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The Special Risks of Nighttime Heartburn

Nighttime heartburn is painful. It disrupts your sleep and it can lead to serious medical problems.

OTC Medicines for Heartburn

If changes to your lifestyle don't ease your nighttime heartburn, over-the-counter medications may do the trick, Cheskin says. The tried and true treatments -- the ones your mom always gave you -- are antacids, which neutralize the acid in the stomach. These include liquids like Maalox or Mylanta, and solid tablets like Rolaids or Tums. "They can be very effective," Cheskin says, "but the problem is that you have to take them more frequently, since they only last a couple of hours."

But Spechler is skeptical. In cases of GERD that are bad enough to require them, he thinks that medicine is usually more effective and easier to live with. "Frankly," Spechler says, "unless the condition is especially severe, or there's some very compelling reason why a person shouldn't take medicine, I don't see any reason to torture patients with very tight dietary restrictions or elevating the head of the bed."

Another class of over-the-counter medicines is H2 receptor antagonists, which reduce the production of acid by the stomach. Some examples are Pepcid AC, Tagamet HB, Zantac 75, and Axid AR.

Studies show that over-the-counter medications can help with symptoms in 60% to 70% of people with chronic heartburn or GERD.

Treating Severe Heartburn and GERD

The newest -- and most effective -- class of heartburn drugs are the proton pump inhibitors. These work by blocking the effects of an enzyme that produces acid in the stomach. So far, only Prilosec OTC is available over-the-counter. Other proton pump inhibitors, such as Aciphex, Nexium, Prevacid, and Protonix, are available with a prescription from your doctor.

A lot of people find that one prescription medication on its own may not be enough. For severe GERD, Spechler says that you may need not only one to two daily doses of a proton pump inhibitor, but also a bedtime dose of an H2 receptor antagonist. You may need over-the-counter antacids, too. In some cases, your doctor may recommend surgery to correct the problem that's causing your symptoms. But surgery isn't always a complete solution. Some people still wind up needing medication afterwards. Be sure you're under a doctor's care if you take heartburn drugs regularly. They can slightly increase the risk of pneumonia.

The key is to get treatment. If you have frequent nighttime heartburn -- and lifestyle changes aren't helping -- see your doctor.

"In recent years, we've become more and more aware of GERD as a risk for much more serious conditions, even cancer," says Cheskin. "It's not just heartburn. So you shouldn't be complacent about it until you have it checked out."

As for White, he says that treatment with a proton pump inhibitor has made a big difference. His symptoms have improved dramatically over the last few years. Nonetheless, his case is severe and his says his doctor thinks he may need surgery in the future.

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Reviewed on April 13, 2009

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