Are You Taking GERD Medications Correctly?

Acid reflux drugs known as proton pump inhibitors (PPIs) can relieve the heartburn and discomfort associated with gastroesophageal reflux disease (GERD), as well as heal damage done to the esophagus by the stomach’s acids. But if you’re looking for optimal results, make sure you’re taking these powerful GERD medications properly. According to a June 2014 study in the American Journal of Gastroenterology, 61 percent of users aren’t doing so.

Researchers surveyed 610 patients taking over-the-counter (OTC) or prescription PPIs about their symptoms and reflux drug use. They found inconsistencies in dosing frequency and timing, which led to poor symptom relief.

Only 39 percent of consumers who purchased over-the-counter PPIs used their drugs correctly. Of the patients whose primary care physician prescribed their PPIs, 47 percent took their drugs correctly. Patients who had a gastroenterologist prescribe their drugs fared best: 71 percent followed the proper dosing directions.

A 2001 study found that only about one-third of primary care providers told patients to take their acid reflux drugs before breakfast, the best time for effectively relieving symptoms and healing esophageal damage. Conversely, most gastroenterologists told patients to take PPIs before the first meal of the day. As a result, gastroenterologist patients reported significantly better outcomes, including greater symptom relief, than consumers or primary care patients.

The mainstay of GERD relief

PPIs reduce the amount of acid produced in the stomach and are ideally taken once a day, immediately before the first meal of the day, to maximize acid suppression. Prescription PPIs include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (AcipHex), dexlansoprazole (Dexilant) and an omeprazole/ sodium bicarbonate combination (Zegerid). Prilosec, Prevacid 24HR, Nexium 24HR and Zegerid are available without prescription.

Some studies have reported that longterm PPI use could lead to hip, wrist, and spine fractures and increase risk of Clostridium difficile infection, which can cause diarrhea and fever. Other risks associated with long-term use are low magnesium, calcium, and vitamin B12 levels. Some evidence suggests a link between PPI use and increased risk of pneumonia. To avoid complications, use the lowest dosage for the shortest duration possible. Ask your doctor at each annual visit whether you still need a PPI or if the dose can be reduced.

Nonprescription antacids, such as Maalox, Mylanta, Gaviscon and Gelusil, and OTC and prescription H2 blockers—or histamine H2-receptor antagonists—reduce the amount of acid in the stomach), such as Tagamet HB, Pepcid AC, Axid AR, and Zantac 75, can remedy occasional heartburn. But GERD often requires long-term therapy.

PPI pointers

Try these tips to get the best relief from PPIs, unless otherwise directed by your doctor:

Take your daily PPI about 20 to 30 minutes before your first meal of the day.

If your doctor prescribes a second dose, take it before dinner.

Don’t skip doses; PPIs must be taken consistently every day to be most effective.

Tell your doctor if you’re taking clopidogrel (Plavix). PPIs may lessen clopidogrel’s effect.

Don’t take an OTC PPI for longer than 14 days, and no more than three times a year without your doctor’s consent.

If you’ve been taking an OTC PPI for more than two weeks, ask your doctor if you should see a gastroenterologist for a better diagnosis and treatment.

Be aware that it takes four to seven days of continuous use for maximum effect, although some people feel better each time they take a PPI.

Try an antacid or an H2 blocker for occasional symptoms. Some people find relief with “on-demand therapy”—taking a PPI as needed only on days when you expect symptoms to be worse—but talk with your doctor before skipping doses.

If you’re prescribed a PPI and an H2 blocker, take the PPI before your breakfast and boost your relief with H2 blockers later in the day.

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HealthAfter50 was published by the University of California, Berkeley, School of Public Health, providing up-to-date, evidence-based research and expert advice on the prevention, diagnosis, and treatment of a wide range of health conditions affecting adults in middle age and beyond. It was previously part of Remedy Health Media's network of digital and print publications, which also include HealthCentral; HIV/AIDS resources The Body and The Body Pro; the UC Berkeley Wellness Letter; and the Berkeley Wellness website. All content from HA50 merged into in 2018.