Acid Reducing Drugs

Many upper digestive symptoms, including heartburn, reflux, indigestion and upper abdominal pain are caused by irritation from stomach acid.   Treatment of these conditions with acid neutralizing or acid reducing medicines is frequently very effective.

  • Antacids such as Tums, Rolaids, Maalox, Mylanta etc. are inexpensive, convenient, safe and widely available without prescription.  Their ingredients have been used for over two thousand years.  They relieve symptoms quickly by neutralizing stomach acid.  Antacids may be taken in addition to other acid reducing medicines.  They are especially useful when taken on an "as needed" basis.
  • H2 Blockers are medicines in pill form that decrease the production of stomach acid. They work for 6 to 12 hours and are effective in relieving symptoms and healing tissue damaged by acid.  Four different H2 blockers are available: cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid). They are similar in safety and effectiveness but each requires a different dose.  H2 Blockers are available in low dosage without a prescription.  Higher doses are available by prescription. They are moderately priced, especially the generic forms, and have excellent safety profiles.
  • Proton Pump Inhibitors (PPI's) are medicines that suppress the production of almost all stomach acid. They are extremely effective and therefore often used for serious conditions or when H2 blockers are not effective. PPIs have very good safety profiles but are expensive, especially the patented precription PPIs (up to $5 per pill).  PPI's are usually taken once a day, ideally first thing in the morning on an empty stomach followed by food 15 to 30 minutes later.   Five PPIs are available: Prilosec (omeprazole), Prevacid (lansoprazole), Aciphex (rabeprazole) and Nexium (esomeprazole).  The only generic form available is omeprazole, however, it remains relatively expensive.   Omperazole is also available without a prescription as Prilosec OTC.  Prilosec OTC is the least expensive PPI costing around 60 cents a pill.

Insurance companies frequently require patients to use H2 blockers before or instead of PPIs.   Most insurance companies approve only one or two PPIs.  A PPI prescription may be approved only for a limited time with further prescriptions requiring prior authorization.   It is usually okay to change from one PPI to another if required by a change in insurance coverage.  It is unusual for a patient to need a specific medicine or duration of therapy that is not covered by their insurance.  In these cases an appeal must be filed with the insurance company.   We assure our patients that we will do our best to advocate on their behalf with their insurance company to provide medically necessary therapy.