H2 blockers reduce acid production, whereas PPIs block acid production altogether. So, PPIs are considered much stronger. Many H2 blockers are available, and most are over the counter (OTC) and do not require a doctor’s prescription. They come in generic or plain forms that are cheaper than the proprietary or marketed forms of the same drug. For the most part, both forms of the drugs work about the same, and for mild to moderate acid reflux the generics are a cost savings and work fine. There are four H2 blockers available in the United States and are sold under several names.
Some OTC H2 blockers are marketed at half of the usual prescription strength; it is important to read the label to see the strength and dose. The prices in the table are approximate and are included only to show you that the generics are dramatically cheaper than the proprietary drugs. The dosing given is average or usual dosing; the actual dosing for acid reflux could be less or more depending on the severity of your acid reflux, so read the dosing recommendations on the package label. As mentioned, these are all available without a prescription, but many nonprescription drugs are not covered under most prescription drug insurance plans. Higher dosing may be available with a doctor’s prescription and could be medications covered by insurance. In most states, there is usually a mandatory substitution to a generic drug if you use a doctor’s prescription.
H2 blockers are effective for mild to moderate acid reflux symptoms. These drugs have been shown in medical studies to be effective in healing esophagitis (inflammation of the lining of the esophagus). And once healed, H2 blockers are effective in maintaining healing of esophagitis when used long-term.
H2 blockers come as pills and a few as elixirs or liquids. After you take the pills, an H2 blocker takes about an hour to start working. So, an antacid might be a better choice if your reflux has already started. Some OTC H2 blockers such as famotidine/calcium carbonate/magnesium hydroxide (Pepcid Complete) come with an antacid included, are effective immediately, and can last up to 12 hours.
For those with predictable, occasional acid reflux, the medication should be taken before symptoms occur. For example, if you are going out for spicy food and are going to have a few alcoholic drinks, take an H2 blocker prior to the meal. If you only have nighttime acid reflux, then take medication before bed. If you have acid reflux daily and several times a day, then take a full dose daily to be more effective. Most H2 blockers reduce acid production for 6 to 12 hours and, accordingly, depending on the particular drug, you can take them anywhere from two to four times a day.
H2 blockers have been on the market for more than 25 years and before PPIs were developed were the number one prescribed drug in the United States. Millions of people have safely used these medications for years, and they are very safe for long-term use. But H2 blockers may not offer enough acid suppression for everyone. Those with severe acid reflux, asthma, aspiration, esophageal strictures, or Barrett’s esophagus may need complete elimination of stomach acid. Proton pump inhibitors are more effective for severe acid reflux and its complications.
What are the different proton pump inhibitors? How should they be taken? Proton pump inhibitors completely shut down stomach cells that produce acid because they work directly on the site of acid production. Because they are the strongest acid-blocking medication, they are considered third-tier treatment for acid reflux. The tiers represent the step-wise management of acid reflux symptoms, starting with the cheapest and safest medication as first tier and ending with PPIs as third tier. PPIs are the most expensive medications for acid reflux and have, generally speaking, more side effects.
Currently, only one over-the-counter PPI, Prilosec OTC, is available; all others require a prescription. Omeprazole is available only by prescription. Despite the previous comment that proprietary and generic drugs are about the same, in my experience, Prilosec OTC is a much more effective drug and costs a quarter as much as the generic.
Proton pump inhibitors as a group are overall much more effective for controlling stomach acid production than H2 blockers are. Proton pump inhibitors are the drug of choice for severe acid reflux symptoms, esophagi- tis, strictures, and Barrett’s esophagus. Sometimes PPIs are used to heal esophageal damage, and then patients are switched to an H2 blocker for long-term maintenance. In many studies, proton pump inhibitors have been shown to be more effective than H2 blockers are in healing esophagitis and maintaining healing. And if symptoms cannot be controlled with an H2 blocker, then long-term PPIs are continued.
Despite the fact that PPIs are strong, they are virtually useless if heartburn is already present because PPIs can take hours to a day to start working. These drugs are most effectively used to prevent acid reflux from occurring. So, PPIs should be taken regularly once or twice a day, not just on the spot when heartburn occurs. A common misconception among patients who take PPIs is that they feel the drug does not work, when really they are taking it incorrectly. Further, PPIs are very sensitive and do not work effectively if you do not take them at the appropriate time. All PPIs must be taken 30 to 45 minutes before eating food. This recommendation cannot be stressed enough. Many patients take PPIs when they get up in the morning, and then they do not eat breakfast, or they take the medication at bedtime for nighttime acid reflux—this is incorrect. If the drug is taken once a day, it should be a half hour before breakfast. If a PPI is taken twice a day, the additional dose is taken half an hour before dinner. Taking a PPI appropriately will ensure you get the maximum benefit from the medication.
H2 Blockers or Proton Pump Inhibitors — How do they Compare? References
By Mortin - Copyright 2009
Last modification 31/12/2009