Heartburn Medications: "Is ZEGERID for Me?"

Print the Questionnaire
and take it to
your doctor

Fill out the questionnaire and take it to your doctor

If you have acid reflux disease or have heartburn more than twice a week, then ZEGERID may be a good heartburn medication for you. Only your doctor can decide about and prescribe ZEGERID. But you can fill out this questionnaire and bring it to the doctor's office.

"Is ZEGERID for Me?" Questionnaire

Check the statements that apply to you and click print at the end. The page will print only the statements that apply to you. Plus, when you print the questionnaire, you will also automatically print a coupon for up to $30 off a ZEGERID prescription.

Next page: ZEGERID Rx Savings Card

Product Description
ZEGERID contains omeprazole, a proton pump inhibitor (PPI), and sodium bicarbonate, an antacid.

Important Safety Information about ZEGERID
ZEGERID is indicated for the treatment of heartburn and other symptoms of acid reflux disease. ZEGERID is used to treat and maintain the healing of erosive esophagitis, which may result from acid reflux. ZEGERID is also indicated for the short-term treatment of active duodenal ulcer and of active benign gastric ulcer.

Side effects of ZEGERID include headache, diarrhea and abdominal pain. Relief of your symptoms while on ZEGERID does not rule out that other serious stomach conditions may exist.

ZEGERID Capsules contain 303 mg of sodium per dose. ZEGERID Powder for Oral Suspension contains 460 mg of sodium per dose. The sodium is in the form of sodium bicarbonate and these amounts should be taken into consideration by anyone on a sodium-restricted diet. People with metabolic alkalosis and hypocalcemia should not take sodium bicarbonate.

ZEGERID Capsules and ZEGERID Powder for Oral Suspension have the same amount of sodium bicarbonate in both the 20mg and 40mg dosages. Two 20mg doses are not equivalent to one 40mg dose, and two 20mg doses should not be used in place of one 40mg dose.

ZEGERID should not be taken by anyone with a known hypersensitivity to any component of the formulation.

To learn more about ZEGERID, see full prescribing information and talk with your doctor.

Please consult with your healthcare professional to see if ZEGERID is right for you. The content of this Web site is not a substitute for professional medical advice and should not be interpreted as treatment recommendations or relied on for medical diagnosis or treatment. Please see complete Legal Disclaimer.

Nexium is a trademark of AstraZeneca LP; Prevacid is a trademark of Tap Pharmaceutical Products, Inc.; Protonix is a trademark of Wyeth Pharmaceuticals Inc.; Prilosec is a trademark of Astra Merck Inc.; Aciphex is a trademark of Eisai Co., Ltd.

	I suffer from heartburn two or more times a week.
	I usually have heartburn during the day.
	I sometimes have heartburn at night.
	I get a sour taste in my mouth.
	I have at least one other symptom such as coughing, wheezing, sore throat, or choking.
	I have bought heartburn medications myself over-the-counter.
	My doctor has prescribed a heartburn medication for me.
	I would like to have the option to take a heartburn medication in pill or powder form.
	I would like to have a heartburn medication that gets into my system rapidly.