Heartburn Symptoms: A Pharmacist's Guide to Treating Heartburn

Try these tips to ease heartburn symptoms.

Medically Reviewed by Brunilda Nazario, MD on August 08, 2008

If you're one of the 40 million Americans who have heartburn symptoms at least once a week -- or even among the 60 million more who have heartburn symptoms at least once a month -- you're probably always looking for new ways to relieve that acid reflux.

Even if your heartburn symptoms aren't severe and frequent enough to require prescription medication, you can still get a lot of help in managing your acid reflux from your local pharmacist. Pharmacists are savvy about not only prescription heartburn medicine, but also over-the-counter remedies and even lifestyle changes that can make a big difference in easing day-to-day heartburn.

Preventing Heartburn Symptoms

In many cases, you may be able to prevent acid reflux before it starts, says Wayne Weart, PharmD, professor of clinical pharmacy and outcome sciences and professor of family medicine with the South Carolina College of Pharmacy, the Medical University of South Carolina campus. "Pay close attention to what you're eating, when you're eating it, and what you're doing right after eating."

Diet and exercise tips to ease heartburn symptoms include:

  • Avoid fatty or greasy foods.
  • Avoid citrus fruits or juices.
  • Replace large, heavy meals with several smaller, lighter meals.
  • Don't lie down or nap for two to three hours after eating.
  • Avoid exercise, bending, and stooping for a couple of hours after eating.

What about spicy foods? Alcohol? Caffeine? Don't they aggravate acid reflux?

For some people, but not others, says Weart. "Fatty foods are pretty universal triggers of heartburn symptoms, but some people with heartburn can eat spicy foods without a flare-up, while others can't."

Most people can identify the foods that trigger acid reflux for them, but if you're not sure, try keeping a diary for a week. Write down what you eat, and when you have heartburn symptoms. You should be able to identify the foods you need to steer clear of.

Other lifestyle changes that may help minimize your heartburn symptoms:

  • If you are overweight, losing a few pounds can help ease heartburn, as can quitting smoking if you're a smoker.
  • Get a wedge pillow for your bed, or even raise the entire head of the bed on blocks 6 to 8 inches. "Let gravity work for you," says Weart. But don't prop yourself up on regular pillows. "You'll be bending in the middle and increase gastric pressure."
  • Avoid tight-fitting clothing, especially anything that is binding around the middle.
  • Certain medications worsen or cause heartburn. These include medications used to treat asthma, cardiovascular conditions, osteoporosis, arthritis, and inflammation. If you think your medicine may be causing acid reflux, ask your doctor if there are alternative drugs that offer the same benefit without the heartburn.

Treating Heartburn Symptoms Over the Counter

Although lifestyle can help ease heartburn symptoms, many people with recurrent acid reflux will still need medications to ease their discomfort. Fortunately, there are plenty of options for over-the-counter heartburn medicine.

"There are a couple of different kinds of heartburn medicine to consider," says Weart. "Most people with heartburn choose antacids first, which are quick to take effect, but short-acting. That means if you take an antacid in the middle of the night, you may wake up again a couple of hours later with recurrent heartburn. H2 receptor blockers are much more effective in the long run."

Isn't there something that offers the fast relief of the antacid, and the long-lasting benefit of the H2 blockers? In fact, there is. "Some heartburn medicines combine antacids with the H2 blockers," says Weart. "These drugs, like Pepcid Complete, offer a fixed combination of the two medications. Or you can do the same thing by taking your favorite antacid with an H2 receptor blocker."

You can also plan ahead to avoid heartburn. If you're going out for a big meal as a treat, and know you might be eating some foods you shouldn't, take your heartburn medicine early. "Take an H2 blocker (like Tagamet or Zantac OTC) about an hour or two before the meal, and it will kick in and suppress the acid that's causing heartburn symptoms before they start," says Weart.

If you have two or more episodes of acid reflux per week, you may want to try taking a 14-day course of over-the-counter Prilosec, a heartburn medicine in a class of drugs called proton pump inhibitors (PPI's). These medicines shut off acid production more completely and for a longer period of time.

"That's the standard treatment for frequent heartburn," says Weart. These heartburn medicines should be taken 30 minutes to an hour before a full meal (not just a cup of coffee and piece of toast) to maximize their benefit.

About half of those who complete the 14-day treatment will no longer have recurrent heartburn. You can try this course of heartburn medicine up to three times in a year; after that, says Weart, you should really seek a physician referral for long-term therapy.

When Heartburn Symptoms Might Be Dangerous

If you're managing your heartburn symptoms on your own, it's essential to know what symptoms should sound the alarm. Call your doctor if you have any of these symptoms:

  • Pain or difficulty when swallowing
  • Unexplained weight loss
  • Bleeding or dark, tarry stool
  • Chest pain
  • Choking or shortness of breath, including severe, persistent hoarseness and coughing

"All of these are atypical and alarming symptoms," says Weart. "You may think it's heartburn but it actually could be something else, like a heart attack. And if you frequently use over-the-counter remedies and don't respond to them or get an inadequate response, check with your doctor. Acid reflux can also be a symptom of something more serious, like malignancies."

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Wayne Weart, PharmD, professor of clinical pharmacy and outcome sciences; professor of family medicine, South Carolina College of Pharmacy, Charleston.

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