These Are the 3 Best OTC Options for Heartburn

These Are the 3 Best OTC Options for Heartburn
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You just finished eating a delicious, cheesy slice of deep-dish pizza. As you lie back on the couch to watch television, you suddenly feel a burning sensation in your chest. What you may be experiencing is heartburn — a symptom of acid reflux. Acid reflux happens when your stomach contents flow backward into your esophagus (the tube that carries food from your mouth to your stomach.)

Heartburn is very common. Almost one-third of U.S. adults report experiencing heartburn recently. Thankfully, there are many medications available to relieve heartburn, and several are available over-the-counter (OTC). Keep reading to learn about the available OTC heartburn medications.

Can heartburn be treated with OTC medications?

Yes. OTC medications can help prevent or treat symptoms of heartburn. They’re usually tried before prescription medications. But if your symptoms last a long time or don’t improve with OTC medications, you may need a prescription medication. This can also be a sign that what you’re experiencing is more than just heartburn.

What OTC medications are available for heartburn?

You may be tempted to reach for an OTC medication to prevent or treat heartburn. But before starting these medications, talk to your provider or pharmacist. These medications can interact with other medications you’re taking. This could lead to unwanted side effects. It can also cause your medications to work less effectively.

There are three groups of OTC heartburn medications. They work in different ways, which we’ll discuss below.

Antacids

As mentioned, heartburn symptoms happen when stomach contents flow back towards the esophagus. The burning sensation you might feel is because the contents of your stomach are acidic. Antacids provide relief by neutralizing your stomach acid. Antacids may treat heartburn, but they don’t prevent gastroesophageal reflux disease (GERD). GERD is a more serious form of acid reflux.

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Antacids usually work quickly — often within minutes. It’s recommended to take antacids within 1 hour after eating or immediately when heartburn symptoms occur. But their effects might not last long — usually for just about 1 hour.

Antacids can also affect how other medications are absorbed. Your healthcare provider may recommend taking other medications 1 hour before or 4 hours after taking antacids.

There are many different antacids available. They usually contain calcium, aluminum, magnesium — or some combination of these. Antacids come in different forms including chewable tablets, liquids, and gummies.

Common examples of antacids include:

  • Tums (calcium carbonate)
  • Milk of Magnesia (magnesium hydroxide)
  • Rolaids (calcium carbonate/magnesium hydroxide)
  • Mylanta (aluminum hydroxide/magnesium hydroxide/simethicone)

Talk to your healthcare provider if you need an antacid for more than 2 weeks. If your symptoms haven’t improved, you might need a stronger medication.

Histamine-2 antagonists

OTC histamine-2 antagonists (H2 blockers) can treat or prevent heartburn symptoms. They work by blocking histamine-2 receptors in your stomach. This lowers the amount of acid made there.

They usually start working 1 to 3 hours after you take them, and can provide relief for several hours. They should be taken before eating or drinking anything that can cause heartburn. However, they can also be used after you start having symptoms. H2 blockers are available as tablets, capsules, and liquids.

The most common OTC H2 blockers include:

Prescription H2 blockers can treat GERD and certain types of ulcers in the stomach and intestines. Nizatidine is an H2 blocker that’s available by prescription only. Certain doses of famotidine and cimetidine are also available by prescription.

If you use H2 blockers for a long time, they may not work as well as they did at first. Over time, your stomach adapts to the medication, which makes them less effective. If you’ve used an H2 blocker daily for longer than 2 weeks or your heartburn has lasted over 3 months, talk to your healthcare provider. You may need a proton pump inhibitor, which we’ll cover next.

Proton pump inhibitors

Proton pump inhibitors (PPIs) may be recommended for people with frequent heartburn symptoms occurring 2 or more days per week.

PPIs block an enzyme — a protein that speeds up a chemical reaction — in stomach cells. This enzyme is known as the “proton pump.” The proton pump is necessary for the stomach to make acid. By blocking it, PPIs lower acid production in the stomach.

PPIs take longer than antacids or H2 blockers to improve heartburn symptoms. It can take about 1 to 4 days for PPIs to have their full effect. PPIs are available as tablets, capsules, or liquids.

