Drugs to treat heartburn, GERD
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PPIs have been heavily promoted, which has led to overuse in people with garden-variety heartburn. Nexium, one of the most widely-prescribed PPIs is also the most expensive at $240 per month (the cash price you would pay if your insurance did not cover it). Not surprisingly, Nexium was also a top-selling drug in 2008 at a whooping $4.8 billion.
Before you turn to a PPI, consider this: If you have occasional heartburn and have not been diagnosed with gastroesophageal reflux disease (GERD), your first and best bet is to try an inexpensive over-the-counter antacid like Maalox, Mylanta, Rolaids, Tums, or generic or drugs like Pepcid AC or Zantac 150, or generic (known as H2 blockers).
But if you suffer from heartburn twice a week or more for weeks or months on end, you should see a doctor because you may have GERD often known as acid reflux. GERD is serious and can inflame or erode the lining of the esophagus. PPIs are effective at treating GERD.
So here's the good news: The latest Consumer Reports Best Buy Drugs analysis of drugs to treat heartburn, GERD and gastric ulcers finds that among the six available PPI drugs, no drug works better than another and all are relatively safe. Two drugs—omeprazole (Prilosec, Prilosec OTC) and lansoprazole (Prevacid, Prevacid 24HR)—are available as a prescription and a nonprescription drug. Two others—omeprazole and pantoprazole (Protonix)—are available as a brand-name drug and a generic, which contains the same active ingredient but costs significantly less.
(See links above to download the full PDF report or a 2-page summary report.)
Taking the evidence for effectiveness, safety, cost, and other factors into account, if you need a PPI, we have chosen the following as Consumer Reports Best Buy Drugs:
- Prilosec OTC
- Generic omeprazole OTC
Safety notes: Several studies have linked PPIs to a higher risk of pneumonia and infection with a bacterium called Clostridium difficile, and other studies have found that long-term use of PPIs may be associated with an increased risk of hip fractures. Talk with your doctor about those risks, especially if you must take a PPI over a long period of time. People ages 65 and over and those with chronic medical conditions should be vaccinated against pneumonia and get a flu shot every year and we emphasize this recommendation for people in those categories who are also taking a PPI.
In addition, anyone taking clopidogrel (Plavix), a blood thinner used to prevent clots after heart attacks and stent placement, should be especially cautious with PPIs. Some studies indicate that PPIs may reduce clopidogrel's effectiveness, which could increase the risk of another heart attack. Our medical advisers recommend that people taking clopidogrel should not take PPIs unless other remedies have not been adequate.
Heartburn/Proton Pump Inhibitors: Drug Comparison
1. "Generic" indicates drug sold by generic name. Among PPIs, only omeprazole and pantoprazole are available as generic drugs.
2. As typically prescribed.
3. Monthly cost reflects nationwide retail average prices for June 2009, rounded to the nearest dollar. Information was derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, Pharmaceutical Audit Suite®. Wolters Kluwer Health is not involved in our analysis or recommendations. Average monthly cost is based on recommended dosage of one pill daily.
2. As typically prescribed.
3. Monthly cost reflects nationwide retail average prices for June 2009, rounded to the nearest dollar. Information was derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, Pharmaceutical Audit Suite®. Wolters Kluwer Health is not involved in our analysis or recommendations. Average monthly cost is based on recommended dosage of one pill daily.
- Full Report (875k PDF)
- 2-Page summary (603k PDF)












