Choosing Wisely

Treating Heartburn and GERD

Using Nexium, Prilosec, and other PPIs carefully

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Heartburn is a feeling of burning pain in your lower chest, behind the breastbone. It comes from acid backing up from your stomach to your throat. You may have seen ads for heartburn drugs, such as Nexium, Prilosec or Prevacid. These drugs are called PPIs (proton pump inhibitors). They keep the stomach from making too much acid.

In most cases, you don’t need a PPI for heartburn. You can get relief from a less powerful drug. And  then you do need a PPI, you should take the lowest dose for as short a time as possible. Here’s why:

Do you need a PPI?

PPIs are powerful drugs. Studies suggest that more than half of the people who take PPIs probably do  not need them. Simple heartburn can be relieved with antacids or other less powerful drugs.

  • Do you have heartburn every now and then—after a big, spicy meal, for example? This kind of heartburn is uncomfortable, but it is not serious. You don’t need a PPI. You can usually get relief from an antacid, like Rolaids or Tums, or an H2 blocker, such as Pepcid AC or Zantac.
  • Have you had heartburn more than twice a week for several weeks? Then you may have GERD (gastroesophageal reflux disease). This is when acid made in the stomach backs up into your throat. Over time, it damages the lining of your esophagus (the tube from your throat to your stomach). If your doctor thinks you have GERD, you may need a PPI.

PPIs have risks.

If you need a PPI, taking a low dose for less than a year is probably safe. But taking a PPI for a year or longer has been linked to:

  • A higher risk of breaking a hip.
  • Low levels of the mineral magnesium in your blood. This can cause shaking, muscle cramps, and irregular heartbeats.
  • Pneumonia.
  • An intestinal infection called Clostridium difficile, which can lead to severe diarrhea, fever, and, in rare cases, death.

PPIs can change the way other drugs work.

PPIs interact with some common prescription drugs. For example, some PPIs can reduce the blood-thinning effect of the drug Plavix (generic clopidogrel). This can increase the risk of heart attack and even death.

PPIs cost more.

Why spend more money on a PPI unless antacids or H2 blockers don’t work?

  • A prescription PPI costs $100 to $300 more each month than an antacid or an H2 blocker.
  • An over-the-counter PPI also costs more than an antacid or an H2 blocker. You can buy Prilosec (generic omeprazole) without a prescription.

But you would still pay $10 more a month for a PPI like this than for an antacid or H2 blocker.

When should you consider a PPI?

If you have GERD, you probably need a PPI. Talk to your doctor if:

  • You have heartburn at least twice a week for several weeks.
  • Food often comes back up into your throat.
  • Your heartburn does not go away after you make the diet and lifestyle changes listed at right and you take antacids or H2 blockers.

If your doctor thinks you need a PPI:

  • Ask to start with a low dose of generic omeprazole or over-the-counter Prilosec (20 mg) or Prevacid 24HR (15 mg).
  • If the heartburn gets better after a few weeks, try to slowly stop using the PPI. Slowly lower your dose. Try taking it every other day. On the days you don’t take the PPI, take an antacid instead.



Advice from Consumer Reports

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2012 Consumer Reports. Developed in cooperation with the American Gastroenterological Association. To learn more about the sources used in this report and terms and conditions of use, visit