Heartburn: When Antacids Aren't Enough

Almost everyone gets heartburn now and then, and an antacid usually takes care of it. But if you're reaching for antacids several times a week, that's a sign it may be more than occasional heartburn. Here's what to know about using antacids safely, and what your options are when they aren't enough.

Antacids: fine for occasional use

Antacids neutralize stomach acid that's already there, so they work fast but don't last long. The common types:

• Calcium carbonate (for example, Tums). Can cause constipation. Very large amounts over a long time can raise calcium levels too high.
• Magnesium and aluminum combinations (for example, Maalox or Diovol). Magnesium tends to cause diarrhea and aluminum constipation. People with kidney disease should check with us before using magnesium products.
• Alginates (for example, Gaviscon). These form a barrier on top of your stomach contents, which is useful for reflux after meals or at night.

Some antacids contain a fair amount of sodium, which matters if you're watching your salt for blood pressure or heart failure.

Watch for interactions

Antacids can stop some medications from being absorbed properly, including thyroid medication (levothyroxine), iron, and certain antibiotics. As a rule, separate antacids from your other medications by a few hours. We can tell you exactly how long for each one.

When antacids aren't enough

If you have heartburn more than twice a week, or it keeps coming back despite antacids, you may have gastroesophageal reflux disease (GERD). Longer-acting medications are better for this:

• H2 blockers, such as famotidine, reduce how much acid your stomach makes.
• Proton pump inhibitors (PPIs), such as omeprazole or esomeprazole, are stronger and work best when taken regularly before a meal.

Some strengths are sold without a prescription, but it's worth talking to a pharmacist before starting. The right choice depends on your symptoms, your other medications and how long you've had the problem.

Pharmacists can prescribe for acid reflux

Acid reflux (GERD) is one of the minor ailments Ontario pharmacists can assess and treat. At The Boardwalk, a pharmacist can review your symptoms in a private consultation, recommend or prescribe treatment if it's appropriate, and fill it in the same visit. The assessment is free with a valid Ontario health card. Learn how minor-ailment prescribing works.

Signs you should see a doctor instead

Heartburn is usually harmless, but some symptoms need a proper medical workup. See a doctor if you have:

• Trouble swallowing, or pain when you swallow
• Weight loss you can't explain
• Vomiting, especially vomit that contains blood or looks like coffee grounds
• Black or tarry stools
• Heartburn that starts for the first time later in life
• Symptoms that don't improve with treatment

Chest pain that comes with exertion, shortness of breath, sweating or pain spreading to the arm or jaw may be a heart problem. Call 911.

Everyday habits that help

• Eat smaller meals, and avoid lying down for two to three hours after eating.
• Raise the head of your bed if you get heartburn at night.
• Notice your triggers. Common ones are alcohol, coffee, fatty or spicy foods, chocolate and peppermint.
• If you smoke, quitting helps reflux too, and we can help with that.

Heartburn during pregnancy is common, but not every product is right for you. Ask us before choosing one.

Questions about heartburn or your antacid use? Stop by 430 The Boardwalk or call (519) 578-3000.