Take Heartburn Medicines Before Breakfast for Best Effect

Many people with heartburn aren't taking their acid-reducing medicine at the right time, which makes the drugs less effective and wastes money, according to new research.

Only about one-third of those buying these medications -- such as Nexium, Prevacid and Prilosec -- over-the-counter used them properly compared to just under half of those who were prescribed the drugs by their primary care doctor. Those who were given a prescription by a gastroenterologist were most likely to use the drugs as they're supposed to be used, with seven out of 10 taking the drugs properly, according to the study.

These drugs are activated once in the body, said the study's senior author, Dr. M. Michael Wolfe, a gastroenterologist and chair of the department of medicine at MetroHealth System. "In order to activate the medicine, you must eat. For that reason, you take it before breakfast. If you don't take the drug correctly, you don't do as well," Wolfe said.

Despite labels advising users to take the drugs before breakfast, people aren't following those directions, he said. Those who aren't taking the medicines properly "are wasting money, they're not feeling well and they aren't getting symptom relief," Wolfe added.

The study was published in the June issue of The American Journal of Gastroenterology.

Heartburn is a painful, burning feeling just below the breastbone, experienced at least once a month by about 44 percent of U.S. adults. About 7 percent have heartburn daily. Frequent heartburn may indicate a condition called gastroesophageal reflux disease, or GERD. Food and acid from the stomach backs up, or refluxes, into the esophagus. Reflux can damage the esophagus and cause serious issues over time.

Direct costs related to GERD, including acid-reducing medicines, top $10 billion each year in the United States, according to background information in the study.

The medications looked at in this study are a class of drugs known as proton pump inhibitors. They work by reducing the amount of stomach acid produced, according to the U.S. National Library of Medicine. Unlike antacids, such as Tums or Rolaids, proton pump inhibitors don't provide immediate relief of heartburn symptoms. It takes about 7 days of continuous use for the drugs to reach their maximum acid-suppressing potential, the study noted.

Wolfe and his colleagues surveyed 610 patients who used heartburn medicine for their GERD. Of that group, 190 got a prescription heartburn medicine from a gastroenterologist and 223 received a prescription from their primary care doctor. The other 197 bought over-the-counter heartburn medicines.

Those prescribed the medicines by their gastroenterologist did best, Wolfe noted, with 71 percent taking the medicines correctly. Only 47 percent of those who got prescriptions from their primary care doctors took them correctly. And just 39 percent of those who bought them over-the-counter used them right, the investigators found.

In a previous study, only one-third of primary care doctors told patients to take the medicines before meals, but nearly all gastroenterologists did, according to the report.

In his study, Wolfe found, the severity and frequency of symptoms were better in those who were prescribed the drug by a gastroenterologist compared to a primary care doctor.

"If you have frequent heartburn, you have a disease, GERD," Wolfe said. "And you really should see a physician and not treat yourself," he explained.

Dr. John Lipham is director of the Digestive Health Center at Keck Medicine of the University of Southern California. Lipham reviewed the findings but was not involved in the study.

"It's something we have known since these medications came out, that they work best if you take them 30 minutes or so before a meal," said Lipham.

However, he pointed out that the new study puts some data behind what experts knew from experience.

Lipham said the new study is the first, to his knowledge, to show a difference in taking the medicine correctly depending on who prescribed it.

Wolfe and Lipham both find that patients often think of the proton pump inhibitors in the same way as antacids, meant to be taken when heartburn strikes.

"But these [proton pump inhibitor] medicines don't work that way," Lipham said. "They need to be stimulated by acid and need to build up in your system. You have to take them at the correct time each day and you also need to take them every day to get the maximum effectiveness of the medications."

As to why doctors aren't all telling their patients how to use these drugs, Wolfe speculated that primary care doctors may be too busy and don't have the time to read all of the drug literature.

The bottom line is "it boils down to education," said Wolfe. Physicians and consumers need to take the time to learn about the drugs.

Ideally, Wolfe said, you should take the medicine in the morning, then ''eat something that causes your stomach to make acid, such as protein, an egg, a piece of cheese, yogurt." For those who hate breakfast, he advises drinking a glass of milk or at least a cup of coffee.