Heartburn - Effective treatment, affordable cost

Heartburn - Effective treatment, affordable cost

Heartburn. Also known as acid reflux, GERD or acid indigestion.

Are you among the estimated 10% of Americans who suffer from acid reflux disease? There wouldn't be so many commercials on the Purple Pill if there weren't millions of you out there.

Heartburn is the most common symptom of acid reflux disease. However, it is not the only symptom. Some people experience chest or stomach pain. Others complain of coughing or a sour taste in their mouth. Some have wheezing, hoarseness, nausea, or belching.

Judicious treatment should begin by avoiding common triggers. Food, alcohol, smoking, medications and stress are the most common culprits. Avoid spicy foods, acidic foods like tomato products and citrus fruits, onions, caffeine and dare I say it, chocolate? Avoid eating late at night. Don't smoke. Don't drink. Listen to your mother.

Most people are aware that aspirin can cause indigestion. Many people don't realize that ibuprofen (Motrin, Advil) and naproxen (Aleve) are almost as likely to do this. Prescription anti-inflammatory medications are also triggers, although Celebrex is probably the least likely to cause heartburn. Some people have similar problems with other medications, such as corticosteroids or hormones.

What's the next step if you're avoiding known triggers but still have symptoms?

(Before I continue, I want to say that persistent heartburn can be a symptom of peptic ulcer disease, heart disease, or even cancer. Check with your doctor to make sure you're okay.)

Now back to treatment.

There are three types of heartburn medications: antacids (which neutralize stomach acid on contact for immediate relief), the H2 blockers (such as Tagamet, Axid, Pepcid and Zantac), which reduce stomach acid production on the order of 50%; and the PPIs (proton pump inhibitors) (Prilosec, Prevacid, Aciphex, Protonix, Nexium, Dexilant), which reduce acidity on the order of 90%. Reglan is in a completely different category and works by improving contractions in the esophagus, allowing acid to pass back into the stomach.

If you have occasional heartburn, such as once a week or less, don't spend $20 on Prilosec OTC. Buy a $5 bottle of Rolaids or Maalox (or better yet, generics), which should last several months.

For more frequent or persistent heartburn, H2 blockers are an excellent and affordable choice. When they came onto the market, they were miracle cures - life-changing for ulcer sufferers. At the time they were quite expensive. But now they're cheap, just $4 for a month. Tagamet, Axid, Pepcid and Zantac are now available over the counter in low doses. Interestingly, they are still available by prescription, generally in higher doses, but often at a lower price than the OTC medications. For example, you can purchase a 30-day supply of generic Pepcid (Famotidine) with a prescription for just $4, while the OTC version can cost 2-3 times as much depending on the strength. It will probably cost less to get a prescription.

Many people, probably millions, who take the more expensive PPIs would do well on the less expensive H-2 blockers. (Again, ask your doctor before taking these regularly. You don't want to mask stomach cancer.) Of the PPIs, Prilosec, Protonix, and most recently Prevacid are now generic. Prilosec and some forms of Prevacid are currently available without a prescription. If you have a formula through your insurance, it is likely that they are regulated. Check your prescription (take it to the doctor) before choosing these medications. It can save a lot of heartache.

If possible, you don't want to take the PPI twice a day - a higher dose once a day is almost always cheaper. The generics are usually the cheapest. However, unlike the H-2 blockers, the OTC versions are cheaper than the prescription versions. Additionally, the most commonly prescribed dosages may cost less than less commonly prescribed dosages, regardless of pill strength. Ask your pharmacist. Although most of these preparations come as capsules and cannot be split like pills, the capsules, which can be safely opened and sprinkled on applesauce or other foods, can be carefully split in half for further savings. Coupons for brand-name PPIs (up to $55 off) are available online or from your doctor.

Reglan (metoclopramide) is not used as commonly as in years past, but it is highly effective for many people. It comes by prescription only but only costs $4/month. If necessary, it can be combined with an H-2 blocker, which still costs less than a PPI. Some people experience side effects, but usually not with low doses or intermittent use.

Hopefully this advice will not only save you heartburn, but also your wallet. Because your doctor may not know the cost of these medications, you should take this item with you to your next appointment.

Copyright 2010 Cynthia J. Koelker, MD

Inspired by Cynthia Koelker