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Key takeaways
Antacids act quickly to neutralize stomach acid but have a short-lived effect, making them suitable for occasional heartburn relief.
H2 blockers reduce stomach acid production with effects lasting several hours, but may lose effectiveness over time due to tachyphylaxis.
Proton pump inhibitors (PPIs) are recommended for frequent heartburn or GERD, offering long-lasting acid reduction, but may carry risks with extended use.
The choice of heartburn medicine should consider the severity and frequency of symptoms, potential interactions with other medications, and the active ingredients’ effectiveness and side effects.
If you’re one of the 60 million Americans that experience heartburn and indigestion every month, you may find yourself searching for relief and wondering what the best heartburn medicine is. With so many options on the market, it can be hard to know where to start.
Whether you’re looking for an over-the-counter heartburn medicine or something a little stronger, it’s important that you find something that works for you because heartburn can be a sign of gastroesophageal reflux. Gastroesophageal reflux, or GERD, is a health condition that can cause damage to the esophagus over time if left untreated. Here’s a look at some of the most common heartburn medicines and how to choose the best one for you.
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What is the best medicine for heartburn?
There are three main categories of heartburn medicines:
- Antacids
- H2 blockers
- Proton pump inhibitors (PPIs)
When choosing a heartburn medicine, it’s important to consider what type of heartburn you’re experiencing as well as the severity. If you’re someone who only experiences heartburn occasionally, an over-the-counter antacid may be all you need. However, if you find that heartburn is a regular occurrence, you may want to consider something stronger, like an H2 blocker or a PPI, which are available over the counter or as prescription medication.
“All three of these medication types are considered safe for short-term use—as long as you stick within the recommended dosing on the bottle,” explains Max Pitman, MD, a medical director at Salvo Health and board-certified physician specializing in gastroenterology and internal medicine at Summit Health in Brooklyn, New York. “For longer-term use, it’s best to discuss with your healthcare provider, since certain medication types—especially the PPIs—have a risk of side effects with extended use.”
1. Antacids
Antacids are the fastest-acting heartburn medicine available and are often the first line of defense against heartburn. They work by neutralizing the acid in your stomach and can provide nearly immediate relief. However, Dr. Pitman warns that the effect of antacids is short-lived because the stomach is constantly making more acid.
Antacids are available over the counter and can be purchased in a variety of forms, including liquids, chewable tablets, and gummies. Some of the most common types of antacids include:
- Tums (calcium carbonate)
- Rolaids (calcium carbonate-magnesium hydroxide)
- Mylanta (calcium carbonate-magnesium hydroxide-simethicone)
- Maalox (aluminum hydroxide-magnesium hydroxide-simethicone)
- Gaviscon (aluminum hydroxide-magnesium carbonate)
According to Suzanne Soliman, Pharm.D., a board-certified pharmacist and chief academic officer of the Accreditation Council for Medical Affairs, antacids usually contain calcium, magnesium, aluminum, or a combination of these. She adds that they may interact with some vitamins or medications, so it’s best to space out your medications and talk to your healthcare provider for guidance on which of your drugs may interact.
2. Histamine-2 antagonists
Histamine-2 antagonists, or H2 blockers, are often used when antacids aren’t effective in treating the symptoms of heartburn. H2 blockers are considered “acid reducers” because they work to actually reduce the amount of acid your stomach makes rather than neutralizing the acid that’s already there. As a result, these medicines take a little longer—30 to 90 minutes—to take effect and provide heartburn relief; however, the effects will last several hours.
“H2 blockers block the action of histamine on the acid producing cells that line the stomach,” Dr. Pitman says. “Normally histamine signals the stomach to produce more acid, so blocking the effect of histamine results in the stomach producing less acid.”
H2 blockers are available over the counter in low doses, or by prescription in higher doses. Common H2 blockers include:
- Zantac (famotidine)
- Pepcid AC (famotidine)
- Axid (nizatidine)
- Tagamet (cimetidine)
Experts advise that while H2 blockers can be useful for the short-term treatment of heartburn, they may lose their effect over time. “H2 blockers are great for on-demand use for more moderate symptoms,” Dr. Pitman says, “but they are not as helpful for long-term use because the body can sometimes become accustomed to H2 blockers, thus making them less effective over time. This effect is known as tachyphylaxis.”
3. Proton pump inhibitors
If you continue to experience heartburn regularly even after taking H2 blockers, you most likely have GERD. In this situation your healthcare provider may recommend a stronger heartburn medicine known as a proton pump inhibitor (PPI).
