• Digestive Health
• Medication

Heartburn Medications: Weigh the Benefits and Risks

Your heartburn medication could be working too well. By reducing acid in your stomach to squelch symptoms from acid reflux or GERD, it could be upsetting your stomach’s natural balance of acid that protects you from other ailments. This growing body of research is still taking shape, but it already has the attention of the U.S. Food & Drug Administration.

Taming acid reflux and GERD should continue to be your primary objective to avoid worsening symptoms and possibly esophageal cancer. However, sometimes less can be more in deciding what medication to take and how often to take it. 

Heartburn medications come in two forms – antacids and blockers. Antacids neutralize stomach acid. Blockers – H2 blockers and proton pump inhibitors (PPIs) – reduce stomach acid and can help your stomach and esophagus heal. Both may pose risks, but PPI blockers may produce more serious ones.

Talk with your health care provider about which medications may work best for you based on your medical history, symptoms and current health issues. Also, heartburn medications can interact or change the way your body absorbs other medications you’re taking.

If you have mild heartburn or feel your symptoms may be controlled without PPIs, talk with your doctor about other ways to douse the fire.

Side Effects and Risks from Antacids

Antacids can be a good treatment for heartburn that occurs once in a while. More common side effects may include constipation, diarrhea, allergic reaction or food sensitivity.

If you take too much or take antacids for longer than directed, you could get an overdose of calcium and experience nausea, vomiting, mental status changes or kidney stones.

If you take large amounts of antacids that contain aluminum, you may be at risk for calcium loss, which can lead to osteoporosis.

Be especially cautious with antacids and discuss taking them with your health care provider if you:  

• Have kidney disease, heart disease or high blood pressure
• Are on a low-sodium diet 
• Are already taking calcium
• Have had kidney stones
• Have a history of stomach ulcers or bleeding disorders
• Are older than 60 
• Drink three or more alcoholic drinks per day

Aspirin-containing antacids can increase your risk of serious bleeding. If you take another medication that increases your risk of bleeding, such as an antiplatelet or anticoagulant drug, you shouldn’t take these antacids.

Risks from PPIs Like Nexium®, Prevacid® and Prilosec®

The acid in your stomach performs a variety of functions that are lost when taking PPIs. In addition to breaking down food, stomach acid also chemically changes some nutrients so they may be more easily absorbed. It also helps kill pathogens in your gut before they can cause illness.

Traditionally, PPIs have been viewed as safe medications with few drawbacks, namely nausea and headaches.  However, studies are showing that suppressing stomach acid secretion for long periods might have these unintended consequences:

• PPI-associated pneumonia: Bacteria are more likely to multiply in the stomach’s less acidic environment and travel to the lungs if you inhale your stomach acid.
• Higher risk for C. diff: Clostridium difficile is a bacterium capable of causing life-threatening cases of diarrhea and conditions like colitis, an inflammation of the colon lining.
• Fracture risk: By lowering stomach acid levels, PPIs might affect your body's absorption of calcium, which is necessary for healthy bones. Over time, this could lead to osteoporosis and fractures, especially in women.  

H2 blockers (e.g., Tagamet®, Pepcid® and Zantac®) are not without side effects, but they may provide a better option for some people since they do not reduce stomach acid as aggressively as PPIs.

Alternative Solutions for Controlling Acid Reflux 

Some patients may have little choice but to continue their current PPI medication due to more severe GERD symptoms or to prevent against stomach ulcers from NSAIDs (nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen), as with arthritis sufferers.

If you have mild heartburn or feel your symptoms may be controlled without PPIs, talk with your doctor about other ways to douse the fire. Consider lifestyle changes, less potent heartburn medications – H2 blockers or antacids – or reduced frequency of PPIs.

Occasional reflux can be treated effectively with antacids and lifestyle changes such as:

• Avoiding trigger foods such as chocolate, coffee and fatty foods
• Chewing gum, which can increase the production of saliva that can soothe an irritated esophagus and wash stomach acid back down into your stomach
• Elevating the head of your bed for night time heartburn

As with all medications, never stop taking a prescription drug without consulting with your health care provider.

Source: Harvard Health Letter, Harvard Medical School; Arthritis Foundation; U.S. National Library of Medicine, National Institutes of Health; Healthline; U.S. Food & Drug Administration