Which heartburn medication should you take?

The main goal of treatment for heartburn and gastroesophageal reflux disease (GERD) is to improve your symptoms by reducing stomach acidity and the production of stomach acid. This can help manage or prevent symptoms like a burning sensation in the esophagus and stomach pain.

Early treatment for GERD can also help prevent complications, such as ulcers.

This article will review the treatment options available for treating heartburn and GERD and their potential side effects.

Antacids

Antacids are typically an option for people who have mild heartburn or GERD symptoms. Antacids are available as over-the-counter (OTC) medications. They work by neutralizing stomach acid.

While OTC antacids do not require a prescription, they can have adverse effects, particularly in people with certain conditions. Consider talking with a doctor or healthcare professional before taking OTC antacids.

Antacid medications include:

• Gaviscon
• Mylanta
• Tums
• Alka-Seltzer
• Rolaids

Side effects

Taking antacids may cause side effects such as:

• diarrhea
• constipation
• nausea
• vomiting
• abdominal pain
• flatulence
• cramps
• headache

Acid reducers: OTC PPIs and H2 blockers

Proton pump inhibitors (PPIs) and histamine-2 (H2) blockers are acid reducers available as OTC medications that can reduce the production of acid in the stomach.

H2 blockers work faster than PPIs and are more suitable for milder and occasional cases of heartburn and GERD. H2 blockers can help heal the esophagus by decreasing the production of stomach acid and reducing the risk of acid reflux.

OTC H2 blockers may include:

• famotidine (Pepcid AC, Pepcid Complete)
• cimetidine (Tagamet HB)
• nizatidine (Axid AR)

Doctors may recommend taking OTC PPIs to treat more frequent cases of heartburn. PPIs are not intended to give immediate relief from heartburn, as they may take a few days before providing full effect. OTC PPIs are only suitable for a 14-day course of treatment that people can repeat up to three times per year.

OTC PPIs are typically more effective than H2 blockers in the long-term management of heartburn and GERD. OTC PPI medications may include:

• lansoprazole (Prevacid)
• omeprazole magnesium (Prilosec OTC)
• omeprazole and sodium bicarbonate (Zegerid OTC)
• esomeprazole (Nexium)

Side effects

Acid-reducer medications may cause side effects such as:

• nausea
• vomiting
• headache
• constipation
• diarrhea
• increased risk of weakened bones over time, though the link to PPIs is not definitive

Prescription H2 blockers

If your symptoms do not improve with OTC medications, your doctors may recommend prescription-strength H2 blockers.

All prescription H2 blockers are available as an oral medication, though famotidine may be administered through an IV for people who are hospitalized.

Prescription H2 blockers may include:

• nizatidine (Axid)
• cimetidine (Tagamet)
• famotidine (Pepsid)

Another H2 blocker, ranitidine (Zantac), was a previous treatment option, but the FDA issued a recall in 2020 due to the presence of impurities in the drug.

Side effects

Side effects of H2 blockers may include:

• diarrhea
• constipation
• fatigue
• drowsiness
• headache
• muscle aches
• flatulence
• sore throat
• runny nose
• dizziness
• abdominal pain

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Prescription PPIs

Doctors may prescribe PPIs to treat several digestive conditions, including GERD. PPIs reduce the production of stomach acid, reducing the risk of reflux.

Doctors typically recommend prescription PPIs instead of OTC PPIs to treat more severe cases of GERD and help heal the esophagus if there is inflammation due to acid reflux.

PPIs are typically prescribed for treating GERD long term. Prescription PPIs may include:

• rabeprazole (AcipHex)
• dexlansoprazole (Dexilant)
• pantoprazole (Protonix)

Side effects

PPIs are typically safe. However, people may experience side effects such as:

• headache
• diarrhea
• upset stomach
• increased risk of Clostridioides difficile (C. diff) infection — up to 2 times higher than for people who do not take PPIs

Other heartburn treatment options

Doctors may recommend some lifestyle changes that may help you improve your acid reflux and manage heartburn or GERD. These may include:

• maintaining a healthy weight, as having overweight or obesity increases the risk of GERD
• elevating your head using extra pillows when sleeping
• quitting smoking
• eating a balanced and healthy diet

It is best for people with GERD to avoid eating foods or drinking beverages such as:

• high fat or deep-fried foods
• acidic foods, like tomatoes and citrus fruits
• mint
• spicy foods
• chocolate
• alcoholic beverages
• coffee or drinks containing caffeine

In some severe cases of GERD, if medications do not provide any improvement to your health conditions, doctors may recommend surgery. Your doctor will review all of your available treatment options and the benefits and risks of each.

Summary

OTC and prescription medications can help manage or prevent symptoms of GERD. Antacids and acid reducers are medications that can help lower and neutralize the levels of acid in the stomach, improving mild cases of heartburn and GERD.

In more severe cases of acid reflux and GERD, doctors may prescribe PPIs and H2 blockers. Lifestyle changes, including eating fewer foods that can trigger stomach acidity, can also help improve your symptoms.

If medications and lifestyle changes do not improve your symptoms, doctors may recommend undergoing surgery.

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