“PPIs are the most widely prescribed heartburn medications in the United States,” Dr. Pitman says. “They work by blocking the action of the ‘proton pump,’ which is the acid-secreting machinery within the acid-producing cells that line the stomach, known as parietal cells.”
Similar to H2 blockers, PPIs work by reducing acid production. PPIs, however, are not only stronger, they are longer lasting than H2 blockers.
Some PPIs are available over the counter in low doses, while higher doses and certain other PPIs are only available by prescription. Examples of PPIs include:
- Prilosec (omeprazole)
- Nexium 24hr (esomeprazole magnesium)
- Prevacid 24hr (lansoprazole)
- Aciphex (rabeprazole)
- Protonix (pantoprazole sodium)
- Dexilant (dexlansoprazole)
PPIs don’t work as quickly as H2 blockers and can take up to four days before you feel their full effect, according to Dr. Soliman. As a result, PPIs should be taken daily. However, they may not be advised for long-term use, as they have been associated with some risks. Experts advise talking to your healthcare provider before you start, or stop, taking a PPI medication.
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What to consider when choosing a heartburn medication
When it comes to heartburn, there is no one-size-fits-all solution. The best treatment for you will likely depend on the severity and frequency of your heartburn symptoms, but there are other factors to take into consideration as well.
When comparing heartburn medications, it’s important to read the label and follow the directions for proper use. Consult your healthcare provider if you have any questions about products or proper usage.
Here are some factors to consider when choosing a heartburn medication.
Frequency of symptoms
The frequency of your heartburn symptoms will play a role in the type of medication you choose. If you only experience heartburn occasionally, an over-the-counter antacid may be all you need for relief.
On the other hand, if you experience frequent heartburn even after making lifestyle changes and trying OTC treatments, you may need a prescription-strength PPI. These are generally recommended for those with severe heartburn that occurs at least two days per week.
However, keep in mind that PPIs are not intended for long-term use. “They should not be used for more than 14 days up to three times per year [unless prescribed by your doctor],” advises Dr. Soliman.
Frequent heartburn symptoms may also be a sign that you have gastroesophageal reflux disease (GERD)—a more severe condition that can lead to complications over time.
Active ingredients
Antacids, H2 blockers, and PPIs all contain different active ingredients. The specific ingredient can affect how well the medicine works for you, as well as how often you need to take it.
It’s also important to consider any other medication you are taking, since H2 blockers and PPIs may interact with other medications. Be sure to read the labels carefully and talk to your healthcare provider about which active ingredient may be best for you and if there are any that you should avoid.
Common active ingredients include:
- Antacids: Calcium carbonate, magnesium hydroxide, aluminum hydroxide
- H2 blockers: Cimetidine, famotidine, nizatidine
- PPIs: Lansoprazole, esomeprazole, omeprazole magnesium, pantoprazole
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Dosage
Dosage will also vary depending on the type of medication you choose and how severe your heartburn is. According to Dr. Soliman, you should choose the weakest medicine that treats your symptoms effectively.
“Always take the lowest dose for the shortest amount of time possible,” Dr. Soliman says. “OTC is a better place to start because it is lower dose, but if your symptoms do not resolve, speak to your healthcare provider, as they may recommend a [prescription strength] H2 blocker or PPI.”
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How long does it take for heartburn medication to work?
The length of time it takes for heartburn medication to kick in depends on the type of medication. Generally, you can expect relief in the following timeframes.
- Antacids: Start to work almost immediately—less than five minutes—after ingesting, but wear off quickly, after about 20-30 minutes
- H2 blockers: About 60-90 minutes—take 30 minutes before a meal to prevent symptoms. Benefits can last up to 24 hours.
- PPIs: Can take one to four days to begin fighting symptoms, however some patients experience relief after a few hours.
Side effects
All medications come with the potential for side effects, which can vary depending on the specific medication. Side effects will also vary from person to person.
Although rare, the following side effects have been noted:
- Antacids: Diarrhea, constipation, kidney stones, and loss of calcium
- H2 blockers: Headache, diarrhea, dizziness, rashes, and gynecomastia (enlarged breast tissue)
- PPIs: Headache, diarrhea, constipation, nausea, and itching
Before you take any medications, do your research to better understand the possible side effects associated with it. Talk to your healthcare provider if you are experiencing any side effects that you believe to be due to your heartburn medication—they may recommend a different heartburn medication for you to try.
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