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Pepcid vs. Prilosec OTC: Which is right for me?

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These 2 over-the-counter medications treat heartburn in different ways. Here’s how they work and how to know which one is best for your symptoms.
Written by Emily Shiffer
Updated on August 5, 2022

If you’ve ever indulged in chili cheese fries and a beer, you’re aware of the pain and discomfort heartburn can bring. More than 60 million Americans experience heartburn at least once a month, and more than 15 million Americans have heartburn symptoms each day, according to the National Institutes of Health.

“Heartburn feels like a burning sensation behind your chest bone and normally happens after eating,” says Dhyanesh A. Patel, MD. He’s a gastroenterologist and assistant professor of medicine at the Center for Swallowing and Esophageal Disorders at Vanderbilt Medical Center. “You might also have regurgitation of stomach contents come up into your mouth.”

A diet high in fatty or fried foods could be the culprit. According to the Mayo Clinic, other heartburn causes include:

  • Spicy foods
  • Acidic foods, such as citrus or tomato
  • Onions
  • Peppermint
  • Chocolate
  • Alcohol
  • Carbonated beverages
  • Coffee or other caffeinated beverages

But not all heartburn symptoms are caused by your diet. Other contributing factors include pregnancy, allergies, certain medications (including beta blockers and sedatives), stress, smoking and gastroesophageal reflux disease (GERD).

Thankfully, you can choose from many medications to help you treat a heartburn episode. Two common ones that you can buy over the counter (OTC) at your local drugstore are Pepcid® and Prilosec OTC®.

(If OTC medications don’t relieve your heartburn symptoms, you may need a prescription-strength medication. Optum Perks can help you save. Use this free pharmacy discount card any time you pick up a prescription.)

While Pepcid and Prilosec both treat heartburn, they work differently. Depending on the specifics of your symptoms, one might be more effective than the other. Here’s what you need to know about each one and how to determine which medication is right for you.


How does it work?

Pepcid, the brand name for the generic medication famotidine, is a histamine H2-receptor antagonist, or H2 blocker. In your stomach, histamines stimulate cells to block histamine receptors and subsequently reduce the amount of acid being secreted in your stomach, Dr. Patel says.

When should I use it?

Pepcid is a fast-acting medication that starts working within 15 to 30 minutes of taking it. It comes in a 10 mg version or a 20 mg “extra strength” option. Its quick release makes it a great choice for people dealing with less frequent heartburn bouts that need relief right away. Pepcid should be taken 15 to 60 minutes before eating.

If your heartburn symptoms typically show up at night, Pepcid is the medication to take, Dr. Patel says. The stomach acid released at night is driven more by histamine receptors than proton pumps (more on those below), so it will work better than Prilosec, he explains.

Just don’t use Pepcid daily for the long-term, Dr. Patel says. Your stomach will start to increase its number of histamine receptors. That leads to less response to Pepcid over time. You should see improvement in about 2 weeks. If you don’t, stop taking it and talk to your doctor.

Pepcid is also available in prescription form. Dr. Patel says that it’s usually prescribed in a 40 mg dose if someone doesn’t get adequate relief with the OTC dose.

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Prilosec OTC

How does it work?

Prilosec OTC (omeprazole) is a proton pump inhibitor. It works by targeting proton pumps in your stomach that produce acid and reducing the amount of acid they release.

When should I use it?

Prilosec OTC is for people who have long-term heartburn. It works more as a preventive medication for heartburn than a quick treatment, Dr. Patel says. And unlike Pepcid, the body doesn’t develop a tolerance to it.

You should take Prilosec OTC once a day before eating. Because it’s a 20 mg delayed-release tablet, it can take between 1 and 4 days to fully feel its effects.

This medication is also available in prescription form. Dr. Patel says it’s usually prescribed in a 40 mg dose.

How long can I safely take these medications?

Both Pepcid and Prilosec OTC should be used consistently for only 2 weeks at a time, according to Dr. Patel. If you continue to have heartburn symptoms, you should see your primary care doctor. You might need further evaluation to figure out what’s going on.

Your doctor might perform an upper endoscopy to look at your esophagus. (With an upper endoscopy, a flexible scope is inserted into the mouth and down the throat so that the doctor can see the esophagus, stomach and upper part of the small intestine.)

Your doctor may test you for food allergies as well. They may also be looking for mechanical issues in your esophagus, a hiatal hernia (a hernia above the diaphragm) or possible cancer.

And if your doctor prescribes a prescription-strength dose of either medication, don’t forget to download our discount prescription coupon app. You could save up to 80%.

Additional sources
Statistics on heartburn: National Institutes of Health
Common causes of heartburn: Mayo Clinic