What is the best acid reflux medicine over the counter

Heartburn is a feeling of burning pain in your lower chest, behind the breastbone. It comes from acid backing up from your stomach to your throat. You may have seen ads for heartburn drugs, such as Nexium, Prilosec or Prevacid. These drugs are called PPIs (proton pump inhibitors). They keep the stomach from making too much acid. They have been shown to heal irritation of the tube between the throat and the stomach (the esophagus).

Table of Contents Show

You may not need a PPI?
PPIs have risks.
PPIs can change the way other drugs work.
PPIs cost more.
When should you consider a PPI?
Antacids
Histamine 2 Blockers
Proton Pump Inhibitors
When to See a Healthcare Provider
What is the best product for acid reflux?
Which acid reflux medicine works fastest?
What medicine can I take daily for acid reflux?

In most cases, you don’t need a PPI for heartburn. You can get relief from a less powerful drug. And when you do need a PPI, you should take the lowest dose for as short a time as possible. Here’s why:

You may not need a PPI?

More than half of the people who take PPIs probably do not need them. Simple heartburn can be treated with antacids or other drugs, plus diet and lifestyle changes.

You may only have heartburn every now and then—such as after a big, spicy meal. This may be uncomfortable, but it is not serious. You can usually get relief from an antacid, like Rolaids or Tums, or an H2 blocker, such as Pepcid AC or Zantac.

PPIs have risks.

If you need a PPI, taking a low dose for less than a year is probably safe. PPIs are expensive and have been linked to higher risk of some
problems. Talk with your doctor before taking them for longer than two weeks. Be sure you have a good reason to take the PPI, and take it
for the shortest time possible.

Some risks of taking a PPI for a year or longer include:

Higher risk of certain fractures.
Higher risk of kidney disease, or kidney disease that gets worse.
A higher risk of heart attack.
In people age 75 and older, a higher risk of dementia.
Trouble absorbing calcium and vitamin B12.
Low levels of magnesium in your blood.
Pneumonia.
An infection in the intestines called Clostridium difficile.

PPIs can change the way other drugs work.

PPIs interact with some common prescription drugs. For example, some PPIs can reduce the blood-thinning effect of the drug Plavix (generic clopidogrel), according to the US Food and Drug Administration. This can increase the risk of heart attack and even death. If you take Plavix, talk to your doctor about whether you should take a PPI.

PPIs cost more.

Why spend more money on a PPI unless antacids or H2 blockers don’t work? Both the prescription and over-the-counter versions of PPIs are usually more expensive than antacids and H2 blockers. If you are worried about cost, talk to your doctor. He or she can help you find
the least expensive medicine that will work for you.

When should you consider a PPI?

Talk to your doctor if you have symptoms such as trouble swallowing, weight loss, or chest pain. Call the doctor if you don’t get better in about two weeks. The doctor will look for signs of problems such as GERD (gastroesophageal reflux disease).

If you have GERD, you probably need a PPI. Talk to your doctor if:

You have heartburn at least twice a week for several weeks.
Food or acid often come back up into your throat.
You take antacid or H2 blockers, and you make changes like the ones described on this page, but your heartburn does not go away.

If your doctor thinks you need a PPI:

Ask to start with a low dose of generic prescription lansoprazole or omeprazole. You can also get these medicines over the counter.
If the heartburn gets better after a few weeks, talk to your doctor about gradually lowering your dose.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

05/2012

Do you have heartburn from acid reflux that just won't quit? You may have gastroesophageal reflux disease (GERD), a condition in which stomach acid routinely backs up into the esophagus. The most obvious and painful symptom of GERD is heartburn.

It's easy to grab over-the-counter heartburn remedies at a drugstore, and these are often the first line of defense against GERD. But a glance down the pharmacy aisle shows a vast array of choices, including Tums and Rolaids (calcium carbonate) and Pepcid (famotidine), to name just a few. You may be left wondering which product will provide the best results.

