Which proton pump inhibitor has the fewest side effects?

Doctors commonly prescribe PPIs to manage symptoms of gastroesophageal reflux disease (GERD), such as heartburn, by reducing the amount of stomach acid you produce.

They’re available as over-the-counter (OTC) drugs and stronger, prescription-only medications.

The ideal PPI for you will depend on the severity of your condition and whether you’re taking any other medications.

Which PPI has the least side effects?

According to the International Foundation for Gastrointestinal Disorders, PPIs are the most common type of medication doctors prescribe for heartburn and stomach acid-related health conditions in the United States.

They reduce the amount of acid your stomach produces by blocking the cells responsible for stomach acid production.

In the United States, several different PPI medications are available for managing symptoms of GERD, including:

• lansoprazole (Prevacid)
• omeprazole (Prilosec)
• rabeprazole (Aciphex)
• pantoprazole (Protonix)
• dexlansoprazole (Dexilant)
• esomeprazole (Nexium)

Side effects can vary depending on your dosage and how long you take PPIs.

According to a 2021 review, short-term PPI use is unlikely to cause side effects. But taking them for longer than 2 weeks increases your risk of experiencing side effects.

The most common side effects of PPIs include:

• nausea
• abdominal pain
• vomiting
• flatulence
• diarrhea

Side effect risk also differs slightly between PPI medications. For example, diarrhea develops in 4% of people taking omeprazole but only around 3% taking lansoprazole.  

Also, some prescription-strength PPIs, such as dexlansoprazole and rabeprazole, can increase your risk of developing upper respiratory tract infections.

Long-term use of PPI medications may also increase your risk of developing health conditions like kidney, liver, and heart disease.

The best PPI medication for you depends on your health history and the medications you’re taking. Talk with a doctor about your options and let them know whether you’re experiencing any unpleasant side effects.

If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Follow the links on drug names for savings on that medication, or search for a specific drug here.

Natural alternatives

There’s some evidence that natural alternatives to PPIs or home remedies may help with GERD symptoms. Still, the Food and Drug Administration (FDA) doesn’t approve them.

These include:

• Baking soda: Baking soda is the main ingredient in antacid medications and helps neutralize your stomach acid and reduce GERD symptoms. Still, having too much can put you at risk of developing metabolic alkalosis, which is when your blood becomes too alkaline.
• Ginger: Ginger helps increase gastric motility, which promotes stomach emptying and can help reduce heartburn. Experts suggest that 4 grams (g) of ginger is a safe dose.  
• Aloe vera: According to a 2015 study involving 79 participants with GERD, aloe vera syrup is a safe and effective treatment for heartburn. It has anti-inflammatory properties that can help soothe the esophagus.

The following lifestyle adaptations may also help reduce the severity of your symptoms:

• quitting smoking (if you smoke)
• avoiding foods that trigger your symptoms, like spicy food
• eating small but regular meals

Other medications

If PPI medications don’t work for you, consider asking a healthcare professional about the following OTC and prescription medications.

Antacids

These OTC medications contain baking soda and are only suitable for mild symptoms of GERD or heartburn.

Be cautious of how often you use them. Overuse can disrupt the digestive system or lead to metabolic alkalosis.

H2 blockers

These medications heal the esophagus and reduce stomach acid. Examples include cimetidine (Tagamet) and famotidine (Pepcid).

Still, they’re generally not as effective as PPIs.

They’re also more likely to cause side effects such as:

• drowsiness
• muscle aches
• abdominal pain
• diarrhea

Summary

PPIs are effective and relatively safe medications for the treatment of GERD. They help reduce the amount of stomach acid you produce.

Side effects are uncommon with short-term PPI use. But long-term treatment with PPIs can increase the likelihood of health conditions like kidney or liver disease.

Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.