There it is again -- that painful, burning sensation known as acid reflux, or heartburn. You want to quench the burn, but the medications you are considering just might cause more problems. Several over-the-counter and prescription medications will effectively treat acid reflux. Antacids act to neutralize the stomach acid. Two other classes of medicines, H2 blockers and proton pump inhibitors, decrease the amount of acid the stomach produces. While typically effective and well-tolerated, you may experience constipation, diarrhea, headaches or other side effects when taking antacids or acid reducers.
How Acid Reduction Works
Heartburn occurs when the contents of the stomach come back up into the esophagus, the tube that connects the mouth to the stomach. The stomach acid irritates the lining of the esophagus, resulting in that burning sensation behind the breastbone. The stomach is naturally protected from the acid it secretes, but the esophagus is not. Thus, stomach contents that are regurgitated into the esophagus can cause symptoms and tissue damage if it happens regularly. Most people experience acid reflux occasionally, but when heartburn happens more consistently, it may be gastroesophageal reflux disease, or GERD -- a condition that requires suppressing the acid as a central part of treatment.
Side Effects of Antacids
There are two major types of antacids. Calcium carbonate is the active ingredient in Tums and Rolaids and similar products. Maalox, Mylanta and similar medications use aluminum hydroxide/magnesium hydroxide instead. These compounds neutralize stomach acid, and there are generally no serious side effects. Constipation and headache are the most common side effects reported with calcium carbonate. Aluminum hydroxide can sometimes cause constipation, while magnesium hydroxide may cause diarrhea. You should talk to your doctor, however, before using antacids regularly if you have any kidney problems. Also, ask your doctor if any of your medications could be affected by taking antacids.
Side Effects of H2 Blockers
While antacids neutralize stomach acid, H2 blockers are drugs that reduce the amount of stomach acid that's made and secreted. There are several different types of H2 blockers: cimetidine (Tagamet), famotidine (Pepcid AC), ranitidine (Zantac) and nizatidine (Axid). H2 blockers take longer to work than antacids but provide longer-lasting relief. Low doses of most are available over the counter, and higher doses require a prescription. Side effects from H2 blockers are rare but may include headache, diarrhea, constipation or dizziness. There are many medications that can interact with H2 blockers, such as the blood thinner warfarin (Coumadin) and a drug called theophylline, so you should discuss your current medications with your doctor before you begin using H2 blockers.
Side Effects of Proton Pump Inhibitors
Proton pump inhibitors, or PPIs, reduce the production of acid by the stomach. Examples of PPIs include omeprazole (Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium). Most are available in low-dose over-the-counter form or by prescription, and in general, PPIs are more effective at reducing acid production than H2 blockers. Side effects of PPIs are rare and typically not serious, but you may experience stomach pain, nausea, diarrhea or constipation, headache or itching. Long-term use of PPIs has been associated with certain types of bacterial infections of the intestinal system, vitamin B12 deficiency, low levels of magnesium and increased likelihood of bone fractures. In addition, PPIs may interfere with certain other medications such as blood thinners, so you should talk to your doctor about any others drugs you may be taking before you use PPIs.
When to See a Doctor
Antacids and acid reducers are generally very safe, with serious side effects being reported only rarely. However, they can interact with other medications and can cause some problems if taken for extended periods of time. Talk with your doctor if you feel the need to take antacids, H2 blockers or PPIs daily for more than two weeks or if you take any other medications. If you experience any reactions that are severe, such as extreme cramping or headache, blurred vision, chest pain or an allergic reaction such as a rash or swelling of the lips or mouth, you should stop taking the medicine and see your doctor immediately. Also, if you are pregnant, breastfeeding or have kidney disease, you should consult your doctor before beginning treatment.
Medical advisor: Jonathan E. Aviv, M.D., FACS