A better understanding of your heartburn triggers can help you sort through the clutter and choose the right GERD remedy, said Robynne Chutkan, MD, the founder of the Digestive Center for Women in Chevy Chase, Maryland.

Here's a rundown of the three main categories of over-the-counter heartburn treatment, each with its own advantages and disadvantages.

Antacids

The best-known class of drugs for curbing heartburn are the antacids—including Tums, Rolaids, and Mylanta (aluminum hydroxide, magnesium hydroxide). Antacids, which contain the salt form of minerals such as magnesium or compounds such as calcium carbonate, curb heartburn by neutralizing acids in the stomach. Some antacids are also a supplemental source of calcium.

Antacids are fast-acting; they relieve reflux symptoms, especially heartburn, right away. "If you had corned beef and fries or if you overdid it at dinner and are having symptoms of heartburn, antacids are appropriate. Antacids make more sense for discretionary use and rare episodes of heartburn," said Dr. Chutkan.

Standard antacids such as Mylanta are also relatively safe, said Mitchell Cappell, MD, chief of gastroenterology at Beaumont Hospital in Royal Oak, Michigan. Although some people who use them may experience diarrhea and constipation, "There are not many side effects, and you can take them long term. But you have to take a lot of antacids because they are not as powerful as other heartburn remedies."

So, how long is it safe to take an antacid? Dr. Cappell said he doesn't worry so much about toxicity in patients taking antacids long term but is "concerned about patients munching them all the time, because they may be suffering from more severe reflux and need a more potent therapy."

Jonathan Schreiber, MD, a gastroenterologist at Mercy Medical Center in Baltimore, summed it up like this: "If your heartburn is brief and related to something you ate, an antacid is fine. It will work quickly and there is little downside, but the negative is that an hour later it's gone from your system. An antacid is not a good choice for a recurring problem."

Although they do suppress acid and will make you feel better faster, antacids do not heal the lining of the esophagus. The acid churned out by the stomach can erode the lining of the esophagus over time, which could cause Barrett's esophagus, a precancerous condition that can lead to esophageal cancer.

Histamine 2 Blockers

Another class of heartburn drug that you can buy over the counter is a histamine 2 (H2) blocker. Stronger than antacids and more long lasting, these remedies reduce the amount of acid the stomach produces by blocking histamine, an organic compound that is released when your body encounters an allergen. There are prescription and nonprescription H2 blockers. In the drugstore, you can find Tagamet HB (cimetidine), Pepcid AC, and Zantac 360, which has been reformulated to include famotidine (a type of H2 blocker).

"These drugs have been around since the 1970s and appear to be relatively safe," said Dr. Cappell. They can also be used for up to two weeks for short-term relief of heartburn.

"They are also preventive in that they block acid production in the first place," said Dr. Schreiber. What does that mean for your heartburn? If you take an H2 blocker, it works for eight to 12 hours. "Some people take these medications twice daily, and they can be helpful for mild reflux or heartburn."

Side effects may include headache, dizziness, diarrhea, constipation, nausea, and vomiting. Additionally, H2 blockers help heal the esophageal lining to some extent.

Proton Pump Inhibitors

PPIs, which have been available in the United States since 1989, block an acid-producing enzyme in the lining of the stomach. These drugs also help heal the lining of the esophagus and do so more effectively than H2 blockers. As of March 2021, the Food and Drug Administration (FDA) named Prevacid 24HR (lansoprazole), Nexium 24HR (esomeprazole), Prilosec OTC (omeprazole), and Zegerid OTC (omeprazole, sodium bicarbonate) as over-the-counter options for heartburn.

Unlike antacids, PPIs take time to work, said Dr. Chutkan. Some people may not feel better until 24 hours or more after taking them, and that's a lot to ask of someone who feels like their chest is on fire. Side effects may include diarrhea or stomach pain.

"PPIs as a group are very effective and safe, but they don't work very quickly," said Dr. Schreiber. "Someone who has heartburn now is probably better off with an H2 blocker or even using an antacid."

