Non-antacid OTC remedies for gastroesophageal reflux disease (GERD) comprise histamine-2 (H₂) blockers and proton pump inhibitors (PPIs). H₂ blockers revolutionized GERD therapy. Gastric H₂ receptor activation starts acid production and may trigger GERD. OTC H₂ blockers include cimetidine (Tagamet HB), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid). Durations, elimination, and side effects vary. Cimetadine is associated with CNS toxicities (including seizures), renal disease complications due to accumulation, and many drug interactions. Refer nonresponders to a doctor.

PPIs supplanted H₂ blockers just as H₂ blockers replaced antacids. PPIs irreversibly block the proton pump of the gastric parietal cell, reducing acid production more effectively than H₂ blockers. The only PPI drug available OTC is omeprazole (Prilosec). PPIs are generally well tolerated. Side effects can include headache, diarrhea, nausea, and abdominal pain. Adult GERD patients should start with 20 mg of omeprazole daily for four to eight weeks. Patients should consult a doctor first, even with OTC drugs.

JAMES M. WOOTEN, PharmD, a member of the RN editorial board, is an associate professor of medicine at the University of Missouri School of Medicine, in Kansas City, MO.

Sources

DeVault, K. R., & Castell, D. O. (2005). Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol, 100(1), 190.

Merck Manual Home Edition. "Antacids: Over-the-counter (OTC) drugs." 2003. (1 Nov. 2007).

National Guideline Clearinghouse. "Gastroesophageal reflux disease (GERD)." 2007. (1 Nov. 2007).