The role of the pharmacist in treating frequent heartburn: A focus on non-prescription proton pump inhibitors

Individuals experiencing symptoms related to acid reflux (e.g. heartburn and regurgitation) commonly seek treatment with self-care modalities. The availability of non-prescription medications for reflux symptoms in Australia provides an important opportunity for pharmacists to guide individuals on how to effectively manage their symptoms. Proton pump inhibitors (PPIs) are the most effective treatment for frequent heartburn (two or more days per week), and, as a result, the use of PPIs has increased markedly over past decades. Currently, five PPIs are available in Australia without a prescription. Treatment guidelines for self-managing frequent heartburn recommend a two-week therapeutic course with a non-prescription PPI in individuals experiencing typical symptoms. However, in practice these individuals may use PPIs intermittently even initially. Pharmacists can help identify appropriate candidates for non-prescription PPIs by inquiring about the nature of their symptoms, including frequency and severity, response to prior interventions, concomitant medications and comorbidities. The presence of atypical symptoms or alarm features, such as chest pain or difficulty swallowing, or a lack of response to a known effective treatment requires referral to a physician for further evaluation. Pharmacists can also ensure that individuals are aware of potential adverse events and drug interactions, and they can clarify expectations about treatment response, including acknowledgement that several days of therapy may be needed to experience a full treatment effect.