4 GERD Counseling Points for Pharmacists

There are several lifestyle changes, OTC options, and prescription drug therapies that patients with gastroesophageal reflux disease (GERD) can rely on to prevent acid reflux symptoms, and pharmacists are one of the best candidates to share this information.

John R. Horn, PharmD, FCCP, pharmacy professor at the University of Washington Medical Center, shared the following related tips in a presentation called “Pharmacist’s Role in GERD: Current Management Options.”

1. Know which lifestyle factors patients can modify to combat GERD.

Some of these tips include eating smaller meals, losing weight if the patient is overweight, quitting tobacco, remaining in the upright position for 2 to 3 hours after eating, elevating the head of a bed by 6 inches, and avoiding dietary triggers. Particular exercises may also exacerbate symptoms.

2. Know which drug therapies patients can try or avoid.

Dr. Horn recommended several drug therapies to ease GERD symptoms, such as antacids and H₂-receptor antagonists, which are appropriate for controlling symptoms that are longer in duration and also preventing their return. Patients may try using these therapies in combination, as well.

However, there are also several drugs that GERD patients may need to avoid, such as anticholinergic agents, antihistamines, calcium channel blockers, exenatide, nitrates, levodopa, nicotine, opiates, and theophylline/beta agonists. Many of these drugs delay gastric emptying, according to Dr. Horn.

3. Counsel patients on appropriate proton pump inhibitor (PPI) use.

Tell GERD patients to avoid chronic, daily administration of PPIs; use step-up therapy; try on-demand PPI before daily dosing; and seek relief from antacids for acute heartburn episodes. Pharmacists should also monitor for potential drug interactions.

According to Dr. Horn, PPI side effects can include:

• Headaches
• Diarrhea
• Reduced B₁₂, iron, and calcium absorption
• Increased risk of Clostridium difficile colitis, especially in hospitalized patients
• Increased risk of pneumonia

4. Set realistic expectations for patients, explain how therapies work, and reinforce lifestyle changes.

It would be beneficial for pharmacists to start conversations with patients about GERD treatment and heartburn, Dr. Horn noted. One tip to mention during these conversations could include keeping a symptom and treatment journal.

In addition, pharmacists should warn patients about potential adverse effects and drug interactions. Lastly, Dr. Horn advised pharmacists to consider the right time for the patient to seek help from a physician for GERD symptoms.