WebMD Ask the Pharmacist

Heartburn and Indigestion: Ask the Pharmacist

July 6, 2010. Pharmacist Heather Free, PharmD, answers questions about heartburn and indigestion.

Question:

What is the difference between omeprazole (found in Prilosec, Zegerid) and esomeprazole (Nexium)?

Answer:

Esomeprazole (Nexium) is very similar to omeprazole (found in Prilosec, Zegerid). Each medication contains the same active isomer, or component, which is what makes them function and belong to the proton-pump inhibitor (PPI) drug class. An inactive isomer is found in omeprazole that is not related to the function of decreasing acid reflux. The medications were discovered by the same company and continue to be manufactured by that company.

Question:

Can a 10-year-old be given over-the-counter gas-relief soft gels?

Answer:

Gas relief medications, specifically simethicone products, have been used in every age group, including infants. One important tip is to pay attention to the dosage to make sure it has a safe and effective concentration for the patient. A child, between the ages of 2-12 years, should take 40 mg of simethicone per dose with meals and at bedtime. Adults can take 80 mg-180 mg of simethicone per dose with meals and at bedtime.
Check the product you have at home. Look for the active ingredient and the dose. This product is not intended to be cut in half. Make sure you follow all directions that are on the label. While over the counter medications are readily available for the consumer, the products are only as safe as our usage. Follow the directions and do not manipulate or deviate from them unless you have been advised by your health care professional to do so.

Question:

My husband just had his wisdom teeth removed and was prescribed Vicodin for pain and clindamycin for an infection in his mouth. Right now he is experiencing really bad heartburn. Is it OK for him to be taking these medications at the same time as an antacid, like Zantac 150 or Tums?

Answer:

Both Vicodin and clindamycin have side effects like upset stomach, nausea, and vomiting, but not heartburn. These medications currently do not have any known drug interactions with Zantac 150 (ranitidine) or Tums. He should be fine taking all these products together. However, watch his symptoms. If symptoms worsen, you may want to seek medical advice to make sure he doesn’t have another condition.

Question:

Can my 9-year-old take over-the-counter Prevacid?

Answer:

Prevacid, or lansoprazole, has recently moved from prescription strength to over-the-counter. The over-the-counter dose is labeled for adults, 18 and older. This medication is intended to treat stomach ulcers or heartburn that occurs 2 or more times per week. It is not a quick fix to elevate symptoms for heartburn. It slows the production of acid within the stomach over a period of time and is taken daily for 14 days. We recommend seeking medical advice if the product needs to be taken for more than 14 days.
I would not give Prevacid to your 9-year-old child. While this product is found over the counter, it still must be used according to its labeled directions in order to be safe and effective. If your child is having constant heartburn or stomach issues, seek medical advice from your pediatrician.
Consider looking at the cause of the symptoms to help educate your child. For instance, eating slower, avoiding certain foods that trigger symptoms, or eating smaller portions may help his/her symptoms. While medications are readily available and sometimes seem to be the quick fix, look at preventing the symptoms by changing behaviors.

Question:

I am taking Protonix for my stomach and some gastric problems. What is the difference between Protonix 40 mg, which is what I’ve been prescribed, and the drug ranitidine 150 mg, which is an over-the-counter medicine?

Answer:

Protonix and ranitidine can both be used to treat GI ulcers, GERD, maintenance therapy for ulcer prevention, and heartburn. Both of these medications block acid production by two different mechanisms. Protonix is a proton pump inhibitor while ranitidine prevents gastric acid stimulation by blocking histamine release in the stomach.
Protonix is prescription strength, while ranitidine is over-the-counter. This means that there could be a price difference, depending on the co-pays with your health insurance. Protonix does have a generic (pantoprazole) that is equally effective as the brand name. If you are thinking about switching, without knowing the severity of your stomach condition is it hard to give information as to whether ranitidine can be supplemented for Protonix.
I recommend that you speak to your health care provider about your options. These medications do work differently and the effectiveness can be different. If the symptoms have subsided, keep in mind that the medication can be the controlling factor. Therefore, it may not be necessary to switch if your current treatment is working for you.

Question:

Can taking clarithromycin 500 mg make stomach problems worse? I started taking it and my stomach hurts. I have ulcers.

Answer:

Just like many antibiotics, clarithromycin can cause upset stomach, nausea, vomiting, and diarrhea. However, there isn’t any contraindication regarding a history of ulcers when taking this medication. If you are taking any ulcer medications, it would be important to check with your pharmacist to make sure there aren’t any drug interactions that would decrease the effectiveness of your ulcer medication, which would cause flare-ups.
The medication can be taken with or without food. If the upset stomach is present, try taking it with food to see if it subsides. If at any point it worsens, you should consult your health care provider to see if another medication is better for you.

