Counseling Points for Patients With Heartburn

Heartburn

Since more than 60 million Americans experience heartburn or acid indigestion at least once a month—and gastroesophageal reflux disease (GERD) is also very common—pharmacists have many opportunities to counsel patients on these conditions.

Drug Topics® recently spoke with Tom Kalista, PharmD, lecturer in the Pharmacy Practice Department at the University of Rhode Island’s College of Pharmacy, to determine the best ways to counsel patients on OTC and prescription medications to treat such symptoms, as well as non-medical interventions such as lifestyle changes.

Drug Topics®: How should pharmacists advise patients who ask for help with heartburn, acid reflux, and GERD? What tips would you provide them on managing their condition?

Kalista: First would be to assess the nature of the patient's heartburn to determine the most appropriate course of action/therapy. Intermittent symptoms are usually easily managed by OTC antacids such as Tums or histamine type 2 receptor antagonists (H2RAs) like ranitidine (Zantac) or famotidine (Pepcid) taken as needed.

Symptoms that occur more regularly/daily are best managed by the patient’s primary care physician and may require prescription therapy.

It can also help to identify and avoid any potential triggers. Spicy foods, acidic beverages such as coffee, and cigarette smoking are common offenders.

Drug Topics®: How would you advise patients on using prescription and OTC heartburn relief medications, based on the latest research?

Kalista: I would recommend trying an OTC medication on an as-needed basis before taking something every day or speaking to their physician. In most cases, antacids can be used as frequently as necessary to provide rapid symptomatic relief.

H2RAs can also be used as needed, but are typically taken no more than once or twice a day and work best if taken in anticipation of symptoms, such as before a meal. They can be taken every day if needed, but should only be done so if prescribed by the patient’s physician.

[Proton pump inhibitors (PPIs)], like omeprazole (Prilosec) or pantoprazole (Prevacid), are available OTC. However, they are not effective for relief of symptoms as needed. These medications are only effective if taken every day to prevent symptoms and, if therapy is needed for more than 2 weeks at time, are only best used if prescribed by their physician.

Tell patients that it is very important to check with their pharmacist before taking any medication to be sure they have appropriate dosing instructions and that there are no interactions with any other medications on their regimen.

Drug Topics®: What non-medical/lifestyle tips would you provide patients suffering from heartburn and GERD?

Kalista: Identifying any symptomatic triggers is an important step in managing heartburn/acid reflux/GERD. Patients should keep an eye out for certain foods/drinks or activities/times of day (especially morning or bedtime) that might worsen symptoms.

While it might not be possible/desirable to avoid certain triggers entirely, it can be very helpful in determining the best approach. Eating a balanced, low-fat diet, drinking plenty of water, and maintaining regular activity/exercise can all also help minimize symptoms.

Drug Topics®: What other important points should pharmacists make to patients suffering from heartburn?

Kalista: It is very important to speak to your physician if symptoms occur very regularly, as heartburn/acid reflux can be symptoms of other concerns. And [patients should] always check with their pharmacist before taking anything —OTC or prescription—to ensure they are using their medication as safely, effectively, and efficiently (in that order) as possible. 

References:

American College of Gastroenterology. Acid Reflux. Accessed December 11, 2020. https://gi.org/topics/acid-reflux/