Heartburn. Also known as acid reflux, GERD, or acid dyspepsia.
Are you one of about 10% of Americans suffering from acidic reflux disease? There would not be so many commercials on the Purple Tablet if you hadn’t been there in the millions.
Heartburn is the most common symptom of acid reflux. However, this is not the only sign. Some people experience chest pain or abdominal pain. Others complain of coughing or sour taste in the mouth. Some have wheezing, hoarseness, nausea, or regurgitation.
Reasonable treatment should begin with the prevention of ordinary triggers. The most frequent culprits are food, alcohol, smoking, medications and stress. Avoid spicy foods, acidic foods such as tomato and citrus foods, onions, caffeine, and dare you say chocolate? Avoid eating late at night. Do not smoke. Do not drink. Listen to your mother.
Most people know that aspirin can cause an upset stomach. Many do not know that ibuprofen (Motrin, Advil) and naproxen (Alevé) can almost do so. Anti-inflammatory drugs are also triggers, although Celebrex is probably the least likely to cause heartburn. Some people have similar problems with other medications, such as corticosteroids or hormones.
If you avoid known triggers, but still have symptoms, what's the next step?
(Before I continue, let me say that continued heartburn can be a symptom of a peptic ulcer, heart disease, or even cancer.
Now back to the treatment.
There are three types of heartburn: antacids (which neutralize stomach acid on contact for immediate release), H2 blockers (such as Tagamet, Axid, Pepcid and Zantac), which reduce the production of stomach acid by about 50% and IPP (proton pump inhibitors) (Prilosec , Prevacid, Aciphex, Protonix, Nexium, Dexilant), which reduce the acid by about 90%. Reglan is in another category entirely and works by improving contractions in the esophagus, so acid returns to the stomach.
For episodic heartburn, say, once a week or less, do not spend $ 20 on Prilosets OTC. Buy a $ 5 bottle of Rolaids or Maalox (or better yet, generics) that should last several months.
For more frequent or resistant heartburn, H2-blockers are an excellent and affordable choice. When they first appeared on the market, they were miraculous drugs - a change of life for those suffering from an ulcer. At the time, they were quite expensive. But now they are cheap, only $ 4 per month. Tagamet, Axid, Pepcid and Zantac are now available without a prescription in low doses. Interestingly, they are still available on prescription, usually in higher doses, but often at a lower price than non-prescription drugs. For example, you can buy a 30-day supply of generic Pepcid (famotidine) with a prescription for only $ 4, while the OTC version can cost 2-3 times more, depending on the strength. It will probably cost less to get a recipe.
Many people, probably millions who take more expensive PPIs, will do well with less expensive H-2 blockers. (Again, ask your doctor before taking them on a regular basis.) From Prilosec PPI, Protonix and more recently, Prevacid are now generic. Prilosec and some forms of Prevacid are currently over-the-counter. If you have a form through your insurance, it is likely that they are regulated. Check your form (bring it to your doctor) before making a decision about these drugs. It can save a lot of misery.
You do not want to take a PPI twice a day, if at all possible - a higher dose once a day is almost always cheaper. Generics are usually the least expensive. However, unlike the H-2 blockers, the OTC versions are less expensive than the recipe versions. In addition, the most regularly prescribed doses may cost less than the less frequently prescribed doses, regardless of the level of tablet strength. Ask your pharmacist. Although most of these drugs come in the form of capsules and cannot be divided, like tablets, capsules that can be safely opened and sprinkled with apple sauce or other food, can be carefully divided in half to further save. Coupons for branded PPIs (up to $ 55) are available online or with your doctor.
Reglan (metoclopramide) is not used as often as in previous years, but it is very effective for many people. He comes only with a prescription, but costs only $ 4 per month. It can be combined with the N-2 blocker, if necessary, which will still cost less than the IPP. Some people experience side effects, but not usually with a low dose or intermittent use.
I hope this advice will spare not only heartburn, but also your wallet. Since your doctor may not know the cost of these drugs, why not take this article with you to the next meeting?
Copyright 2010 Cynthia J. Kelker, MD
