NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). These conditions include indigestion and heartburn.

Many indigestion and heartburn treatments are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Alginate containing products have low acid suppressant activity and should be reserved for patients with reflux symptoms.

Liquid antacid preparations are more effective than solid tablets

Peptac

(Combination of sodium alginate, sodium bicarbonate, and calcium carbonate)

• Oral suspension^SF 250mg / 133.5mg / 80mg in 5ml (£3.29 = 500ml)

Indications

• Reducing symptoms of oesophageal reflux

Dose

• 10-20ml after meals and at bedtime

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. Contains 6.2mmol of sodium and 1.6mmol of calcium carbonate in 10ml

Acidex Advance

(Combination of sodium alginate and potassium bicarbonate)

• Oral suspension^SF, 1g / 200mg in 10ml (£3.84 = 500ml)

Indications

• Reducing symptoms of laryngopharyngeal reflux

Dose

• 5-10ml after meals and at bedtime

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. Contains about 5.1mmol of sodium and 2mmol of potassium in 10ml

Gastro-oesophageal reflux disease (GORD) in children

See also: Specialist infant formulas

Gaviscon Infant

(Sodium alginate and magnesium alginate)

• Oral powder sachets^SF (contains about 1.04 mmol of sodium per dose) (£7.64 = 30 sachets)

Indications

• Gastric regurgitation, gastro-oesophageal reflux and reflux associated with hiatus hernia in infants and young children

Dose

• Neonate: body-weight under 4.5kg, one 'dose' as required, max 6 doses per day; body-weight 4.5kg and above, 2 'doses' as required, maximum 12 doses per day
• Child 1- 23 months: body-weight under 4.5kg, one 'dose' as required, maximum 6 doses per day; body-weight 4.5kg and above, 2 'doses' as required, maximum 12 doses per day

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. Dose mixed with feeds (water or fresh expressed breast milk in breast-fed infants).
3. Parents and carers need to be advised on the challenges that administering alginates to a breast fed infant may bring. Gaviscon Infant should be mixed with 5ml of cooled, boiled water to form a smooth paste, then add in another 10ml of water and mix. Local specialists also recommend mixing with fresh expressed breast milk as an alternative to water. The treatment should be administered part way through the feed, using a syringe, spoon or finger.
4. Each half of the dual-sachet is identified as 'one dose'. To avoid errors prescribe as with directions in terms of dose.
5. Do not use Gaviscon Infant in children at risk of dehydration (for example because of vomiting, diarrhoea, fever or high room temperature), in children at risk of intestinal obstruction, in children already consuming thickened feeds (because of the risk of intestinal obstruction), in pre-term infants, or in children with renal impairment or congestive cardiac failure (because of the sodium content).
6. If a trial is successful, continue for 3 months or until weaning (ingestion of solid foods) is established.
7. See Paediatric reflux disease guidance