A number of medications used to reduce stomach acid production have been switched from prescription status and are now available over the counter (OTC). These medications are very effective to treat indigestion and acid reflux. Indigestion is used to describe nonspecific abdominal discomfort. Symptoms are mild and can include bloating, fullness, heartburn and nausea. Indigestion is very common, with 60 million Americans reporting that they experience indigestion at least once a month and more than 25 million have symptoms daily. Excessive stomach acid production contributes to indigestion. Acid reflux is also known as GERD. GERD results when stomach acid backs up into the esophagus. Products available to reduce stomach acid include antacids, H2 receptor blockers, and proton pump inhibitors.

Antacids have been available without prescription for many years. Antacids neutralize stomach acid rather than reduce acid production. They include chemicals such as sodium bicarbonate, calcium carbonate, magnesium hydroxide, and aluminum hydroxide. Popular brand names include Rolaids, Tumms, Maalox and Mylanta. They are available in chewable tablets and liquid suspensions. They are very fast-acting, offering relief within minutes, but their effects do not last very long, requiring frequent dosing. Side effects are mild and are most often associated with overuse of these products. Sodium bicarbonate products contain large amounts of sodium which can raise blood pressure and cause fluid retention. Magnesium products can have a laxative effect at higher doses. Aluminum-containing products are suspected of contributing to Alzheimer's Disease, although the association has not been firmly established. Calcium-containing products can contribute to the formation of certain types of kidney stones. All can affect the kidneys and contribute to kidney disease. Antacids are effective for indigestion but are not as useful for GERD.

H2 receptor blockers include ranitidine, cimetidine, and famotidine. Brand names include Zantac, Tagamet, and Pepcid. Histamine activates stomach acid production when attached to H2 receptors in the GI tract. These agents block histamine from attaching to these receptors, which decreases acid production. All were first available by prescription only but are now OTC. They are quick-acting, working in 30 minutes to an hour. They are long-lasting, effective for 12 to 24 hours. Headache and dizziness are common minor side effects. More serious side effects are rare but include irregular heartbeat, mood changes, and seizures. These products are effective for both indigestion and GERD.

Proton pump inhibitors inhibit acid production in the acid-producing cells in the stomach, completely stopping acid production. Over-the-counter products include Prilosec OTC and Prevacid 24 HR. Both of these were switched from prescription status. These products are slower-onset, taking at least an hour before they start to work, but are long-lasting and are taken once a day. Because of their slower action these medications are less effective for indigestion but are very effective for GERD. Side effects are rare but include headache and nausea. More serious side effects include rash, anxiety and depression. Long-term use is suspected of causing increased risk of bone fracture. There have also been reports of decreased effect of the blood clot preventing actions of Plavix when taken together.

All of these products can interact with other medications. Ask your doctor or pharmacist before taking any OTC medications if you are taking prescription medications, and mention all OTC products taken to your doctor if you are given a prescription medication.

Reference: http://www.mayoclinic.com/health/drug-information/DR602357, http://digestive.niddk.nih.gov/ddiseases/pubs/indigestion/.

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