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So you get
Heartburn what do you do?

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This information is to help you have an informed discussion with your doctor or pharmacist.

What is Heartburn?

Heartburn is a symptom that comes with a problem called Gastro-Esophageal Reflux Disease or GERD and sounds like "gurd". GERD happens when acid in your stomach goes up the food tube called the esophagus. Normally the acid should stay in your stomach. When the acid comes up the food tube, you may have one or more of these symptoms:

A warm feeling or burning under the chest bone called heartburn.
Burping, belching or gas coming up.
A taste of old food or stomach contents in your mouth.

What can I do to help prevent my heartburn?

Eat small meals
Sit up after eating
Avoid wearing tight clothes
Stop smoking
Maintain a healthy weight
Put 4-inch blocks under the legs at the head of the bed to reduce night symptoms
Do not eat 2 to 3 hours before lying down
Avoid foods that make your symptoms worse
These may include fatty foods, chocolate, onions, peppermint, citrus fruit, coffee and alcohol.
When should I see my doctor?
You should see your doctor if you have:
no relief from preventive measures and non-prescription medications
moderate to severe chest pain
nausea, vomiting or if you vomit blood
pain with exercise or pain that goes into your back, neck, or arm (these may be signs of heart problems)
Some medications may make your symptoms worse.
These include:
Anti-anxiety medications
Sleeping pills
Calcium channel blocking drugs used for heart disease and blood pressure control
Some asthma medications
Medications used for pain such as ibuprofen (Advil®, Motrin®) and naproxen
Products with iron in them
Antibiotics called tetracyclines

If you take any of these medications, you should talk to your doctor about how to help your symptoms while taking these medications. Do not stop taking ANY medications without first talking with your doctor.

How well do medications work?

Non-prescription medication

Antacids work by neutralizing the acid in your stomach. Antacids work fast and help to relieve symptoms in 5 to 15 minutes. Some names of antacids are Tums®, Rolaids®, and Maalox®. A glass of water can sometimes be as effective as an antacid.

Research has shown that:
All antacids seem to have the same effect and no antacid works better than another.

Some products also contain simethicone but this provides no additional benefit over plain antacids. You can pick an antacid based upon the cost and the dosage form. Some people like tablets and others like liquid.

H2-blockers work by reducing the amount of acid in your stomach. Some names for non-prescription H2-blockers are: ranitidine (Zantac®), famotidine (Pepcid®).

Research has shown that:
All H2-blockers seem to have the same effect.
No H2-blocker seems better than another.
H2-blockers often work well when used as a single night time dose.

Prescription medication

Your doctor can prescribe higher doses of an H2-blocker such as cimetidine (Tagamet®), ranitidine (Zantac®), nizatidine (Axid®), or famotidine (Pepcid®).

If these agents don't work your doctor may prescribe another class of drugs called proton pump inhibitors (PPI's). These may be more effective but are more expensive. PPI's include: lansoprazole (Prevacid®), omeprazole (Losec®), and pantoprazole (Pantoloc®). All proton pump inhibitors are equally effective and cost is usually the deciding factor between them.
What does the research show about the benefit of non-prescription heartburn medication?
58% of people felt better in 2 hours when they took non-prescription medication*, whereas 47% of people who did not take a medication also felt better.
Some people take non-prescription medication* 30 minutes before a meal to help prevent heartburn. 15% of people who did this, did not get heartburn; 3% of people who took no medication did not get heartburn.

*Non-prescription H2-blockers.

Other Resources To learn more about the information on this sheet contact:
Your Doctor
Your Pharmacist

The Canada Drug Guide Project, funded by Health Canada, aims to test the use of consumer-friendly information drawn from the best available studies.

Production of this document has been made possible by a financial contribution from the Health Transition Fund, Health Canada. The views expressed herein do not necessarily represent the official policy of Health Canada.