Medications

a. Over the counter antacids - neutralize acids in stomach

• aluminum hydroxide
• calcium hydroxide
• calcium carbonate
• magnesium hydroxide
• magnesium carbonate
• magaldrate (contains aluminum and magnesium)
• sodium bicarbonate

b. Over the counter foaming agents -lie on top of stomach contents, decreasing the ability of the acid to come in contact with the esophagus.

• Alginic acid (Gaviscon)
• Sodium alginate (Gaviscon)

c. Over the counter H2 - receptor antagonist-decrease acid production

• ranitidine(Zantac, generics)
• famotidine(Pepcid, Fluxid, Ulcidine, generics)
• cimetidine(Tagamet, generics)
• nizatidine(Axid, generics)

d. Prescription strength H2-receptor antagonists decrease acid production. These medications relieve symptoms in 60% of patients and heal mild esophageal complications% of patients.

• ranitidine(Zantac, generics)
• famotidine(Pepcid, Fluxid, Ulcidine, generics)
• cimetidine (Tagamet, generics)
• nizatidine (Axid, generics)

e. simethicone helps to reduce gas and is often found in medications for heartburn to help reduce belching.

f.Proton Pump Inhibitors (PPI) show potent decrease in acid secretion and rapid symptom relief and healing rates in about 90% of patients.

• Esomeprazole (Nexium)
• lansoprazole (Prevacid)
• omeprazole (Losec, Prilosec, Zegerid)
• pantoprazole (Pantolol, Protonix)
• rabeprazole (AcipHex)

g. Prokinetics help strengthen the lower esophageal sphincter and increase rate of stomach emptying. They have a high incidence of side effects and are of little benefit except in delayed gastric emptying or alkaline esophagitis.

• bethanechol (Urecholine, Duvoid, Urabeth)
• metoclopramide (Reglan, generic forms)
• domeperidone

Heartburn treatment should always begin with healthy lifestyle choices. If this is not effective alone, a foaming agent, antacid or an over the counter H2-receptor antagonist may be added. If these are not effective, symptoms become more severe or occur three or more times weekly, you should see a physician. If you are on a health plan, most likely they will require you try a H2-receptor antagonist next and reserve PPIs if this does not work, because of the price.