WITHDRAWAL OF RANITIDINEIn April 2020, the
Food and Drug Administration (FDA)requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. This recommendation was made because unacceptable levels of NDMA, a probable carcinogen (cancer-causing chemical), were found in some ranitidine products. If you’re prescribed ranitidine, talk with your doctor about safe alternative options before stopping the drug. If you’re taking OTC ranitidine, stop taking the drug and talk with your healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, dispose of them according to the product’s instructions or by following the FDA’s guidance.
Many people use over-the-counter (OTC) drugs to treat minor gastrointestinal problems. In fact, OTC medications are often among the first treatments people use for symptoms of gastroesophageal reflux disease (GERD), such as heartburn and regurgitation.
Some people can treat their GERD symptoms with lifestyle changes, like eating fewer fatty and spicy foods. But these changes may not work for everyone.
If you make lifestyle changes and your symptoms don’t improve within a few weeks, your doctor may suggest you try OTC treatments.
Three types of OTC medications that can help control GERD symptoms are:
Heartburn is caused by acid reflux, which occurs when stomach acid flows up into the esophagus.
Doctors often suggest antacids as a first treatment to help soothe minor heartburn. These drugs help reduce symptoms by decreasing the amount of acid in your stomach. Antacids typically work within minutes of taking them, offering more immediate relief than other treatments.
Antacids contain aluminum, magnesium, calcium, or some combination of these substances. They’re typically available as chewable or dissolving tablets. Some brands are available as liquids or gums as well.
Common OTC antacids include:
Antacids sometimes cause side effects such as diarrhea and constipation. These side effects are more common when antacids are used too often. Be sure to follow the dosage instructions on the package of your antacid.
H2 blockers reduce the amount of acid produced in your stomach to lower your risk of heartburn. Typically, they start to work within an hour of when you take them. This means they act more slowly than antacids. However, they can provide longer symptom relief, lasting 8 to 12 hours.
H2 blockers are available OTC and by prescription. The OTC H2 blockers include:
- cimetidine (Tagamet HB)
- famotidine (Calmicid, Fluxid, Pepcid AC)
- nizatidine (Axid, Axid AR)
H2 blockers can cause side effects such as:
PPIs block acid production in your stomach. They’re the most powerful drugs for reducing acid production and are most appropriate for people with more frequent heartburn. They’re typically the most effective treatment for GERD.
PPIs come in pill form. Many are available by prescription only, but a few are available OTC:
- lansoprazole (Prevacid 24HR)
- omeprazole (Losec, Omesec, Prilosec OTC)
- omeprazole with sodium bicarbonate (Zegerid)
- esomeprazole (Nexium)
PPIs may cause several side effects, including:
- pain in your abdomen
- upset stomach
Side effects that are less common but more serious have also been linked to PPI usage. These include an increased risk of pneumonia, bone fracture, and rarely, hypomagnesemia (low magnesium levels) that may be life threatening.
Some people may use a combination of antacids, H2 blockers, and PPIs to manage acid reflux. However, combining them can cause side effects such as diarrhea or constipation in some cases.
Be sure to talk to your doctor before combining any OTC treatments for GERD with other medications.
You may wonder if an OTC or prescription GERD medication would be better for you. The right choice depends on how frequent and severe your symptoms are.
If your symptoms aren’t very frequent or severe, OTC medications may work well. The OTC forms of H2 blockers and PPIs have lower dosage levels than the prescription versions. They’re approved for short-term relief of minor discomfort.
If you use an OTC medication more than twice a week for your GERD, or if your symptoms don’t improve with treatment, speak to a doctor.
Frequent, severe symptoms may be a sign of a more serious problem. And they could get worse over time if left untreated. In these cases, you may need a prescription medication.
Prescription medications can provide stronger relief from GERD symptoms. Certain prescription-strength medications, such as prescription PPIs, can also help heal damage to the esophagus caused by acid reflux.
If you have GERD symptoms and aren’t sure what kind of medication to take, talk to your doctor. They can confirm whether you have GERD and develop a treatment plan that will work for you.
Be sure to ask your doctor any questions you may have. These might include:
- What lifestyle changes could reduce my symptoms?
- Which kind of OTC medication would be best for me?
- Would a prescription GERD medication work better for me?
- Am I taking any medications that might interact with an OTC medication?
- How and when should I take my GERD medication?
Changes in your daily habits may help reduce GERD symptoms. Your doctor can suggest changes that might work for you, such as:
- losing weight
- quitting smoking
- eating fewer fatty foods
- avoiding spicy or acidic foods
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