H2 blockers (acid reducers) for gastroesophageal reflux disease (GERD)

H2 blockers (also sometimes referred to as acid reducers or H2 receptor antagonists) are available in nonprescription and prescription forms. Prescription forms are stronger than the nonprescription forms.

H2 blockers are usually taken by mouth, although some can also be given as an injection. Two doses (morning and evening) are generally recommended to control both daytime and nighttime symptoms. Doctors sometimes recommend a single dose, taken at bedtime, for people who have difficulty remembering to take their medications.

H2 blockers reduce the production of stomach acid. This makes the stomach juices less acidic so that any stomach juice that gets into the esophagus is less irritating. This relieves symptoms and allows the esophagus to heal.

H2 blockers are used to treat the symptoms of gastroesophageal reflux disease (GERD). They may be prescribed for your symptoms without any diagnostic testing if your symptoms indicate GERD.

• H2 blockers may be used together with antacids.
• Nonprescription H2 blockers may be used for up to 2 weeks for short-term symptom relief. They can safely be used on a long-term basis if they are successfully controlling your GERD symptoms. But if you are using nonprescription H2 blockers and continue to have GERD symptoms, you should consult your doctor.
• Prescription H2 blockers may be used on a long-term basis to relieve persistent GERD symptoms.

All of the H2 blockers in this class are about equally effective.¹ Ranitidine (such as Zantac) is the most widely prescribed acid reducer. It may eliminate most symptoms of GERD in about 40% of people who take the drug twice a day for 6 weeks. Taking the drug for a longer period of time or increasing the dose has not been shown to improve symptoms more than the standard treatment method.

The ability of H2 blockers to help a person's symptoms depends on how severe inflammation is in the esophagus and on the strength of the medication (nonprescription or prescription strength). Generally, most people with mild to moderate GERD symptoms who take H2 blockers find their symptoms get better. H2 blockers are not as effective as proton pump inhibitors in treating moderate to severe cases of GERD that have caused inflammation or wearing away (erosion) of the lining of the esophagus (esophagitis).

H2 blockers have been in use since the late 1960s. H2 blockers are well-studied and are considered very safe.

Minimal side effects occur with short-term use of H2 blockers. Side effects may include:

• Headache.
• Dizziness.
• Diarrhea.
• Constipation.
• Nausea.
• Vomiting.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Depending on the severity of your symptoms, medications may need to be taken every day or only occasionally when GERD symptoms occur. Long-term—often lifelong—drug treatment is usually needed for GERD symptoms that are more severe, because symptoms tend to return when drug treatment is stopped. Surgery is the only other effective option to prevent GERD symptoms from recurring.

Treatment of inflammation in the esophagus (esophagitis) with H2 blockers usually lasts 8 to 12 weeks. If H2 blockers do not help relieve the symptoms, the doctor may recommend using a proton pump inhibitor (acid blocker) instead.

Prescription-strength cimetidine, ranitidine, and famotidine are all available in a generic form. This may make them a more cost-effective alternative for some people. Ask your doctor about whether using a generic form of one of these drugs is right for you.

H2 blockers are probably safe to use during the last 6 months (second and third trimesters) of pregnancy. But discuss this with your doctor if you wish to use H2 blockers during pregnancy.

H2 blocker medications do not work well for everyone. Between 25% and 40% of people who try H2 blockers find they do not relieve their symptoms. Of those who have irritation, inflammation, or wearing away (erosion) of the lining of the esophagus (esophagitis), between 40% and 60% find that treatment with H2 blockers does not completely heal the erosion.²

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Citations

1. Katzka DA, Rustgi AK (2000). Gastroesophageal reflux disease and Barrett's esophagus. Medical Clinics of North America, 84(5): 1137–1161.

2. Fisher RS (2000). Treatment of gastroesophageal reflux disease. In MM Wolfe et al., eds., Therapy of Digestive Disorders, pp. 3–16. Philadelphia: W.B. Saunders.