Treatments for GERD: Over the Counter Medicines
Most people who have GERD do not suffer symptoms every day and the symptoms usually do not last for long—lasting from a few minutes to a few hours. Most episodes of reflux are brought on by overeating, eating the wrong foods, or lying down too soon after eating. These symptoms can often be cured by simple lifestyle changes and treated with over-the-counter (OTC) medications.
Over-the-counter medication for heartburn accounts for over $1 billion a year in sales in the US alone. These medications are readily available in pharmacies, drug stores, and supermarkets and provide relief for many sufferers of GERD. The medication is relatively inexpensive, especially when compared to prescription medicine. They are also very safe when taken properly and rarely conflict with other prescription medicines. OTC medicines used to treat intermittent heartburn can be divided into four general categories: topical agents, which coat the lining of the esophagus and stomach; antacids; H2-blockers; and home remedies.
However, OTC medicines should only be used occasionally and only for brief periods of time. If you have to take several antacids daily to control your symptoms, you may need a stronger prescription medicine and should consult a physician. If you need to take these medicines on a regular basis for longer than two weeks, you may need to consult a physician.
Although side effects are uncommon with these agents, all medications have the potential to cause side effects. As a rule, a medication that contains magnesium has the potential to cause diarrhea. Medications containing magnesium should be used with caution by anyone with poor kidney function, or any renal insufficiency, as magnesium can accumulate in the body to high levels if the kidneys are unable to dispose of it properly. Any agent that contains aluminum has the potential to act as a constipating agent and if used routinely, to lower levels of phosphate in the blood, which can cause bone weakening. Agents that contain calcium have the potential, though uncommon, to cause kidney stones and may lead to elevated calcium levels in the blood.
It is also important to note that many of the OTC medicines for heartburn and acid indigestion contain sodium, a component of salt. If you are on a salt-restricted diet, you’ll need to read the labels carefully to make sure you do not ingest too much sodium. Any person with occasional episodes of heartburn who has chronic kidney problems, renal insufficiency, or a history of congestive heart failure should talk with his or her doctor about the benefits and risks of the various OTC medicines. Some antacids that are low in salt are Gelusil, Mylanta DS, Nephrox suspension, Rolaids, and Titralac. Di-Gel is sodium-free. Nephrox does not contain magnesium.
Gaviscon (alginic acid). Alginic acid is a topical agent designed to mix with the mucus and saliva in the esophagus and stomach to form a “pool” of liquid that floats on top of the mucosal lining of these two organs. This pool acts as a barrier to protect the cells and tissues beneath the mucosal lining from the caustic actions of acid. Alginic acid is sold under the brand name of Gaviscon in both liquid and tablet form. It is generally thought to work better during the day than at night.
Antacids are useful in treating acid reflux, heartburn, and other symptoms of GERD because they convert the caustic and potentially dangerous hydrochloric acid found in stomach acid into neutral water and a salt. Antacids also decrease the potential caustic effect of pepsin, another chemical found in gastric secretions.
The amount of medicine needed to relieve symptoms of heartburn and regurgitation varies from person to person, based on body size, weight, use of other medicines, the severity of symptoms, amount of acid that needs to be neutralized, and size and time of last meal. Solid tablets or liquid antacids may affect response to treatment as well. One small study showed that chewable antacids provide more protection from acid reflux than the same medication taken in liquid form, though liquids generally act faster.
Alka-Seltzer (sodium bicarbonate). Two tablets every 4 hours, with a maximum dose of 8 tablets in 24 hours. Patients on a salt-restricted diet should use this medication carefully. Alka-Seltzer is not recommended for heartburn pain.
Gelusil (aluminum hydroxide, magnesium hydroxide, simethicone). One to 2 teaspoons every 4 to 6 hours, or 2 to 4 tablets every 4 to 6 hours. The maximum dose is 12 teaspoons in 24 hours, or 12 tablets in 24 hours. Sodium-free and sugar-free.
