Prescription Treatments

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Prescription Treatments

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To the Heartburn Center

Frequent heartburn that occurs more than twice a week usually responds best to medication that works 24 hours a day. Most of the over-the-counter treatmentsover-the-counter treatments, with the exception of Prilosec OTC, do not work this way.

Histamine-2 (H2) Blockers

In prescription form (usually higher doses than the over-the-counter versions), H2 blockers can generally relieve heartburn and treat GERD. These medications are particularly useful at alleviating heartburn but may not be as good for treating esophagitis (inflammation that occurs in the esophagus) that is the result of GERD.

Histamine stimulates acid production, especially after meals, so H2 blockers are best taken 30 minutes before meals. They can also be taken at bedtime to suppress nighttime production of acid. Examples of prescription H2 blockers:

• Axid
• Pepcid
• Tagamet
• Zantac

Side effects include headache, abdominal pain, diarrhea, nausea, gas, sore throat, runny nose, and dizziness.

Proton Pump Inhibitors (PPIs)

Depending on the source of your problem, your doctor can prescribe medications that block acid production more effectively and for a longer period of time than the H2 blockers, namely the family of medications doctors call proton pump inhibitors. PPIs are best taken an hour before meals. They include:

• Aciphex
• Nexium
• Prevacid
• Prilosec
• Protonix

Most doctors do not believe that one drug is significantly more effective than the others in managing GERD. These medications are also good for protecting the esophagus from acid so that esophageal inflammation can heal.

Side effects include headache, diarrhea, abdominal pain, bloating, constipation, nausea and gas.

Promotility Agents

Promotility agents work by stimulating the muscles of the gastrointestinal tract, which may help prevent acids from staying in the stomach too long, and strengthening the lower esophageal sphincter, reducing reflux into the esophagus. Reglan is a promotility agent occasionally used to treat heartburn associated with GERD. The side effects of Reglan may include drowsiness, fatigue, diarrhea, restlessness, and movement problems.

Another promotility agent, Propulsid, was removed from the market in 2000 because it caused serious heart arrhythmias (abnormal heartbeats) in some people.

Reviewed by the doctors at The Cleveland Clinic Department of Gastroenterology & Hepatology.

Edited by Cynthia Haines, MD, WebMD, January 2006.

SOURCES: American Academy of Family Physicians. American College of Gastroenterology. National Digestive Diseases Information Clearinghouse.