About Pharmaceuticals
GERD today is typically treated with medications such as histamine receptor antagonists (H2 blockers), such as Pepcid, Tagamet and Zantac, and proton pump inhibitors (PPIs), such as Nexium, Prilosec and Protonix. Frequent heartburn or reflux that occurs more than twice a week usually responds best to heartburn medicine that works 24 hours a day. Most of the over-the-counter (OTC) treatments, with the exception of Prilosec OTC, do not work this way.
Histamine-2 (H2) Blockers for Heartburn and Reflux
In prescription form (usually higher doses than the over-the-counter versions), H2 blockers can generally relieve heartburn and treat reflux. These drugs 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
- Zantac
- Tagamet
Side effects include headache, abdominal pain, diarrhea, nausea, gas, sore throat, runny nose, and dizziness.
Proton Pump Inhibitors (PPIs) for Heartburn and Reflux
Depending on the source and severity of your heartburn or reflux, your doctor can prescribe acid suppressive medications more effective and longer lasting than H2 blockers called called proton pump inhibitors (PPIs). PPIs are best taken an hour before meals. Examples include:
- Aciphex
- Nexium
- Prevacid
- Prilosec
- Protonix
- Zegerid
- Kapidex
- Dexilant
- Zegerid
- Vimovo
Most physicians believe that none of these medications is significantly more effective than another in managing GERD, though some are more effective for some GERD sufferers than others. 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, gas, nausea, and constipation.
Promotility Agents for Heartburn and Reflux
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 can be serious and may include drowsiness, fatigue, diarrhea, restlessness, heart arrhythmia, and movement problems.
Why Pharmaceuticals Are Not a Long-term Solution
While effective in treating mild to moderate GERD, these medications can lose their effectiveness over time. They also don’t treat the underlying root causes of reflux, the deteriorated anatomy of the antireflux barrier, so life-long medication therapy is required. In addition, recent studies on the adverse effects of long-term use of PPIs indicate a significantly higher incidence of hip fractures, particularly among women.
FDA Consumer Health - Possible Increased Risk of Bone Fractures with Certain Antacid Drugs (pdf)
Yang 2006, Survery of Hip Fractures in patients with greater than ONE Year of PPI Therapy
Targownik 2008, Survey of osteoporosis related fractures in patients taking PPIs (pdf)
Lagergren 1999, GERD as a risk factor for esophageal adenocarcinoma (pdf)