Maalox and Extra Strength Maalox (aluminum hydroxide, magnesium hydroxide). For regular Maalox, 2 to 4 teaspoons can be taken up to 4 times a day. Extra Strength Maalox contains simethicone, which can help break up larger gas bubbles into smaller gas bubbles. The recommended dose of Extra Strength Maalox is 2 to 4 teaspoons can be taken up to 4 times a day.
Mylanta (aluminum hydroxide, magnesium hydroxide, simethicone). Two to 4 teaspoons or 2 to 4 gelcaps up to 4 times a day. The maximum dose is 12 gelcaps in 24 hours, or 24 teaspoons in 24 hours.
Mylanta DS (aluminum hydroxide, magnesium hydroxide, simethicone). This is the same as Mylanta but with double the quantities of ingredients. Two to 4 teaspoons up to 4 times a day, with a maximum of 12 teaspoons in 24 hours.
Phillips’ Milk of Magnesia (magnesium hydroxide). One to 3 teaspoons up to 4 times a day, with a maximum dose of 12 teaspoons in 24 hours. Patients with poor kidney function should use this medication carefully.
Prelief (calcium glycerophosphate). This medication is very different from the other antacids listed here. It is actually classified as a dietary supplement, not as a drug. It is supplied as either tablets or a packet of granules that are designed to be mixed with acidic food before eating the food. The calcium glycerophosphate neutralizes the acid in the food and thus minimizes stomach upset and potentially decreases symptoms of acid reflux. The manufacturers do not specify a daily maximum dose. Chronic use may lead to elevated and potentially dangerous blood calcium levels, however, so we urge caution.
Riopan (magaldrate). One to 2 teaspoons up to 4 times a day, with a maximum dose of 8 teaspoons in 24 hours. People with poor kidney function should not use this medication chronically.
Rolaids (calcium carbonate, magnesium hydroxide). One to 4 tablets hourly as symptoms occur, with a maximum of 12 tablets in 24 hours. Low in sodium and each tablet has 22 percent of the daily recommended intake of calcium.
Titralac and Titralac Extra Strength (calcium carbonate). Two tablets every 2 to 3 hours as needed for Titralac, with a maximum dose of 19 tablets in 24 hours. One to 2 tablets every 2 to 3 hours for Titralac Extra Strength, with a maximum dose of 10 tablets in 24 hours. Low in sodium.
Tums (calcium carbonate). Two to 4 tablets up to 4 times a day, with a maximum dose of 16 tablets in 24 hours. Chronic use can cause constipation in addition to high calcium levels in the blood.
Nizatidine, cimetidine, famotidine, and ranitidine are the four types of H2– (histamine type 2) blockers, all of which reduce acid secretion by inhibiting H2 receptors on acid-secreting cells in the stomach. All the OTC H2-blockers sold are a lower dose than is available by prescription.
Over-the-counter antacids are often effective in treating symptoms once they occur, but if there is a food or type of meal that reliably produces an episode of heartburn for you, you might want to take one of the OTC H2-blockers one hour before you eat that food.
Axid AR (nizatidine). One tablet (75 mg) every 12 hours, with a maximum dose of 2 tablets in 24 hours.
Mylanta AR Acid Reducer (famotidine). This is very different from the other Mylanta products; originally available only as a prescription in a 20-mg dose, it can now be purchased OTC in a 10-mg dose. In OTC strength, 1 10-mg tablet can be taken twice a day, with a maximum dose of 2 in a 24 hour period.
Pepcid AC Acid Controller (famotidine). One 10-mg tablet can be taken twice a day, with a maximum dose of 2 in a 24 hour period.
Tagamet HB 200 (cimetidine). One 200-mg tablet can be taken twice in 24 hours, usually 30 to 60 minutes before eating a meal that might cause heartburn. Potential interactions with other medications, such as warfarin (Coumadin, a blood thinner), theophylline ( for chronic breathing problems such as asthma), and phenytoin (seizure medicine), are more common than with antacids.
Zantac 75 (ranitidine). One 75-mg tablet can be taken twice in 24 hours, usually one to two hours before eating a meal that might cause heartburn.