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Heartburn Current Topics in Heartburn

Are Over-the-Counter Heartburn Drugs as Good as Prescriptions?

Over-the-counter (OTC) drugs used to treat heartburn are certainly less expensive than prescription versions and seem to be just as effective, according to a 2007 analysis by Consumer Reports Best Buy Drugs. But the bottom line is that choosing the best and most affordable drug to treat your heartburn may not be so simple.

Proton pump inhibitors (PPIs) are a class of drugs used to treat chronic heartburn, gastroesophageal reflux disease (GERD) and ulcers, all of which are caused by the acid in the stomach that is used to digest food. These drugs work by blocking an enzyme that produces acid, thereby lowering the amount present in the stomach.

One PPI, Prilosec OTC, recently became available as an over-the-counter option for patients to treat GERD and its symptoms. PPIs should not to be confused with antacids, such as Maalox, Tums and Rolaids, which work differently and provide more short-term relief from heartburn without eliminating the underlying cause of the pain, excess acid.

Prescription PPIs, which include Prilosec, Nexium, Prevacid and generic versions, cost upwards of $200 a month for the standard dose, whereas Prilosec OTC costs only $19 for a one-month supply. That can translate into more than $2,000 in savings over the course of a year, leading Consumer Reports to name Prilosec its “Best Buy Drug” for PPIs.

“Many people with heartburn and acid reflux could save $1,000 to $2,000 a year by taking an over-the-counter drug that’s just as effective as high-priced prescription drugs,” said Gail Shearer, director of the Consumer Reports Best Buy Drugs project.

But this simple equation leaves out some important considerations.

“As a blanket statement, it is a stretch to say that over-the-counter PPIs are a better value than prescription PPIs. It does not take into account the multiple factors involved in drug choice,” said Dr. Philip Katz, chairman of the Division of Gastroenterology at Albert Einstein Medical Center and treasurer of the American College of Gastroenterology

First, the cost analysis of Prilosec OTC leaves out patients with medical insurance and drug coverage. Some insurance plans will cover the cost of generic PPIs for as little as $10 a month out of pocket for the patient. Many others will cover name-brand PPIs for a little more, but still less than the over-the-counter version.

Additionally, Katz adds, patients may respond differently to each type of PPI, so Prilosec OTC may not always provide the best course of treatment for a patient.

“There are indeed individual responses from one PPI to another,” he said.

Moreover, using an over-the-counter PPI does not take the place of a doctor’s expertise. “It’s entirely possible that the consumer will get the wrong impression and think the physician is not needed in the diagnosis.”

Chronic heartburn and GERD can be a very serious condition, leading to the erosion of the esophagus and even cancer if it is not adequately managed. However, don’t be afraid to discuss your out-of-pocket costs when choosing treatment. If you don’t have adequate drug coverage, your doctor may steer you in the direction of Prilosec OTC, but if your insurance covers it, there may be better, cheaper options available via prescription.

No matter what, using any type of drug—whether it is available over-the-counter or by prescription—long-term use carries risks.

“Anyone using any drug long-term should be under the care of a physician,” said Katz.