Educating the Older Adult in Over-the-Counter Medication Use

Judith Glaser, DO; Lydia Rolita, MD


Geriatrics and Aging. 2009;12(2):103-109. 

In This Article

Dyspepsia and Heartburn Medications

Heartburn is a common symptom experienced by older adults, and the risk for developing gastroesophageal reflux disease (GERD) increases with age. Sixty percent of people use nonprescription medications to treat their symptoms instead of visiting their physician.[23] There are three types of OTC medications for the treatment of dyspepsia or heartburn: antacids, histamine2 receptor antagonists (H2RAs), and proton pump inhibitors (PPIs) (see Table 4).

Over-the-counter antacids made of alumina, magnesium, calcium carbonate, or simethicone have been used for many years. They neutralize gastric acid and have a fast and brief onset of action. These medications are considered safe and are well tolerated by most; however, they may mask symptoms of more serious underlying problems such as Barrett's syndrome or esophageal adenocarcinoma. Adverse effects to be aware of include diarrhea with the use of magnesium-containing agents, constipation with the use of aluminum-containing agents, and milk-alkali syndrome with the overuse of calcium carbonate agents. People who are at risk for kidney stones should be cautious of calcium overload. Also, antacids can interfere with the absorption of certain medications (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 acute liver disease.[24] The use of cimetidine with fluoxetine presents the risk of parkinsonism. See Table 4 for drug interactions.

Many PPIs have recently been switched to OTC. Symptomatic relief cannot be expected until multiple dosages have been taken as these have the slowest onset of action and the longest duration. Proton pump inhibitors have the same drug interactions as H2RAs and are generally well tolerated with few side effects. They must be taken on an empty stomach, 30 minutes prior to a meal to work correctly.

All chronic symptoms of GERD or heartburn should be addressed by a health care professional. People should know that treatment of dyspepsia and heartburn could potentially mask an underlying illness. There is a higher rate of GERD complications among the older adult; thus, an appropriate evaluation is warranted.[1]


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