OTC Counciling

Heartburn Risk Factors from Food/Alcohol

- Food: Alcohol, caffeine, carbonated drinks, citrus fruit, coffee, fatty foods, spicy foods

- Medications: Anticholinergic agents, Aspirin, Calcium channel blockers

Other Heartburn Risk Factors

Emotion, exercise, stress, smoking, tight-fitting clothing, pregnancy, lying down after eating

Nonpharmacologic Therapy

- Symptom diary

- Wear loose-fitting clothing

- Avoid eating large meals

- If nocturnal: avoid laying down within 3 hours of meal, elevate head of the bed

- Stop or reduce smoking

- Lose weight if overweight

- Avoid use of aggravating medications if possible

Antacids dosing/administration

product-specific recommended doses at onset of symptoms

- May be repeated in 1-2 hours if needed

Antacids Onset

Less than 5 min

Antacids Duration

20-30 min

Antacids Side effects

- usually well tolerated

- aluminum: constipation

- calcium: belching/gas

- magnesium: diarrhea

- sodium bicarbonate: belching/gas

Antacids Follow up

Reevaluate if using more than twice a week

Antacids Recommendation

- Aspirin + sodium bicarbonate + citric acid (Alka-Seltzer)

- Calcium carbonate (Tums)

- Calcium carbonate + magnesium hydroxide (Rolaids)

H2RAs Dose/Administration

- Take one tablet twice a day

- May take at onset of symptoms orr 30-60 min before anticipated heartburn

H2RAs Max in 24 hours

Max 2 tablets in 24 hours

H2RAs onset

30-45 min

H2RAs Duration

4-12 hours

H2RAs Side Effects

Usually well tolerated

- Watch for headache, diarrhea, constipation, dizziness

H2RAs Follow up

If routine self-treatment is needed for more than 2 weeks - refer

H2RAs Recommendation

- Famotidine (Pepcid AC)

H2RA + Antacid Dose/Administration

Chew 1 tablet daily 15-60 min before symptoms are expected

H2RA + Antacid max in 24 hours

Max 2 tablets in 24 hours

H2RA + Antacid Onset

Less than 3 min

H2RA + Antacid Duration

8-12 hours

H2RA + Antacid Side Effects

- gas, belching

- products with calcium: constipation

- products with magnesium: may cause diarrhea

H2RA + Antacid Follow Up

If routine self treatment is needed for more than 2 weeks = refer

PPIs Dose/Administration

Take 1 tablet/capsule 30-60 min before a meal once daily, EVERY day

- Do not crush or chew

- Take for a maximum of 14 days

- Do not use more than once every 4 months

PPIs Onset

May occur on 1-3 hours, may take 1-4 days for complete relief

PPIs Duration

12-24 hours

PPIs Side Effects

Well tolerated

- Watch for headache, abdominal pain, diarrhea, constipation, gas

PPIs Follow Up

If heartburn continues during treatment, continues for more than 2 weeks, recurs within 4 months = refer

PPIs Recommendation

- Esomeprazole

- Omeprazole

Bismuth Subsalicylate Dose/Administration

Pepto-Bismol Liquid: Take 30 mL every 30 min as needed

- Do not use if aspirin allergy **

Bismuth Subsalicylate Onset

less than 5 min

Bismuth Subsalicylate Duration

Lasts 30 min

Bismuth Subsalicylate Side Effects

Dark discoloration of tongue and stool

Bismuth Subsalicylate Follow Up

Re-evaluate if using more than twice a week

Bismuth Subsalicylate Recommendation

Maalox, Pepto-Bismol