You’ve tried modifying your diet, changing your schedule, and lowering your stress level. Yet, you still struggle with the uncomfortable feeling of acid reflux.
Unfortunately, this is a common situation for many.
Acid reflux affects one in five adults. It is painful. And the condition could be a sign of a more serious problem. If you get reflux twice a week or more, you could have gastroesophageal reflux disease (GERD). Over time, GERD can damage the esophagus and increase cancer risk.
That’s why many doctors choose to treat reflux with medications. Doctors usually prescribe Histamine H2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs).
This post will tell you how these medications work and what side effects they may cause. We’ll also tell you three questions to ask your doctor before you start a PPI or H2RA drug.
Histamine H2 Receptor Antagonists (also known as H2 blockers)
H2 blockers, or H2RAs, are often prescribed for stomach conditions. They work by reducing stomach acid production, but more on that later.
H2 blockers are FDA-approved for short-term treatment of certain conditions, including:
Mild to infrequent heartburn
Medicines in this drug class have names that end with the suffix “-tidine.” Examples include:
Cimetidine (brand name is Tagamet)
Famotidine (brand name is Pepcid AC)
Nizatidine (brand name is Axid)
Ranitidine (brand name is Zantac)
H2RA drugs are short-acting. They only work between 4–10 hours. One way to remember this group of medications is to think of the name. H2 blockers end in “-tidine.” So, you can prevent reflux after meals if you take it before you go “to dine” or “-tidine.”
H2RA medications are available over-the-counter (OTC) and by prescription. They come in different forms, including pills, capsules, and chewable tablets.
How They Work
Histamine is a molecule found in many body tissues. You may know of histamine from ads or TV commercials for allergy medicines. Histamine does work in other parts of the body to trigger allergic reactions. In the stomach, it stimulates cells to produce gastric acid.
After eating, your body releases histamine into the GI system. It binds to receptor cells in the stomach called H2 receptors. This action causes the stomach cells to release gastric acid.
H2 receptor blockers work as the name says. They reduce stomach acid secretion by blocking histamine H2 receptor cells. H2RAs start working in about one hour, and effects may last from 4–10 hours. Because of the short duration, H2 blockers are helpful for occasional symptoms. If you are going to eat foods that trigger reflux, you can take this medicine ahead of time to prevent reflux later.
Unfortunately, after about a week of taking H2RAs, your body gets smart. You will develop a tolerance to H2 blocker drugs. Then your body compensates by producing more stomach acid. Therefore you should not take this medication for more than 1–2 weeks unless directed by a doctor.
Side effects from H2 blockers are uncommon and usually mild.
Yet, side effects can include:
Adults over 50 and people with kidney or liver disease have a higher risk of side effects. Severe adverse effects of H2RAs can include:
Pregnant or breastfeeding women should talk to their doctor before taking any medication.
Proton Pump Inhibitors (PPIs)
Proton pump inhibitors (PPIs) are a popular medication for reflux treatment. In fact, omeprazole (brand name is Prilosec) made the list of top 10 most prescribed drugs in the US in November 2021. And Nexium is one of the biggest-selling drugs in history.
OTC PPIs are FDA-approved to treat frequent heartburn in adults aged 18 and older.
Medications in the PPI drug class have names that end with the suffix “-prazole.” Examples include:
Dexlansoprazole (brand name is Dexilant)
Esomeprazole (brand name Nexium)
Lansoprazole (brand name is Prevacid)
Omeprazole (brand name is Prilosec)
Pantoprazole (brand name is Protonix)
Rabeprazole (brand name is AcipHex)
PPIs are available OTC and by prescription.
These are slower-acting medications and may work for up to three days. In fact, it may take that long to get relief with this medication.
How They Work
PPIs work by slowing a mechanism of stomach acid production called the proton pump. The gastric proton pump causes cells in the stomach to secrete acid. PPI drugs turn these pumps off, which reduces the amount of stomach acid the body makes around the clock.
Doctors may prescribe PPIs once or twice daily, 30 minutes before meals. Single doses are usually taken in the morning before breakfast. For twice daily dosing, it is best to take the second dose before dinner.
It is important to note that PPIs may not work for everyone. As many as 50% of those who try PPI medicines for non-erosive GERD, symptoms do not go away. Also, studies show that in patients with laryngopharyngeal reflux (LPR), PPI therapy is no more effective than placebo in producing symptom relief.
The American College of Gastroenterology suggests that patients stop taking PPIs for reflux when symptoms have gone away for at least two weeks. Along with PPI therapy for reflux, they also recommend:
use of H2RAs or antacids for infrequent symptoms
use of PPI courses intermittently if symptoms return
PPI treatment is only approved by the FDA for short-term use, 4–8 weeks.
Side effects of PPIs may include:
Chronic PPI use can also cause adverse effects, including:
Low magnesium levels
Vitamin B12 deficiency
Increased risk of food-borne infections
Another risk of PPI use is “rebound acid secretion.” This happens when a person’s stomach acid levels go up after stopping PPI treatment.
PPIs have helped millions. Still, many claim that they are dangerous. There are currently more than 15,000 lawsuits against makers of PPI drugs. Claims include kidney failure and other health injuries related to these medicines.
Questions To Ask Your Doctor About H2RAs and PPIs
Before you take acid reflux medication, talk with your doctor. Consider the benefits versus risks and how the drug might affect you.
To start a dialogue with your doctor, here are a few questions to ask if you’re considering taking a PPI or H2RA.
“How should I take it?”
If you take other medicines, supplements, and herbs, find out if they might interact with an anti-reflux medication. For example, if you take antacids for fast relief, ask if you should stop these.
Also, ask your doctor when and how long you should take the medication.
“How often should I check my B12 level?”
There is clear evidence that H2RAs and PPI medications lower vitamin B12 levels. Stomach acid breaks down food, so the body can absorb vitamins like B12 from foods we eat. As a result, less stomach acid means decreased vitamin absorption.
Your risk of vitamin deficiency increases the longer you take reflux medications. Many doctors recommend routine monitoring, but it is helpful to ask.
“Do I need a bone density test?”
A long-term side effect of PPI medications is porous bones, also known as osteoporosis. Chronic PPI use increases your risk for bone fractures. Certain parts of the body may become fragile, such as:
Osteoporosis affects all men and women. Yet, Caucasian and Asian women past menopause are at higher risk. If you fall into these categories, ask your doctor if you need regular bone density tests.
Also, ask if you should supplement your diet with extra calcium and vitamin D for strong bones. If so, find out the recommended dose. A nutritious diet and regular weight-bearing activity increase bone strength.
Combining therapies like diet and lifestyle changes with OTC medications can often help more than one treatment alone. Still, choosing a treatment for your acid reflux symptoms can be tricky. Now you know about the medications commonly used to treat reflux and how to talk to your doctor about what might be best for you. We hope you use this practical information to improve your health and wellness.
If you found this information helpful, share Acid Reflux Warrior with someone who could benefit.
This article is meant for informational purposes only. If you suffer from frequent heartburn, acid reflux, or GERD, check with a qualified medical or health professional to assess your unique GI problems and help you treat your symptoms.
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