Just how effective are PPIs? The best objective measure of the effectiveness of a heartburn remedy is its ability to reverse erosive esophagitis, a condition in which the lining of the esophagus is visibly irritated or injured. To diagnose this condition, a thin, flexible tube outfitted with a camera is passed into the mouth and down the esophagus.

Studies have shown that roughly 85% of people with erosive esophagitis are healed when they take a PPI, according to Dr. Schreiber. Furthermore, an April 2022 study published in Neurogastroenterology & Motility found that the success rate range of alleviating reflux symptoms for PPI groups was 34.4% to 80.8%, compared to the success rate range for placebo groups, which was 10.4% to 51.7%.

When to See a Healthcare Provider

Treating heartburn that comes with acid reflux involves more than just taking a pill or munching on antacids. These medications work in tandem with lifestyle changes such as cutting out caffeine; consuming smaller, more frequent meals; quitting smoking; and avoiding alcohol, a known heartburn trigger.

"You can't expect a pill to work if you are drinking eight cups of coffee and smoking two packs a day," said Dr. Chutkan. Other tips that may help extinguish heartburn include not eating after 7 p.m. and propping your head up while you sleep.

Caffeine relaxes the lower esophageal sphincter, a circular muscle that creates a valve between the esophagus and the stomach. Think of the muscle as a door. "When the door is shut, no acid comes back up. But when the door opens, the acid backs up, from stomach to food pipe," said Dr. Cappell. "Caffeine, smoking, and alcohol all tend to make reflux more severe, and they may act by opening this door."

If you have classic acid reflux or heartburn such as a pain in the chest with frequent burping or nausea, it's OK to try over-the-counter remedies—especially if it occurs after a large, fatty meal or late at night, said Dr. Chutkan.

"If you have very occasional reflux symptoms——and who doesn't?——it may be reasonable to take over-the-counter medication. But if you are getting it regularly, if it's severe, or if the medication that you took before stops working, definitely see a doctor and preferably a gastroenterologist," added Dr. Cappell. "The symptoms may be due to another condition, to severe reflux that requires more powerful medicines, or to complications of reflux that require further medical evaluation and treatment."

Steer clear of the over-the-counter aisle and head straight to your healthcare provider if you have any of these red flags: pain or difficulty swallowing, vomiting, unexplained weight loss, or persistent abdominal pain. Also, you'll want to call your healthcare provider whenever your symptoms change in character. If you used to have heartburn, but now food feels like it is stuck in your chest, for example, it might be time to seek medical attention.

Furthermore, knowing the difference between heartburn and heart attacks (myocardial infarctions) can help you determine if you're dealing with something more serious. According to MedlinePlus, heart attacks can include signs such as shortness of breath, upper body discomfort, nausea, vomiting, lightheadedness, and chest discomfort that can sometimes feel like indigestion or heartburn. If you think you might be experiencing a heart attack rather than heartburn—or other symptoms along with the heartburn that may warrant immediate medical attention—contact emergency care personnel as soon as possible.

What is the best product for acid reflux?

If your symptoms strike less often, use a fast-acting over-the-counter antacid such as Maalox, Mylanta, Rolaids, or Tums. Or try an over-the-counter H2 blocker, such as famotidine (Pepcid AC) or ranitidine (Zantac 75). They tend to cause fewer side effects and are typically cheaper than PPIs.

Which acid reflux medicine works fastest?

Gaviscon+ is the only antacid product that provides fast-acting, long-lasting heartburn relief. It quickly neutralizes stomach acid and helps keep acid down for hours.

What medicine can I take daily for acid reflux?

Proton Pump Inhibitors (PPIs) for Heartburn and Reflux Dexlansoprazole (Dexilant) Esomeprazole (Nexium) Lansoprazole (Prevacid) Omeprazole (Prilosec and another with sodium bicarbonate, Zegerid)