Common OTC PPIs include:

All of these PPIs are available by prescription as well. Pantoprazole (Protonix) and dexlansoprazole (Dexilant) are other PPIs available by prescription only.

When used OTC, PPIs should only be used for 14 days at a time up to 3 times each year. Taking them for longer — unless otherwise directed to by your healthcare provider — can lead to harmful side effects. More on this later.

Is one OTC medication better than the others?

It depends on your heartburn symptoms and how frequent they are.

Antacids are good options for heartburn symptoms that occur once in a while. This is because they work pretty quickly, so it shouldn’t take long for you to feel relief. But they usually don’t last long.

H2 blockers and PPIs block the production of acid in your stomach, so they provide longer relief than antacids. But they take more time to take effect. This is why H2 blockers and PPIs may be more helpful for people who have more frequent heartburn symptoms.

For people with GERD, PPIs can be more effective than H2 blockers. But PPIs can also cause more serious side effects than other OTC heartburn medications.

What side effects can I expect from OTC heartburn treatments?

OTC heartburn medications cause different side effects. They can also interact with other medications you’re taking. Make sure to discuss these risks with your healthcare provider before starting a medication.

Common side effects of antacids, H2 blockers, and PPIs are listed below.

Potential side effects:

 AntacidsH2 blockersPPIs
 ・Diarrhea of antacids containing magnesium
・Constipation with antacids containing calcium or aluminum
・Headache
・Sleepiness or tiredness
・Constipation
・Diarrhea
・Stomach pain
・Headache
・Dizziness
・Rash
・Nausea
・Constipation
・Gas
・Diarrhea
・Stomach pain

More severe side effects can occur with these medications too. Taking antacids too often for a long time can cause problems. Antacids with calcium can cause kidney stones, and antacids with aluminum can cause weaker bones (osteoporosis).

H2 blockers can have serious side effects in people with kidney or liver issues and people over 50 years old. Confusion, slurred speech, and hallucinations can occur. It’s most common with cimetidine, but can happen with any H2 blocker. Let your healthcare provider know if you have any kidney or liver issues before starting an H2 blocker.

Taking PPIs for a long period of time has also been linked to health problems. These include:

  • Bacterial infections like Clostridium difficile
  • Higher risk of fractures (especially in the hip, wrist, and spine)
  • Kidney problems
  • Liver problems
  • Low magnesium and vitamin levels
  • Pneumonia

It’s unclear just how much PPIs contribute to the risk of these side effects, but they’re still worth discussing with your healthcare provider.

When should I see a healthcare provider for heartburn?

Many people occasionally experience heartburn, and OTC medications are usually effective in providing relief. But if you’re having heartburn more than two to three times a week, you should let your healthcare provider know.

And, if your symptoms worsen or don’t improve with OTC medications, talk to your provider. Needing medications frequently or worsening symptoms can be a sign of a more serious health condition like GERD or peptic ulcer disease (PUD).

Heartburn symptoms can also resemble signs of a heart attack. Although heartburn does not cause heart attacks, it’s important to know the signs of a heart attack. These include chest pain, feeling weak, and pain in one or both arms. How to tell the difference between a heart attack and heartburn is discussed in more detail in a previous GoodRx Health article.

Call 9-1-1 immediately if you notice the symptoms of a heart attack.

The bottom line

Heartburn feels like a painful, burning sensation in your chest. It can happen when acid travels backwards from your stomach to your esophagus. Different OTC medications can help relieve heartburn symptoms.

Antacids work the quickest to provide immediate relief, but their effects don’t last long. H2 blockers and PPIs take longer to work but their effects last longer. However, OTC heartburn medications can interact with other medications you’re taking. Make sure to talk to your healthcare provider or pharmacist about the side effects of these OTC medications before starting them.

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References:

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American College of Gastroenterology. (n.d.). Acid reflux.

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U.S. Food and Drug Administration. (2017). FDA drug safety communication: Clostridium difficile associated diarrhea can be associated with stomach acid drugs known as proton pump inhibitors (PPIs).

U.S. Food and Drug Administration. (2017). FDA drug safety communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors.

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Written by Kevin Le, PharmD, BCPS, BCPPS | Reviewed by Christina Aungst, PharmD

 

 

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