Heartburn medicine: it's all the same, isn't it?
According to the advertisements, they all work wonderfully. Rolaids, Pepcid, Prilosec, Prevacid. But is not there some sort of difference between antacids and The Purple Pill? What about over-the-counter medications as compared to prescription drugs?
Not only is there a difference in how these medications work, there is a great difference in price. Knowing what to use can not only alleviate your symptoms, but spare your wallet as well.
For occasional symptoms of heartburn, for example those related to eating a spicy meal, several options exist. If you know ahead of time that the food you're planning to eat will cause heartburn, pre-treatment is the best answer. Both the over-the-counter H2-blockers (Pepcid, Zantac, Axid, and Tagamet) and the proton pump inhibitors (PPIs) (Prilosec, Prevacid) are effective. The PPIs are stronger but the H2-blockers are cheaper. For most people, any of these will work. Generally speaking, they take at least an hour to begin decreasing acid production. Unlike antacids (Rolaids, Maalox, Tums) they must first be absorbed into your blood stream to work.
If you forget to pre-medicate, you can certainly take any of these medications once symptoms begin. The antacids neutralize stomach acid on contact and provide the quickest relief. (Remember your high school chemistry?) However, as more acid is produced, more antacid will be needed. Pepcid Complete contains both famotidine and a combination of two antacids (calcium carbonate and magnesium hydroxide). The antacids work to neutralize stomach acid until the famotidine has a chance to be absorbed and decrease acid production. The same can be accomplished less expensively by using generic famotidine or ranitidine (generic Zantac) along with a generic antacid.
Some patients complain that the H2-blockers (Pepcid, Zantac, Axid, and Tagamet) are ineffective. These medications decrease stomach acid production on the order of 50%. The OTC medications are about half the milligram strength as prescription versions, but are the same drugs. Generics of Zantac, Axid, Pepcid, and Tagamet are still available by prescription, and may actually cost less than over-the-counter medication – a month's supply may cost as little as $ 4.
The PPIs (Prilosec, Prevacid) decrease acid output by as much as 90%. In the past few years, two have gone over the counter, while several others remain by prescription (Aciphex, Protonix, Dexilant, Nexium). They all work about the same, although certain patients seem to obtain greater relief from one or the other. The OTC versions cost $ 20- $ 30 a month, compared to well over $ 100 for prescription medication.
One problem with having these medications over the counter is the danger of disguising a serious problem. The OTC medications warn you to see your doctor if symptoms persist beyond a few weeks, which is certainly good advice. You don't want to camouflage a serious ulcer or a cancerous condition. If you need occasional relief from heartburn, using over-the-counter medication is fine. If it's a daily problem, be sure to see your physician to rule out a serious concern.
Copyright 2010 Cynthia J. Koelker, MD