Helping Heartburn Patients Navigate OTC Options

Relief for heartburn and acid reflux is often found in OTC medication aisles, where patients can choose among antacids, alginates, histamine 2 receptor antagonists (H₂RAs), and proton pump inhibitors (PPIs).

A paper published in Current Medical Research & Opinion addressed the pharmacist’s approach to providing guidance for those who need help.

From their meta-analysis, the researchers verified the following counseling basics:

• Pharmacists can direct patients who have occasional heartburn to antacids, alginates, and H₂RAs. They should advise these patients to take these OTC medications before provocative meals or other triggers, or as needed for symptomatic treatment.
• Patients with heartburn that is frequent or of greater severity are better served by OTC PPIs.
• Pharmacists can advise patients who have frequent heartburn to take PPIs daily for 2 to 4 weeks, which may resolve it completely.

After confirming symptoms and selecting appropriate agents, the pharmacist’s primary role is to educate patients, the authors noted. Counseling points include how to take the drug, what to do if it does not alleviate symptoms, and when to consult a physician.

If symptoms remain unresolved or return rapidly during PPI treatment, patients need to be told to consult a doctor. Conversely, if symptoms return months after patients completed a short course of PPIs, they may simply need another short course of treatment.

The researchers included a treatment algorithm detailing the OTC selection process. It expanded upon previous algorithms by emphasizing the following changes:

• Preferred treatment strategies are based on symptom frequency and severity, as well as impact on the patient’s life.
• The pharmacist plays an essential role in educating patients.
• Patients whose symptoms fail to resolve in 2 to 4 weeks or who relapse within 3 months after a short course of PPIs need referral to a physician.

In the United States, PPIs are indicated for frequent heartburn occurring 2 or more days per week. Regulatory agencies in other parts of the world have approved PPIs for short-term treatment of reflux symptoms regardless of frequency, and they are an option for patients with occasional bothersome reflux and those who prefer not to take antacids, alginates, or H₂RAs.

Few published trials have examined short-term OTC PPI treatment. In those that have, the most common adverse events have included diarrhea, headache, abdominal pain, and nausea/vomiting.