Should I switch my acid reflux medicine?

Q. I have been taking over-the-counter Prilosec for acid reflux. I saw an advertisement for Zegerid claiming it had an extra additive. But the main ingredient, omeprazole, seems to be the same? Should I switch?

A. You are correct. The ingredients are the same. Zegerid contains omeprazole (the active ingredient in Prilosec). Zegerid also contains 1,100 milligrams of sodium bicarbonate (about 1/4 teaspoon).

Omeprazole is part of a class of drugs called proton pump inhibitors (PPIs). These are the most potent blockers of stomach acid. To be effective, these drugs need to be absorbed from the intestine into the bloodstream so they can reach the inside surface of the stomach cells. That's where PPIs work.

Here's the problem: as the drug passes through the stomach, the acid in the stomach breaks down the PPI before it reaches the intestine.

To get around this problem, PPIs (other than Zegerid) have protective coatings around the tablets. This keeps the acid from breaking down the active ingredient. (The downside is that the coating slows down the absorption of the active ingredient from the intestine into the bloodstream.)

The makers of Zegerid solved the problem a different way. Instead of using a coating, they added sodium bicarbonate. This chemical neutralizes the acid before it can break down the active ingredient. When the omeprazole in Zegerid reaches the intestine, it is absorbed into the blood more quickly because it doesn't have a protective coating.

Should you switch? It depends upon two factors:

• whether or not the Prilosec controls your symptoms
• which costs more.

If your current medicine doesn't control your symptoms, you could try the Zegerid. And it's a good idea to talk with your doctor. Any time you have symptoms that persist, you want to be sure you just have acid reflux. And your doctor may suggest a different therapy.

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