugs might not provide immediate relief; they can take up to four days to start working.
Because of the risks mentioned above, our medical consultants suggest minimizing how long you take a PPI. Before you begin, ask your doctor how long you’ll need to take it. When PPIs are used to treat GERD, they should be taken for at least two weeks or longer if your doctor recommends. You'll likely need to take it for at least four weeks if you have ulcers in your throat to give them enough time to heal.
Once it's time to stop taking them, ask your doctor for strategies to slowly taper the PPI because quitting suddenly could trigger rebound heartburn symptoms. While there are no set guidelines for discontinuing PPIs, one strategy is to reduce your dose by half every week—for example taking it every other day for one week, then switch to only taking it every few days for week. Once you’re on the lowest dose for one week, you should be able to stop altogether.
Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
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