Objective: This article reviews the use of nonprescription histamine2-receptor antagonists (H2RAs) in the management of secretory disorders of the upper gastrointestinal tract.
Data sources: The scientific and consumer literature pertaining to the over-the-counter availability and therapeutic uses of H2RAs was reviewed.
Study selection: References related to safety, efficacy, comparative efficacy with antacids, and economic impact of H2RA therapy were emphasized. Additional importance was placed on information describing the pharmacist's role in nonprescription H2RA therapy.
Data extraction: Data from product package inserts as well as the scientific literature were extrapolated to provide information on indications, dosage and administration, adverse effects, drug interactions, and patient information.
Data synthesis: The literature review focused on the relative role of these agents as an alternative to traditional nonprescription treatment of self-limiting gastrointestinal conditions as well as the advice and instructions that the patient should receive.
Conclusion: H2RAs represent a nonprescription option for the prevention and treatment of heartburn, acid indigestion, and sour stomach. They are effective and safe, but take longer to work and are more expensive than antacids. The availability of H2RAs without a prescription may reduce overall health care costs by decreasing the need for physician office visits. However, the pharmacist should counsel patients on the proper use of these products. In their role as primary care providers, pharmacists must evaluate whether the products will relieve a given patient's symptoms or whether the patient requires referral to another clinician (e.g., physician) for a more thorough examination and treatment.