Question:

What does delayed release mean in the drug Nexium?

Answer:

Delayed release means that there is an enteric coating or capsule that protects the medication from being destroyed by gastric acids of the stomach to allow the active ingredient to get to the intestine for proper absorption and functioning.

Question:

What are the warnings about Prilosec and other drugs like it?

Answer:

The FDA recently released a warning about the increased risk for fractures of the hip, wrists, or spine with high doses or long-term use of proton pump inhibitors. The labeling on all PPIs will change to reflect this new finding. If you have been taking Prilosec, an over-the-counter product, for longer than 14 days and without the advice of your health care professional, I would discontinue and seek medical advice.
If you are currently taking this medication according to the recommendations of your health care professional, be sure to continue. Nevertheless, ask questions upon your next visit to the office. If you have any other concerns or issues, don’t hesitate consulting your health care professional or your local pharmacist about whether this medication is right for you.

Question:

Are there any side effects of taking too much Pepto-Bismol?

Answer:

The most common side effect with taking too much Pepto-Bismol is the temporary and harmless black darkening of the tongue and stools. This can subside and is caused by a reaction to sulfa in the mouth.
However, there are more serious side effects with toxic levels of Pepto-Bismol, such as severe allergic reactions (rash, hive, itching, difficulty breathing, tightness in chest, swelling of the mouth, face, lips, or tongue), fever, hearing loss, nausea, ringing in the ears, severe constipation, and vomiting. If any of these symptoms do occur, stop taking the medication and consult your health care professional.

Question:

Is there a big difference in Nexium 40 mg and Prilosec 20 mg if the Prilosec is taken twice a day?

Answer:

Prilosec 20 mg is the approved over-the-counter dosage by the FDA for consumers to use safely. The medication should be used once daily, according to the label on the product. It is important to realize that Nexium and Prilosec are two different medications and the strengths should not be compared as equal. Different studies have been conducted for each medication individually to determine what doses are the safest and most effective for treatment.
If you are taking over-the-counter Prilosec and it is not effective for the treatment of your symptoms, consult your health care professional about your condition. Do not assume that doubling the dose of the over-the-counter medication will have the same coverage as the prescription strength. While these two medications are both made by the same company, you should only accept advice from your health care professional about whether the dose of the over-the-counter medication should be increased.

Question:

My husband was told that using uniodized sea salt and drinking room temperature water will cleanse your colon. Any thoughts?

Answer:

Thanks for your question today. I think it is really important that the public understands that "home remedies" like uniodized sea salt and drinking room temperature water can actually put you at risk. This could introduce a variety of issues like bacteria and disruption of your body's normal state, which could get you a trip to the hospital.
I would also ask why he wants to cleanse his colon. There may be other issues going on here that need to be evaluated by a health care provider. If you are unsure about home remedies, always talk to your pharmacist first. Better safe than sorry.

Question:

Can finasteride cause stomach problems or heartburn? I already take omeprazole for heartburn. I started taking finasteride a little over a week ago and my stomach is in turmoil. Is this just a coincidence, or could the finasteride be causing the problem?

Answer:

Finasteride does not have any side effects or contraindications associated with stomach problems or heartburn. In addition, there are no drug interactions found or currently reported between finasteride and omperazole. However, this doesn’t mean that drug interactions cannot exist between these two medications. Consult your health care professional or pharmacist if the stomach issues continue to worsen.

Question:

My physician prescribed omeprazole for me a few weeks ago, and it has really taken care of my symptoms. However, I still have some concerns regarding when I should take it. I'm taking a 40 mg capsule twice daily, and it is suggested that I take the doses a half-hour before a meal. Does this mean I should always take it on an empty stomach? If I forget to take a dose prior to a meal, should I skip the dose or is it safe to take it after eating?

Answer:

Omeprazole 40 mg twice daily is a high dose and is not recommended over a long period of time. It is a safe and effective medication used within the recommended prescribing guidelines. The medication is intended to decrease the release of stomach acid. Therefore it is the most effective if taken 30 minutes prior to having a meal.
This medication has 24-hour coverage. Therefore, it should not be taken prior to every meal. It is intended to be taken on an empty stomach. If you take it with food, the stomach will release acid to digest the food. The acid can decrease the absorption of the medication, and decrease the effectiveness. Therefore, I would not recommend taking the medication with food or a meal. It is important to take the dose 30 minutes prior to a meal or first thing in the morning.

