Heartburn

Question 1

CALCIUM CARBONATE: Tums: Antacid

Answer 1

Treatment onset <3 h/ duration 20minutes -3h
Adults and Children ≥12 y of age, 2-4 tablets po q2h prn (max 7500 mg calcium carbonate per 24 h);
Children 6-11 y of age, 364 mg po q2h prn
(max 966 mg/24 h)
Children 2-5 y of age, 161 mg po q2h prn
(max 483 mg/24 h)
Tablet, Chewable Tablet, Capsule, Suspension
Diarrhea, cramping, abdominal pain, constipation

May take with or without food, although most foods can enhance absorption. Bran, foods high in oxalates, or whole grain cereals may decrease calcium absorption. Consider lifestyle modifications, including avoidance of late and large meals, staying upright for at least 3 h after a meal, weight loss, smoking cessation, and elevating the head of their bed to resolve heartburn symptoms.

Question 2

MAGNESIUM HYDROXIDE: Milk of Magnesia: Antacid

Answer 2

Treatment onset 5 min/ duration 20 min-3h
Adult and Children ≥12 y of age, 400-1200 mg po prn up to qid
Children <12 y of age, not recommended
Tablet, chewable tablet, suspension
Diarrhea

Lifestyle interventions (increasing exercise, intake of water, and dietary fiber) are generally first-line management of constipation. Take product with 240 mL of water.

Question 3

FAMOTIDINE: Pepcid:H2RA

Answer 3

Prevention/ Treatment onset 30-45min/Duration 4-10h
Prevention:: tk 15-60min before irritating foods
Adults and Children ≥12 y of age, 10-20 mg po bid for up to 14 d
Constipation, diarrhea, nausea
Tablet: 10 and 20 mg

Avoid high-fat, acidic or spicy foods, and large meals. Maintain healthy weight and avoid tight-fitting clothes. Elevate the head by using blocks under bed legs or foam pillow wedge; do not stack traditional pillows. Take 30-60 min before meals or at bedtime. May take with food or antacids if needed. Other PPI and H2 antagonists available OTC; warn patients not to take multiple products concurrently to avoid additive risk of adverse effects.

Question 4

RANITIDINE: Zantac: H2RA

Answer 4

Prevention/ Treatment onset 30-45min/Duration 4-10h
Prevention:: tk 15-60min before irritating foods
Adults and Children ≥12 y of age, 75-150 mg po bid prn × up to 14 d
Tablet 75 and 150 mg
Constipation, Diarrhea, nausea, skin rash

Avoid triggers, including alcohol, caffeine, and smoking. Avoid high-fat, acidic or spicy foods, and large meals. Maintain healthy weight and avoid tight-fitting clothes. Elevate the head by using blocks under bed legs or foam pillow wedge; do not stack traditional pillows. Take 30-60 min before meals or at bedtime. May take with food or antacids, if needed. Other PPI and H2 antagonists are available OTC; warn patients not to take multiple products concurrently to avoid additive risk of adverse effects.

Question 5

OMEPRAZOLE: Prilosec OTC, Zegerid OTC, : PPI

Answer 5

Preventative treatment onset 2-3h / Complete relief in 1-4 days
20 mg po daily × 14 d
Abdominal pain, diarrhea, headache
Tablet 20mg

Avoid triggers, including alcohol, caffeine, and smoking. Avoid high-fat, acidic or spicy foods, and large meals. Maintain healthy weight and avoid tight-fitting clothes. Elevate the head by using blocks under bed legs or foam pillow wedge; do not stack traditional pillows. May take with food or antacids if needed. Best taken 30-60 min before breakfast or the largest meal of the day. Other PPIs and H2 antagonists are available OTC; warn patients not to take multiple products concurrently to avoid additive risk of adverse effects. Do not take for >14 d, but may repeat every 4 mo. Refer to HCP if symptoms recur before 4 mo. May require 1-4 d for full effect.

Question 6

ESOMEPRAZOLE: Nexium: PPI

Answer 6

Preventative treatment onset 2-3h/ Complete relief in 1-4 days
20 mg once daily × max 14 d
Headache
Oral Capsule, Delayed Release 20 mg

Avoid triggers, including alcohol, caffeine, and smoking. Avoid high-fat, acidic or spicy foods, and large meals. Maintain healthy weight and avoid tight-fitting clothes. Elevate the head by using blocks under bed legs or foam pillow wedge; do not stack traditional pillows. May take with food or antacids if needed. Best taken 30-60 min before breakfast or the largest meal of the day. Other PPIs and H2 antagonists are available OTC; warn patients not to take multiple products concurrently to avoid additive risk of adverse effects. Do not take for >14 d, but may repeat every 4 mo. Refer to HCP if symptoms recur before 4 mo. May require 1-4 d for full effect.