Heartburn is a painful burning sensation experienced in the chest due to reflux of acid and other stomach contents into the oesophagus.
It is usually triggered by poor diet and lifestyle, which decrease the pressure of lower oesophageal sphincter (LES) causing it to relax and give way for the acid to flow back up.
Heartburn is a relatively common disorder and can be treated with simple medications. However, its negligence can lead to the development of chronic and more problem-some disorder called gastro oesophageal reflux disease.
OTC drugs for Heartburn Treatment
Over the counter drugs are the medicines that can be taken without the prescription of the doctor, and hence are available freely at pharmacies and medical stores.
They are mostly available for a number of diseases, pain, itching, allergies, and other disorders and are usually taken to cure any problem in its preliminary stage.
OTC drugs have been declared safe enough to be sold over the counter but still, are considered to have side effects and related risks.
Some interact with other medications, foods, drinks being taken at the same time, some can cause allergies and some might be harmful to the people with a certain medical condition.
Therefore it is important to be vigilant and aware of any OTC medicine to be taken to avoid and discomfort [1].
Types of OTC Drugs used for Heartburn and their Mechanism of Action
A number of medicines are available over the counter to treat heartburn. They are characterized based on their mode of action on the gut to reduce acid reflux.
They are usually safe to take but again might pose problems to some people with allergies or with any other medical condition.
The prescribed dose for each OTC drug is given on the label which should be followed strictly and the drugs should be avoided during pregnancy and breastfeeding.
Heartburn OTC drugs are usually grouped in 2 broad categories namely antacids and acid blockers. The acid blockers are again divided into two subtypes which are proton pump inhibitors and H2 blockers [2].
Antacids
Antacids work to neutralize the acid in the stomach. They work instantly to give relief from heartburn, but the effect is short-lived.
Chemically, they are compounds with high pH value (alkaline nature), which mix with the low pH acid in the stomach to make it neutral.
A number of antacids are available in the market in the form of powders, tablets syrups or chewing gums which contain just antacids or are in combination with other types of heartburn medications such as acid blockers.
The liquid form usually works faster than tablets. They are supposed to be taken when the heartburn occurs or after an hour of eating food.
Antacids are usually suitable for occasional heartburn or less severe reflux disease.
People with kidney disease, heart disease, and high blood pressure should never take antacids with prescription as they may interfere with the normal functioning kidney or heart.
People on low sodium diet or those who are taking calcium supplements or taking any other medication every day should also consult the doctor before taking any kind of antacids.
Pregnant women and nursing mothers should ask for doctor’s advice before taking such medications to avoid any future harm [3].
Acid Blockers
Acid blockers work to block the production of excess acid in the stomach to provide relief from the reflux of acid and hence the painful symptoms of the disease.
These drugs provide alleviation from heartburn for a longer period of time and are used for recurrent heartburn problem which is usually not treated by simple antacids.
As mentioned above, they are divided into two categories based on their activity on the gut.
1. H2 blockers
H2 blockers or H2 antagonists or Histamine type 2 receptor antagonists bind to the histamine type to receptors in the cells of the gut and interfere with the secretion of acids in the stomach.
They are usually a little slow in their action (30-90 minutes) but then the effect is long lasting with maximum efficacy [4].
They are available as capsules, tablets or syrup and are taken by mouth often with the first meal of the day.
In some cases, they can also be taken before the evening meal, in which case, it would be directed on the label of the drug being taken.
Consumption of H2 blockers should be immediately stopped if any side effect is observed.
Also if the medication is not providing relief for more than a week or the symptoms are not improving, a doctor should be consulted immediately, while stopping the further consumption of the drug without prescription [5].
2. Proton Pump Inhibitors
Proton pump inhibitors greatly reduce the production of acid in the stomach.
They are used when the reflux is not treated by wither antacids or H2 blockers and when heartburn lasts for more than two weeks.
Like H2 blockers, proton pump inhibitors also work slowly but the effects are long-lasting.
They work by inhibiting the proton pumps (H + /K+ ion channels) in the gut to interfere with acid production.
They are available in the form of capsules or tablets and are to be taken by mouth. They are usually consumed 30 minutes before the first meal of the day.
People with the chronic form of heartburn may need to take it every day but a less severe disorder can go with the medication being consumed every alternate day [6] .
Popular Over the Counter Heartburn Drugs
1. Alka-Seltzer
It is an antacid consisting of a combination of anhydrous citric acid and sodium bicarbonate, both of which are potent acid neutralizers.
It is taken by dissolving 2 tablets in 4 ounces of water. For children above 12 years and adults, it can be taken by the dose of 2 tablets, every 4 hours, or as needed.
The dose should never be increased beyond 8 tablets in 24 hours.
For adults over 60 years, the dose should not be exceeded beyond 4 tablets in 24 hours.
Children below 12 years of age should never be given Alka-Seltzer without prescription [7].
2. Gelusil
It contains magnesium and aluminium hydroxide, both of which are antacids. Another ingredient of gelusil is simethicone which is an anti-gas agent and provides relief from flatulence.
It is available in the form of chewable tablets. It is taken in a dose of 2-3 tablets at a time which can be repeated hourly if symptoms return.
The dose should never be exceeded above 12 tablets in 24 hours and the maximum time for which it can be used without prescription is for 2 weeks.
Beyond this time period, if the symptoms are not cured, a doctor should be consulted. Children below 12 years should never be given gelusil without prescription.
3. Pepto-Bismol
This liquid drug contains a compound called bismuth salicylate which is an antacid. 1 dose of pepto bismol is measured as 2 tablespoons or 30 mL.
For children above 12 years of age and adults, 1 dose can be given every ½ to 1 hour or as needed.