Question:

Is it good to take milk with any antibiotic to keep your stomach from hurting?

Answer:

Every antibiotic has different absorption characteristics. Some antibiotics work better with or without food. Some are better with a fatty substance, such as milk. However, some may have a drug interaction with the calcium contained in dairy products. In this case milk should not be drunk with the medication and the consumption of the two should be separated out by about 2 hours.
The best liquid to take medication with is water. It is important to check with your local pharmacist at the time of picking up the antibiotic or any medication to see if there are any food restrictions with your prescriptions.

Question:

I have been taking Nexium 20 mg once a day for 8-10 years. I am now on omeprazole caps (a generic). I would like to stop using it. I have been experiencing some heartburn and indigestion. "They" say that by taking a proton pump inhibitor, your vitamins and minerals aren't absorbed as well. Is this true?

Answer:

If you have been experiencing symptoms of heartburn and indigestion, the medication may need to be adjusted to provide most effective treatment that is safest for you. Nexium and omeprazole both belong to the same drug class, proton pump inhibitors. It is important to work with your health care professional to make sure that your condition is not worsening, or to see if there is another cause that can be treated by a different medication.
Proton pump inhibitors have been associated with vitamin B12 deficiencies after long-term use, usually meaning more than 3 years. It is important to work with your local pharmacist to find out the most information on the medication you are taking to help you decide, with your health care professional, whether or not it’s right for you.

Question:

Can Janumet and Zantac be taken together?

Answer:

There is a moderate interaction with one of the components found in Janumet (metformin/sitagliptin) and Zantac (ranitidine). Ranitidine is a cationic drug and theoretically could decrease the excretion of metformin. This drug interaction has been observed when using another cationic medication, cimetidine. Because of this we use caution with similar medications.
These interactions can increase the risk of lactic acidosis, which included symptoms of malaise, myalgia, respiratory distress, hyperventilation, slow or irregular heartbeat, somnolence, abdominal upset, or other unusual symptoms. Lactic acidosis is a possible side effect from the metformin. Consult your healthcare professional if both of these medications are being prescribed together. Monitor your reactions for side effects of lactic acidosis, and stop medication right away if the symptoms occur.

Question:

Can you take Nexium and Crestor together?

Answer:

Currently there are no drug interactions found between Nexium and Crestor. However, this does not mean interactions cannot exist. It is important to work with your pharmacist to see if any new information has come about between these two medications. It’s recommend that you take the Nexium 30 minutes prior to breakfast and any Crestor typically before bedtime.

Question:

Can omeprazole and lansoprazole be taken interchangeably, from day to day?

Answer:

There is no literature that currently states that alternating these two medications is more effective. They are both proton pump inhibitors and work in the same way. Both medications have doses found over-the-counter. Lansoprazole does have a stronger strength found as a prescription. Work with your health care professional and your local pharmacist to find out which one is the most cost-effective.

Question:

Is there a safe over-the-counter antacid to use while nursing? My son is 3 months-old.

Answer:

Some antacids may pass into breast milk. However, no evidence exists that indicates that the ingestion of antacids through breast milk causes problems for nursing babies whose mothers use antacids occasionally. It is important that you check with your pharmacist about any possible interactions prior to taking an antacid. Without knowing the name of a specific antacid it is difficult to say it is safe.

Question:

I am taking Nexium. Would there be an interaction if I'm also taking an enzyme with probiotics?

Answer:

Currently, there are no drug interactions found between Nexium and probiotics. However, this does not mean that one cannot exist. It is important to work with your pharmacist to see if there is any new information regarding these two products.

Question:

What is the major difference between famotidine and omeprazole?

Answer:

Famotidine (Pepcid products) is in a drug class called H2 blockers. Omeprazole (Prilosec) belongs to the proton pump inhibitors. These medications work two different ways to decrease acid production and flare-ups with stomach issues. Both medications can be found over-the-counter. Famotidine is typically taken 1 to 2 times daily, while omeprazole is taken once daily (may be dosed differently than recommended in over-the-counter packaging label by prescriber). It is also important to keep in mind that since they are two different medications, the side effect profile will be different.

Question:

I went to the doctor today and she put me on Protonix. Does this pill cause you to gain weight? I do not want to gain weight and I am supposed to take it for 4 weeks.

Answer:

It depends on if you have lost weight due to an ulcer or other severe stomach issues. The medication itself does not cause you to gain weight, but it will help in the digestion of food so it can be digested without causing stomach pain or reflux.

Question:

What is the difference between Prilosec and Prevacid?

