Page 132 - Community pharmcy practice E-book 2025

02/11/2025, 00:29

For PPIs/H2RAs: emphasise correct timing (before meals), consistent daily use, and persistence
of symptoms may need review.

Reinforce lifestyle changes: highlight that medications alone will not fully control reflux if
lifestyle/triggers persist.
Provide realistic expectations: PPIs may take several days to have full effect (sometimes 2-5
days).
Advise on when they should seek medical review: if symptoms persist beyond expected timeline,
worsen, develop red-flag signs (see referral list), or if they need frequent escalation (e.g., daily PPI
use for months without review).
Encourage keeping a symptom diary: note timing of meals, triggers, what makes worse or better.
This can help both patient and clinician adjust plan.
For nocturnal symptoms: advise head-of-bed elevation, avoid eating 2-3 h before lying down, and
avoid lying flat after meals.
Warn about certain medications/lifestyle factors that worsen reflux (NSAIDs, smoking, alcohol,
large late dinners) and suggest discussing with physician if they are using them.
If on other medications (especially interacting drugs): highlight importance of adherence and
monitoring.
Encourage follow-up: “Let’s review how you’re doing in about 4–6 weeks; if you’re still having
frequent symptoms despite doing all of this, we’ll talk with your doctor about next steps.”

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