OTC Options for Heartburn: The Role of the Pharmacist

More and more proton pump inhibitors (PPIs) are making the jump to OTC status, and this plethora of new options may confuse patients.

More and more proton pump inhibitors (PPIs) are making the jump to OTC status, and this plethora of new options may confuse patients.

Pharmacists are positioned to help patients personalize their best choices for heartburn control. In addition, pharmacists are tasked with filtering through patients’ presentations and screening for red flags that signal the need for physician care.

A recent narrative review of this topic familiarized pharmacists with current treatment recommendations for heartburn and acid regurgitations.

The authors described how the World Gastroenterology Organisation, the National Institute for Health and Care Excellence, and the American College of Gastroenterology recommend lifestyle interventions such as weight loss and trigger food avoidance for all patients with heartburn. These organizations also advise using antacids or alginates for symptomatic relief of infrequent mild to moderate heartburn.

PPIs are the best choice of therapy for frequent (at least weekly) uncomplicated heartburn, which affects 18.1% to 27.8% of all North Americans. The drugs’ once-daily dosing makes them favored over histamine receptor antagonists (H2RAs), which are dosed twice daily.

However, PPIs have a longer onset of action than H2RAs, which have a longer onset of action than antacids and alginates. So, if quick relief is the goal, then antacids and alginates are the better choice.

Red flags include symptoms suggestive of cardiac-type chest pain, painful or difficult swallowing, recurrent bronchial symptoms/cough, hoarseness, signs/symptoms of gastrointestinal bleeding, and progressive unintentional weight loss. A physician consult is recommended if any of these symptoms are present.

Pharmacists should also refer patients to a physician if any heartburn treatment is ineffective after a 2-week trial, or if the patient needs 4 or more treatment trials per year.

Some medications such as nitrates and calcium channel antagonists can increase the rate of heartburn. Patients taking these medications should communicate symptoms to their prescriber, who may recommend a change in therapy.

Pharmacists should remember that there is no correlation between the underlying severity of the condition and the frequency or intensity of symptoms.

This review appeared in the June 2015 issue of the International Journal of Clinical Pharmacy.