News & PerspectiveDrugs & DiseasesCME & Education

SpecialtiesAllergy & ImmunologyAnesthesiologyBusiness of MedicineCardiologyCritical CareDermatologyDiabetes & EndocrinologyEmergency MedicineFamily MedicineGastroenterologyGeneral SurgeryHematology-OncologyHIV/AIDSInfectious DiseasesInternal MedicineMultispecialtyNephrologyNeurologyOb/Gyn & Women's HealthOncologyOphthalmologyOrthopedicsPathology & Lab MedicinePediatricsPlastic SurgeryPsychiatryPublic HealthPulmonary MedicineRadiologyRheumatologyTransplantationUrology

Dental and Oral HealthMedical StudentsNursesPharmacistsToday on Medscape

Log In

Search News & PerspectiveGo

News & Perspective Multispecialty

Geriatrics & Aging

Educating the Older Adult in Over-the-CounterMedication Use

Disclosures

DYSPEPSIA AND HEARTBURN MEDICATIONSHeartburn is a common symptom experienced by older adults, and the risk fordeveloping gastroesophageal reflux disease (GERD) increases with age. Sixtypercent of people use nonprescription medications to treat their symptomsinstead of visiting their physician.[23] There are three types of OTCmedications for the treatment of dyspepsia or heartburn: antacids, histamine2receptor antagonists (H2RAs), and proton pump inhibitors (PPIs) (see Table4).

Over-the-counter antacids made of alumina, magnesium, calcium carbonate,or simethicone have been used for many years. They neutralize gastric acidand have a fast and brief onset of action. These medications are consideredsafe and are well tolerated by most; however, they may mask symptoms ofmore serious underlying problems such as Barrett's syndrome or esophagealadenocarcinoma. Adverse effects to be aware of include diarrhea with the useof magnesium-containing agents, constipation with the use of aluminum-containing agents, and milk-alkali syndrome with the overuse of calciumcarbonate agents. People who are at risk for kidney stones should be cautiousof calcium overload. Also, antacids can interfere with the absorption of certainmedications (see Table 4).

H2RAs have a slower onset of action and a longer duration than antacids.Severe side effects are rare. Cimetidine has been reported to cause acuteliver disease.[24] The use of cimetidine with fluoxetine presents the risk ofparkinsonism. See Table 4 for drug interactions.

Many PPIs have recently been switched to OTC. Symptomatic relief cannotbe expected until multiple dosages have been taken as these have theslowest onset of action and the longest duration. Proton pump inhibitors havethe same drug interactions as H2RAs and are generally well tolerated with fewside effects. They must be taken on an empty stomach, 30 minutes prior to ameal to work correctly.

All chronic symptoms of GERD or heartburn should be addressed by a healthcare professional. People should know that treatment of dyspepsia andheartburn could potentially mask an underlying illness. There is a higher rate

Judith Glaser, DO, Lydia Rolita, MDGeriatrics and Aging. 2009;12(2):103-109.

Previous PagePrevious Page Next PageNext Page

CommentComment

of GERD complications among the older adult; thus, an appropriate evaluationis warranted.[1]

4 of 8

Latest in Internal Medicine

2015 MOC Standards Reflect Feedback, Fail to Stem Critics

Sugar, Not Salt, May Be at Fault for Hypertension

ABIM Budges on Maintenance of Certification Program

The State of Senior Health: It Depends on Your State

Low-Value Services Given to Many Medicare Patients

Geriatrics and Aging. 2009;12(2):103-109. 2009 1453987 Ontario, Ltd.

About MedscapePrivacy PolicyTerms of UseWebMDMedscape FranceMedscape DeutschlandMedicineNeteMedicineHealthRxListWebMD CorporateHelp

All material on this website is protected by copyright, Copyright 1994-2015 by WebMD LLC. This website alsocontains material copyrighted by 3rd parties.

more

CCoommmmeennttiinngg iiss lliimmiitteedd ttoo mmeeddiiccaall pprrooffeessssiioonnaallss.. TToo ccoommmmeenntt pplleeaassee LLoogg--iinn..Commenting is moderated. See our Terms of Use.