How to choose the best acid reflux medication for you
When you experience heartburn, it is the result of some of the acid content of your stomach making its way up into your esophagus. This process is called acid reflux. It can feel like a burning in your chest and is often worse after meal times or after eating certain foods.
If you experience occasional heartburn, certain foods may trigger your symptoms, and lifestyle changes will be enough to manage it. If this does not work, there are various medications you can try to help relieve heartburn symptoms.
You may wish to try OTC medications like antacids first. If these do not help relieve your symptoms, you can talk with a healthcare professional. They may want to see if you have gastroesophageal reflux disease, or GERD. Around 20% of people in the United States have GERD.
In this case, a healthcare professional may prescribe acid reflux medications. These are typically stronger versions of the OTC medications you can buy.
Antacids are the oldest effective treatment for heartburn and can include common household ingredients such as baking soda. They work to neutralize stomach acids and inactivate a stomach enzyme called pepsin, relieving symptoms of acid reflux.
You usually take antacids after symptoms begin. They provide temporary relief from symptoms but don’t stop heartburn from happening again. They work quickly, but the effects only last for a few hours.
Some OTC antacid medications, such as Alka-Seltzer, contain aspirin. If you are taking blood-thinning medication, you should avoid medications that contain aspirin.
Possible side effects of antacids include:
Antacids are cheap and relatively safe. Side effects are only likely if you overuse them. Be sure to follow the directions on the label. Brands of medication that include antacids include Gaviscon and Tums.
Histamine-2 blockers, or H2 antagonists, are medications that reduce how much acid your stomach produces. They typically work after around 1 hour, and their effects can last several hours. They provide fast relief from heartburn symptoms, and all types of H2 blockers are equally effective.
You can use these medications to prevent an episode of heartburn by taking them 30 minutes before a meal. There are multiple strengths of H2 blockers available.
Some possible side effects of OTC H2 blockers include:
Brands such as Zantac 360° produce these medications as tablets. Always follow the instructions on the label to avoid side effects.
Antacid/acid-reducing combination medications
H2 blockers such as famotidine are available with added antacids as OTC medications. Brands such as Pepcid Complete combine the acid-neutralizing abilities of antacids with the acid-reducing abilities of H2 receptor blockers.
Proton-pump inhibitors (PPIs) also work by reducing the amount of acid your stomach produces, just in a slightly different way. PPIs work by blocking the site of acid production in your stomach and are suitable for short-term relief from frequent heartburn. They’re available OTC or on prescription.
These medications do not provide immediate relief, taking 1 to 4 days to work. You should not take these medications for longer than 14 days, three times per year.
Some are available OTC in low strengths, such as Prilosec, which is a 20-milligram version of the prescription medication omeprazole.
Side effects from OTC PPIs are rare. However, possible side effects can include:
- stomach pain
- excess wind (flatulence)
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PPIs are available in high dosages and are the most potent medications for reducing stomach acid production.
These medications are often helpful in treating GERD, and a healthcare professional must prescribe them. There are many different types available. For example, omeprazole is among the top 10 prescriptions for medication in the United States.
Other prescription strength PPIs are:
Like their OTC counterparts, these medications do not treat symptoms of heartburn immediately. PPIs work differently for different people. If you find your medication is not effective, you can speak with a healthcare professional so you can work together to find the best medication for you.
Prescription PPIs can help treat long-term acid reflux effects, such as the condition Barrett’s esophagus.
Side effects from long-term use of these medications are lacking in evidence but may include:
- infection due to less potent stomach acid
- vitamin B12 deficiency
- magnesium deficiency
H2 receptor blockers
Prescription-strength H2 blockers are useful for reducing stomach acid. They are a cheap, effective, and safe treatment for heartburn. A healthcare professional may prescribe H2 receptor blockers for GERD and chronic heartburn. They may also help treat Zollinger–Ellison syndrome, a condition that causes excess stomach acid.
Examples of H2 blockers include:
Only 1.5 % of people taking H2 receptor blockers experience side effects. These can include:
- dry mouth
- difficulty urinating
H2 receptor blockers are effective medications for reducing stomach acid. If you experience side effects, speak with a healthcare professional. They will discuss whether there is an alternative medication to help you. You should never stop taking your medications unless instructed to do so by a professional.
These medications can help to manage acid reflux. They work by strengthening the muscle at the lower end of the esophageal sphincter, allowing stomach contents to empty faster. This means there is less time for acid reflux to occur and cause heartburn.
Some prokinetics include:
Prescriptions of prokinetics may work alongside PPIs or H2 receptor blockers. However, unlike these typically safe medications, prokinetics can have dangerous side effects. For this reason, prokinetics are only for treating severe cases of GERD.
Some of these side effects include:
- irregular heart rate
- tardive dyskinesia
Acid reflux and GERD occur when stomach acid rises to your esophagus, causing heartburn and discomfort.
Several prescription and OTC medications are available to treat symptoms of acid reflux. Each works in a different way, and some will be more suitable for you than others.
If you are experiencing acid reflux and OTC medications are not helping your symptoms, consider speaking with a healthcare professional. They may recommend prescriptions or diagnose any underlying conditions such as GERD.
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- FDA drug safety communication: FDA warns about serious bleeding risk with over-the-counter antacid products containing aspirin. (2018). https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-about-serious-bleeding-risk-over-counter-antacid-products
- H2 blockers. (n.d.). https://aboutgerd.org/treatment/medications/h2-blockers/
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- Nugent CC, et al. (2022). H2 blockers. https://www.ncbi.nlm.nih.gov/books/NBK525994/
- Over-the-counter (OTC) heartburn treatment. (2021). https://www.fda.gov/drugs/information-consumers-and-patients-drugs/over-counter-otc-heartburn-treatment
- Side effects of omeprazole. (2021). https://www.nhs.uk/medicines/omeprazole/side-effects-of-omeprazole/