Acidity. Also known as acid reflux, GERD, or acid indigestion.
Are you one of the estimated 10% of Americans who suffer from acid reflux disease? There wouldn’t be so many “Purple Pill” commercials if there weren’t millions of you out there.
Heartburn is the most common symptom of acid reflux disease. However, it is not the only symptom. Some people experience chest pain or abdominal pain. Others complain of a cough or a sour taste in the mouth. Some have wheezing, hoarseness, nausea, or regurgitation.
Sensitive treatment should begin by avoiding common triggers. Food, alcohol, smoking, medications, and stress are the most common culprits. Avoid spicy foods, acidic foods like tomato and citrus products, onions, caffeine, and dare I say it, chocolate? Avoid eating late at night. don’t smoke don’t drink Listen to your mother.
Most people know that aspirin can cause acid indigestion. Many don’t know that ibuprofen (Motrin, Advil) and naproxen (Aleve) are almost equally likely to do this. Prescription anti-inflammatory medications are also triggers, although Celebrex is likely less likely to cause heartburn. Some people have a similar condition 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 tell you that ongoing heartburn can be a symptom of ulcer disease, heart disease, or even cancer. Check with your doctor to make sure you’re okay.)
Now back to the treatment.
There are three types of heartburn medications: antacids (which neutralize stomach acid on contact for immediate relief), H2 blockers (such as Tagamet, Axid, Pepcid, and Zantac), which reduce stomach acid production by 50% , and PPIs (proton pump inhibitors) (Prilosec, Prevacid, Aciphex, Protonix, Nexium, Dexilant), which reduce acidity by around 90%. Reglan is in another category entirely and works by enhancing contractions in the esophagus so acid returns to the stomach.
For occasional heartburn, say once a week or less, don’t spend $20 on Prilosec OTC. Buy a $5 bottle of Rolaids or Maalox (or better yet, generic) which should last you several months.
For more frequent or stubborn heartburn, H2 blockers are a great and affordable option. When they first appeared on the market, they were life-changing miracle drugs for people suffering from ulcers. At that time they were quite expensive. But now they’re cheap, as low as $4 for a month’s supply. Tagamet, Axid, Pepcid, and Zantac are now available over the counter in low doses. Interestingly, they are still available by prescription, usually in higher doses, but often at a lower price than over-the-counter medications. For example, you can buy a 30-day prescription supply of generic Pepcid (famotidine) for just $4, while the OTC version can cost 2-3 times as much, depending on the strength. It will probably cost less to get a prescription.
Many people, probably millions, who are taking the more expensive PPIs would be fine with the less expensive H-2 blockers. (Again, ask your doctor before taking these regularly. You don’t want to mask stomach cancer.) Of the PPIs, Prilosec, Protonix, and more recently Prevacid are now generic. Prilosec and some forms of Prevacid are currently available over the counter. If you have a form through your insurance, they are likely regulated. Check your formulary (take it with you to your doctor) before deciding on these drugs. It can save you a lot of headaches.
If possible, you don’t want to take PPIs twice a day; a higher dose once a day is almost always cheaper. Generics are generally less expensive. However, unlike H-2 blockers, the OTC versions are less expensive than the prescription versions. Also, more frequently prescribed doses may cost less than less frequently prescribed doses, regardless of pill strength. Ask your pharmacist. Although most of these preparations come in capsules and cannot be split like pills, capsules that are safe to open and sprinkle on applesauce or other foods can be carefully split in half for additional savings. Coupons for brand name PPI (up to $55 off) are available online or from your doctor.
Reglan (metoclopramide) is not used as often as it was in years past, but it is very effective for many people. It comes by prescription only, but costs as little as $4 a month. It can be combined with an H-2 blocker if needed, which would still cost less than a PPI. Some people experience side effects, but not usually with low doses or intermittent use.
Hopefully, this tip will save you not only heartburn, but your wallet as well. Since your doctor may not know the cost of these medications, why not bring this article to your next appointment?
Copyright 2010 Cynthia J. Koelker, MD