Answer:

Prilosec and Prevacid belong to the same drug class, which is the class of proton pump inhibitors. The mechanism of action within the body will be the same, producing similar side effects. Both medications have generics and can be found over the counter. They are simply made by different companies.

Question:

Is there a coated naproxen medication to help prevent stomach problems?

Answer:

All over-the-counter and prescription-strength naproxen have a shiny coating on the pill, which means it has a slight enteric coating to prevent stomachache. In addition, this medication should be taken with food to help buffer the effects on the stomach.

Question:

I have had gastritis for the past 8 years. I have tried Nexium, omeprazole, and now I’m taking Aciphex every day. But I’m having bad heartburn and sour stomach. Can I take or mix it with Mylanta? Are there any side effects?

Answer:

I would not add any more medications on your regimen without consulting your health care professional and getting the condition looked at. It is important to make sure we understand why you are experiencing the symptoms and treat it appropriately rather than just covering up with medication that isn’t working. If you primary care office cannot fix the issue, consult a GI specialist.

Question:

Is it OK to take Nexium at night before going to bed?

Answer:

It is best to take Nexium 30 minutes prior to breakfast, to experience longer-lasting effects throughout the day. However, if you are more compliant and seem to have symptoms just before going to bed, it would not be inappropriate to take before going to bed.

Question:

How should I take omeprazole and levothyroxine? Both are supposed to be taken in the morning (4 hours apart).

Answer:

Currently, there are no drug interactions found between levothyroxine and omeprazole. However, this does not mean that interactions cannot exist. It is important to work with your pharmacist to see if there is any new information regarding these two products. Omeprazole should be taken 30 minutes prior to a meal. Levothyroxine should be taken 30 minutes to one hour prior to a meal. They can be taken together with water on an empty stomach if needed.

Question:

My sister-in-law has been taking Nexium for 14 years. It’s very expensive. Are there any generics that help the same way?

Answer:

Currently Nexium does not have a generic available on the market. However, it belongs to the proton pump inhibitor drug class, which includes several generics, both prescription and over-the-counter strength. For over-the-counter, there are two medications available, which are Prilosec (omeprazole) and Prevacid (lansoprazole). Prescription medications that have generics available are Prevacid (lansoprazole) and Protonix (pantoprazole). She should check with her insurance company to see what medications in the same drug class are covered. Then she can bring the information to her prescriber.

Question:

Is it OK to take Prilosec while taking Avelox, an antibiotic? I heard that you’re supposed to wait two hours before taking an antacid when you’re on Levaquin, which is another antibiotic. Is the situation the same?

Answer:

Currently, there are no drug interactions found between Prilosec and Avelox. However, this does not mean that interactions cannot exist. It is important to work with your pharmacist to see if there is any new information regarding these two products.

Question:

Is there a drug interaction between Synthroid and Prevacid? Can they be taken at the same time or should there be a couple of hours between dosages?

Answer:

Currently, there are no drug interactions found between Synthroid and Prevacid. However, this does not mean that interactions cannot exist. It is important to work with your pharmacist to see if there is any new information regarding these two products. Prevacid should be taken 30 minutes prior to a meal. Synthroid should be taken 30 minutes to one hour prior to a meal. They can be taken together with water on an empty stomach.

Question:

I am taking the following: Arimidex, Xanax, calcium, and ranitidine. Are they all safe to take together?

Answer:

Currently the medications you listed will not interfere with each other. However, this does not mean that no drug interactions exist. It is important to check with your pharmacist every month to make sure that drug interactions have not been reported.

Question:

How long do you recommend staying on a PPI for GERD?

Answer:

This is a great question because there is currently much debate about this issue. Recent studies have shown that long-term use of PPIs can lead to an increase in bone fracture risks in women. I would encourage you to have a discussion with your health care provider about the risks and benefits.

Question:

What happens if you crush or chew a Prilosec OTC pill?

Answer:

This medication is not intended to be crushed or chewed, which may interfere with the absorption of the medication and decrease the effectiveness. If you are experiencing symptoms of heartburn or an ulcer, seek advice from your health care professional. There are liquid products available also.

Question:

I am currently on Cymbalta 60 mg, hydrochlorothiazide 12.5 mg, lisinopril 10 mg, and Nexium. I am perimenopausal with hot sweats and other symptoms. My gyn prescribed Prempro. Is Prempro going to conflict with my other medicines?

Answer:

Currently the medications you’re taking will not interfere with Prempro. However, this does not mean that no drug interactions exist. It is important to check with your pharmacist every month to make sure that drug interactions have not been reported.


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