Page 131 - Community pharmcy practice E-book 2025

02/11/2025, 00:29

Pharmacological Treatment
• For self-care mild to moderate GERD the pharmacologic options include: Antacids and
alginates (for symptomatic relief of acid/heartburn) — antacids neutralize acid; alginates form a
“raft” barrier.
• Histamine-2 receptor antagonists (H2RAs) (e.g., ranitidine, famotidine) — for less severe,
intermittent symptoms.
• Proton pump inhibitors (PPIs) (e.g., omeprazole, esomeprazole, pantoprazole) — first-line
for frequent or more severe reflux/erosive disease. Asian Journal of Hospital Pharmacy
•
• Important pharmacist-specific counselling/facts: PPIs should be taken about 30–60
minutes before the largest meal of the day (often breakfast) for optimum effect.
• OTC PPI use is typically for a fixed short course (for example 14 days) unless prescribed
long-term by physician.
• Monitor for drug–drug interactions (e.g., PPIs and clopidogrel, absorption issues with some
medications).
• Review for side effects (e.g., long-term PPI use risks: fracture risk, B12 deficiency,
infections). (Note: needs clinician oversight).
• In refractory cases (symptoms persist) or when complications suspected → referral or
further investigation (endoscopy, motility study).

Pharmacist’s role: select appropriate OTC product, check for contraindications / overlapping
therapy, advise when escalation is needed, and liaise with prescriber if needed.

Patient Counselling Tips
• Explain nature of condition: “Reflux means stomach acid coming up into your oesophagus;
we want to reduce how often/ how badly that happens and protect you from damage.”
Use of medications: For antacids/alginate: explain how to use (e.g., after meals/at bedtime) and
that they relieve quickly but may not address underlying cause.

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