Wal-Mart, CVS, Rite Aid, and Walgreens this month pulled the over-the-counter (OTC) heartburn drug Zantac from their shelves, over concerns that it contains a chemical possibly linked to cancer. Other countries, including Canada, France, Hong Kong, and India, have issued recalls for Zantac and its generic version, ranitidine.
This is a radical step that CVS said it was taking “out of an abundance of caution.” Is this an overreaction, or is it justified? Our concierge family doctors at MD 2.0 in Jupiter want to give you the latest information available about this popular OTC product and offer some alternatives.
The chemical in question, nitrosodimethylamine (NDMA), is a type of nitrosamine, a known carcinogenic chemical also present in small amounts in some processed and grilled meats, as well as water, dairy foods, and even some vegetables. This is the same contaminant that prompted the recall of various blood-pressure drugs earlier this year.
Last month, the U.S. Food and Drug Administration (FDA) issued an alert reporting that some random Zantac samples it had tested contained NDMA.
The alert warned that it found low but “unacceptable” levels of NDMA, but stopped short of recommending a recall of the product. It did, however, recommend that patients who take the drug regularly consider switching to an alternative medication.
Because each person is different and reacts to various drugs differently, the marketplace has produced a number of medications made to treat heartburn, or gastroesophageal reflux disease (GERD). This includes Pepcid (generic name famotidine) and Tagamet (generic name cimetidine), which are in the same family as ranitidine but so far have not been found to contain NDMA.
This class of drugs is known as H2 receptor blockers, which work by reducing the amount of stomach acid secreted by the stomach lining. They normally reduce or eliminate heartburn within about an hour.
Then there are the popular proton pump inhibitors (PPIs), including Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole), and Prevacid (lansoprazole). PPIs work by blocking and reducing the production of stomach acid, and take longer to work than the H2 receptor blockers, often several weeks.
And of course PPIs carry their own possible risks when used long-term. These include higher risks for kidney disease, fractures, dementia, and cardiovascular problems, including heart attacks.
The old standbys that preceded both H2 receptor blockers and PPIs are the OTC antacids like Tums, Maalox, and Rolaids. While they can cause either constipation or diarrhea in some, they are generally safe to use.
But what can you do about the pain of heartburn (an aptly named condition)?
Start with lifestyle changes.
1. Identify triggers
Some people can tolerate chocolate, tomatoes, spicy foods, alcohol, garlic, citrus foods, ginger, and other foods with no problem at all. Those who are prone to GERD, however, quickly learn to avoid such triggers, either under certain conditions or in certain combinations or all the time. Greasy, fried, and fatty foods are also well-known contributors to heartburn, as are fizzy drinks and tobacco smoke. Know which foods to avoid.
2. Lose abdominal weight
Excess weight carried around the middle can constrict internal organs, causing upward pressure on the stomach and forcing acid upward into the esophagus, triggering heartburn. The same is true for constricting clothing such as tight waistbands or girdles. Even a heavy meal can have this effect, especially right before bed. Try to eat dinner at least two hours before retiring for the night.
3. Sleep on a slant
Either elevate the top half of your bed or sleep propped up on pillows to keep stomach acid from draining into the esophagus. Some people also find relief by sleeping on their left side, which also tends to keep acid contained in the stomach.
4. Reduce stress
Among other ill effects, stress can lead to an increase in production of stomach acid, and thus an increase in GERD. Try relaxation or meditation techniques, hobbies, or just slowing down in general as much as possible.
There are dozens of heartburn remedies that many people swear by including apple cider vinegar, aloe juice, and baking soda mixed in water, which will neutralize stomach acid. These or others may work for you.
If you have questions about Zantac or any other heartburn medication you’re taking, feel free to ask us, especially if you’re worried about the recall. And if heartburn is a continuing problem for you, be sure to let us know. It could be masking an ulcer, which requires medical treatment.