The Negative Effects of Heartburn Medications: What Everyone Should Know

The word heartburn is a misnomer, although the pain and burning occurs in the chest, it is not associated with the heart. Heartburn can be an occasional occurrence or a chronic symptom and result of an increasingly common condition called gastroesophageal reflux disease (GERD).

Heartburn medications, over-the-counter (OTC) and prescription, may have negative effects including interfering with kidney function and the absorption of important medications. The type of medications needed depends on the cause and extent of heartburn symptoms.

Why People Need Heartburn Medications

Acid reflux and heartburn are "common digestive conditions that most people experience from time to time. When these signs and symptoms occur more than twice each week or interfere with your daily life, doctors term this GERD" (Mayo Clinic Staff, 2009).

GERD occurs when the esophageal sphincter fails to close properly and/or function, acid flushes back into the esophagus, termed acid reflux. Eventually there is erosion of the less protected esophageal wall leading to heartburn and other complications.

According to the Mayo Clinic Staff, "most people can manage the discomfort of heartburn with lifestyle changes and over-the-counter medications. But, for people with GERD, these remedies may offer only temporary relief. People with GERD may need stronger medications, even surgery, to reduce symptoms" (2009).

Heartburn Medications and Their Negative Effects

Heartburn medications are classified based on their method of action, i.e. promotility, antacids, Histamine-2 blockers, coating drugs, and proton pump inhibitors. Whether OTC or prescribed by a doctor, each class of heartburn medication has a negative effect that should alert you, your doctor, and your pharmacist.

Promotility drugs

If acid reflux is due to decreased motility or emptying of the stomach (such as gastroparesis in a diabetic), promotility drugs such as Reglan (generic Metoclopramide) is obtained by prescription. Lawyers are currently seeking a lawsuit against the drug company that makes Reglan due to extrapyramidal side effects, such as tics, tremors, jerkiness, and uncontrolled facial movements.

Certain drugs, i.e. those used for psychiatric disorders (Zyprexa, Wellbutrin, Prolixin, etc.) may produce extrapyramidal signs, the addition of Reglan could potentiate these effects, and they should not be used together. Even opiate analgesics may cause an increase in Reglan's effects on the nervous system. Promotility drugs may also cause an irregular heartbeat.

Antacids

Antacids, such as Tums, Maalox, and Mylanta, "neutralizes stomach acid, thereby decreasing the acid's ability to cause irritation and inflammation of the esophagus. Some may contain a foaming agent to help block the stomach acid from backing up into the esophagus. Prolonged antacid use and excessive consumption of calcium may cause high calcium levels and result in serious metabolic disease" (Windle, 2005).

Antacids, for mild symptoms of GERD/heartburn, also interfere with many medications, their effects, and absorption. People use them indiscriminately, not realizing how dangerous they can be if. They are for temporary use only; if after a few weeks the symptoms do not subside, a doctor should be consulted to rule out a chronic condition.

Antacids may contain aluminum, calcium carbonate, sodium bicarbonate, and magnesium, which should be used cautiously in some diseases (especially of the kidney and heart). Many people are already on dialysis to remove these compounds from their system; a buildup of magnesium may lead to kidney damage.

Histamine-2 Blockers

H2 blockers such as brand name drugs, Tagamet, Zantac, and Pepcid, actually affect the amount of acid produced by the stomach; they are used for mild to moderate symptoms and are available over-the-counter (OTC) at approximately half the strength, per pill, as the prescription dose. Therefore, if the doctor orders a dosage of 150mg three times a day, the OTC brand probably comes in 75mg per pill requiring more pills to take. Unfortunately, sufferers of heartburn related to an acid reflux disease fail to take the medication as ordered or properly to avoid complications related to repeated esophageal exposure to toxic stomach acid.

Interestingly, H2 blockers "decrease the body's ability to excrete caffeine. Individuals who consume large quantities of caffeine may experience tremors, insomnia, or heart palpitations. Cimetidine [generic of Tagamet] may increase the likelihood of alcohol intoxication" (Windle). These drugs may also cause confusion and disorientation in the elderly.

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors block the secretion of acid from the stomach, allowing the esophageal tissue time to heal, and are stronger and more powerful than H2 blockers; they should be used for GERD, not mild heartburn. Their drug class ends in -prazole, i.e. Lansoprazole (Prevacid) and Omeprazole (Prilosec-one of the little purple pills).

According to Fisichella and Patti, "data have shown that PPIs can interfere with calcium homeostasis [equilibrium] and aggravate cardiac conduction defects [the heart's electrical system]. These agents have also been responsible for hip fracture in postmenopausal women" (2009).

PPIs are also available OTC, sometimes at the prescription strength used by many. Since these drugs may increase blood levels of important seizure, heart, and blood clotting medications, long-term OTC use without the guidance of a physician is not recommended. Treatment may take 4 to 8 weeks.

Coating Drugs

Coating drugs, such as Carafate, "binds to proteins from secretions in the stomach and esophagus, [it] forms a substance that protects the lining of the stomach and esophagus" (Windle). They also decrease the effect of many pertinent medications for seizures, heart and lung disease in addition to interfering with certain antibiotics. Because Carafate contains aluminum, people with kidney disease should only use under their doctor's supervision.

The Safe Use of Heartburn Medications

Treatment for heartburn entails a change in diet and lifestyle modifications, not just medications. A person should suspect a more chronic condition if they experience symptoms of heartburn more than 2-3 times a week. Antacids alone will not heal damaged tissue; most people have to take another type of heartburn/GERD medication, depending on the severity of their symptoms. Abusing antacids, even Rolaids and Tums can affect the calcium concentrations in our body, leading to heart and kidney problems.

Because of the possibility of negative effects, a person should inform the pharmacist and doctor of all medications they are taking, OTC, and prescription. When people use the same pharmacy for their prescription medications, computer programs can issue an alert if there are any negative effects (interactions) with other medications on their profile. It is also important to read and review literature accompanying drug prescriptions, especially drug-drug and food-drug interactions.

If a person opts to buy their prescribed heartburn medication OTC, for proper treatment, they should make sure to take the exact dose per doctor's order. As for heartburn medications interfering with the absorption of other medications, it is imperative to have drug-monitoring levels (i.e. Warfarin, Theophylline, and Digoxin levels) routinely checked by a physician.

References

Fisichella, P., Patti, M. MDs. (2009, April 28). Gastroesophageal Reflux Disease. eMedicine. http://emedicine.medscape.com/Gastroesophagealrefluxdisease/article/176595

GERD. (2009, May 23). Mayo Clinic Staff. http://www.mayoclinic.com/health/gerd/DS00967

Windle, Mary L. PharmD. Understanding Heartburn/GERD Medications. (2005, September 22). eMedicineHealth. http://www.emedicinehealth.com/understanding_heartburngerd_medications/article_em.htm