You may not find over-the-counter H2 blockers effective for moderate to severe heartburn. If the reflux disease is severe enough, it may require increased medication dosing or a prescription-strength H2 blocker. If H2 blockers are not effective enough in controlling symptoms, then movement to the next tier of acid reflux therapy is warranted. PPIs are the most potent of the medications used to treat acid reflux because they block stomach acid production completely.
Remember, both H2 blockers and PPIs are very effective in preventing heartburn. They do not work well once symptoms have occurred—antacids are more effective when symptoms are present. If symptoms occur while you are taking an H2 blocker, read the label on the H2 blocker because not all drugs are sold at the same dose. Ranitidine HCL, for example, is sold over the counter and comes in a 75-mg and 150-mg pill. The packaging on both is nearly identical, and failure of the smaller dose may be remedied by taking the larger dose. Further, ranitidine HCL works for about 12 hours, if you have nighttime symptoms and are taking a dose at breakfast time, it will be ineffective because the medication ideally should be taken about an hour before anticipated symptoms. So, the strength of a medication and when it is taken account for most treatment failures. If these changes do not control symptoms, then a stronger medication may be in order.
The most common reason PPIs fail to work effectively is because they are taken incorrectly. As previously discussed, PPIs need to be in the bloodstream and available to cells that produce acid when the cells are ready to make acid. PPIs do not work unless this is the case, and so must be taken 30 minutes prior to eating food. Food stimulates the tiny pumps in stomach acid cells to make the actual acid. PPIs block this acid production by blocking the functioning of the proton pumps in the acid-producing cells. Pumps are only activated when acid production is stimulated and are inactive during periods when food is not available. So, the timing of taking PPIs must be closely coordinated with eating.
Most PPIs take 24 to 48 hours to work and may not work the first day you use them. Generally, PPIs work for 10 to 16 hours, so again, a pill taken before breakfast may not be effective for nighttime symptoms. Thus, if you have only nighttime acid reflux, a dose of PPI before dinner is more effective. Alternatively, if you have day and night symptoms, taking the medication twice a day, once before breakfast and once before dinner, may be more effective.
If the symptoms still do not resolve with twice-a-day dosing of the PPI, it may be time to discuss with your doctor the possibility of changing medications. Some PPIs are stronger than others, and trials of different drugs may help you find the most effective one. Finally, if all else fails, then more testing could be in order to confirm that your symptoms really are acid reflux and not something else such as a heart problem. On rare occasions, PPIs can fail to control acid reflux and a surgical anti-reflux procedure should be considered.
By Mortin - Copyright 2009
Last modification 31/12/2009
What If My Acid Reflux Medication Is Not Working? References