It should never be exceeded beyond 8 doses (16 tablespoons or 240 mL) in 24 hours. It should not be taken beyond two days.
Persistence of symptoms should be informed to a doctor. Children below 12 years of age should never be given this drug without prescription [8].
4. Maalox
Its contents are similar to that of gelusil (aluminium hydroxide, magnesium hydroxide and simethicone) and work in a similar way.
The only difference is that this drug is available in the form of syrup and not tablets as gelusil.
For adults and children 12 years or older; it can be administered in a dose of 2-4 teaspoon (10-20 mL) up to 4 times a day or as needed.
The dose should not be increased beyond 4 times (50-80 mL) in 24 hours and doctor should be consulted for children below 12 years of age [9].
5. Tums
It is an antacid majorly available as chewable tablets. It contains an alkaline acid neutralizer called calcium carbonate as its active ingredient.
For adults and children above 12 years of age, 2-4 tablets can be chewed when the symptoms occur.
The dose can be repeated a few times a day but overdose should be avoided. It should never be taken more than 2 weeks if the symptoms are not relieved by the drug [10].
6. Tagamet
It is a H2 blocker containing cimetidine as an active ingredient. It is taken by swallowing one tablet with a glass of water right before or anytime up to 30 minutes before eating food or drinking any beverages that cause heartburn.
The dose should not be exceeded beyond 2 tablets in 24 hours and children should not be given this without prescription [11].
7. Pepcid AC
It contains famotidine as an active ingredient which works the same as cimetidine with minor differences.
It is also an H2 blocker and should be taken in a dose of 1 tablet with a glass of water.
It is strictly to be swallowed and not chewed. For children above 12 years and adults, it should be taken 10-60 minutes before eating food or drinking beverages that cause heartburns.
It should never be given to children below 12 years of age without prescription [12].
8. Axid/Axid AR
The tablet contains nizatidine which again is an H2 blocker. For adults and children above 12 years of age, it is taken I a dose of 1 tablet with a glass of water to relieve symptoms.
To prevent symptoms, it is taken right before eating or anytime before 60 minutes of eating or drinking anything that can cause heartburn.
The dose should not be exceeded beyond 2 tablets in 24 hours and children below 12 years of age should not be given this drug without prescription.
9. Zantac
Another H2 blocker, zantac contains ranitidine hydrochloride as an active ingredient. It is taken in a dose of 150 mg or 10 mL of syrup (2 teaspoonful) twice daily [13].
Zantac is also available as tablets which can be taken in a dose of 1 tablet with a glass of water to relieve symptoms or 30-60 minutes before eating or drinking to prevent symptoms [14].
Children below 12 years of age should not be given this without prescription [15].
10. Prevacid 24 HR
It contains lansoprazole which is a proton pump inhibitor. For adults over 18 years of age, it can be taken in doses 1 capsule with a glass of water once every 24 hours for 14 days.
The capsule should never be chewed or crushed and the dose should not be exceeded beyond 14 days if the symptoms are not relieved.
The course can be repeated not more often than every 4 months and children under 18 years of age should never be given this drug without a prescription.
11. Prilosec
A proton inhibitor, prilosec contains omeprazole as its active ingredient. The recommended dose for adults above 18 years of age is 20 mg daily up to 4 weeks.
It is to be taken just before meals to prevent and relieve the symptoms of heartburn [16].
12. Zegerid
This drug is a combination of a proton pump inhibitor and an antacid. It contains omeprazole and sodium bicarbonate (acid neutralizer) as its contents.
For ages 18 years or older, it is to be taken in a dose of 1 tablet which is to be swallowed with a glass of water, once in 24 hours for 14 days.
The course can be repeated not more often than 4 months. It should never be taken beyond 14 days or the course should never be repeated before 4 months of the previous dose.
For children and people below 18 years of age, a doctor should be consulted [17].
Side Effects and Precautions for OTC Drugs
OTC drugs can cause a lot of side effects especially if taken by people who have allergies or a different medical problem at the time of administration of the drug.
Different types of OTC drugs for heartburn have different side effects.
For instance, antacids with magnesium may cause diarrhoea, brands with calcium and aluminium may cause constipation and brands with calcium may, though rarely, cause kidney stones.
Taking large amounts of antacids containing aluminium may increase the risk of calcium erosion from the body and osteoporosis.
Thus, antacids should be taken in limited amounts and any person with who is pregnant, nursing, with an allergy and with a kidney or heart disorder should consult a doctor before consuming any kind of antacid [18].
Side effects of H2 blockers are very rare. The least these drugs can do is cause headache (mostly drugs with famotidine and ranitidine) and diarrhoea and rashes (mostly drugs with cimetidine).
Side effects of nizatidine are extremely rare. A doctor should immediately be contacted in case of occurrence of symptoms other than the ones listed above [19].
It should be avoided during pregnancy and breastfeeding without a doctor’s prescription.
Like H2 blockers, proton pump inhibitors also did pose much harm and side effects.
They may cayse dizziness, headache, diarrhoea, nausea, itching and constipation at the most.
It should not be taken in pregnancy and breastfeeding without consulting with a doctor.
The medicine may react with warfarin and other blood clotting inhibitors so care should be taken if already taking such drugs [20].
Summary
Over the counter drugs are usually safe to take for people having no other medical problems or for those who are not taking any other drugs or herbs on a daily basis.
There are a number of OTC drugs available in the market to treat heartburn, based on their mode of action and strength.
They should be chosen based on the extent of symptoms of heartburn and the starting should be done with the lowest dose to avoid any discomfort.
OTC drugs are free from side effects and confer maximum efficacy if proper care is taken while dosage and consumption.