Heartburn (Acid Reflux) Medication: OTC vs Prescription Options

Heartburn is a common and uncomfortable symptom, affecting more than 15 million Americans daily. Thankfully, there are many treatment options available, including prescription and over-the-counter (OTC) medications. 

In this article, I’ll describe the causes of heartburn and the OTC medications available. I’ll also cover the side effects of heartburn medication and how to use heartburn medication safely. Finally, I’ll explain when you should see a healthcare provider for more personalized care.

Over-the-counter Medications for Heartburn

Over-the-counter (OTC) medications can help treat heartburn, but it may take a little trial and error to figure out what works best for you. If you still experience symptoms after two weeks, see your healthcare provider or doctor, who may recommend prescription medication.

OTC treatment options include:  

Histamine-2 (H2) blockers

These medicines, available both by prescription and OTC, help reduce the amount of acid your stomach produces, which can help alleviate heartburn. H2 blockers don’t work as quickly to reduce heartburn as antacids, but the effect can last longer. Examples of H2 blockers include famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75). 

Antacids 

OTC antacids are usually the first-line recommendation for acid reflux and heartburn. They work by neutralizing acids in your stomach and can provide fast, short-term relief. Antacids are available in multiple forms—chewables, dissolving tablets, and liquids.

Some examples of antacids include calcium carbonate (Tums), loperamide (Imodium), simethicone (Mylanta), and sodium bicarbonate (Alka-Seltzer).

Proton pump inhibitors (PPIs) 

PPIs are especially effective at reducing stomach acid to treat symptoms of indigestion and heartburn. Your doctor may recommend PPIs if antacids or H2 blockers have failed to resolve your symptoms.

Recently, some PPIs have become available OTC, including esomeprazole (Nexium) and omeprazole (Prilosec). Other PPIs, like Dexlansoprazole (Dexilant) and Rabeprazole (AcipHex), are only available with a prescription. 

OTC vs Prescription GERD Medications

Most people try out OTC medications before seeing a healthcare provider for prescription GERD medications. Some OTC medications, including antacids like Alka-Seltzer, Maalox, and Mylanta, can provide immediate relief if you’re already experiencing heartburn or indigestion, and other medications, like H2 blockers, can lower your risk of experiencing it in the first place. 

Prescription medications like proton pump inhibitors (PPIs) can also lower your risk of experiencing it and may provide longer-lasting relief than some OTC medications, though those may work more immediately. Talk to your healthcare provider about your needs and which may work best for you.

The best prevention of Heartburn is dietary modifications. Controlling the amount of fried, spicy, citrus, and irritative foods in one’s diet can greatly improve digestive health. These foods irritate the stomach and esophagus thus causing reflux.  Not laying back after eating, not smoking and staying hydrated can also help digestion and preventing GERD and heartburn.

Side Effects of Heartburn Medication

Like most medicines, heartburn medications may cause side effects. Though rare, the most commonly reported side effects of antacids and acid-reducing medications are:

• Headaches
• Nausea
• Constipation
• Diarrhea

If you experience one or more of the above side effects while taking an antacid or acid-reducing medication, they will likely go away on their own. If side effects persist, reach out to your doctor. Side effects of proton pump inhibitors (PPI) may be more serious.

Research shows that long term use of PPIs can lead to kidney problems, including kidney failure. Experts recommend using PPIs only when necessary and not as a regular medication.

Additionally, you should not take PPIs if you are elderly, immunocompromised, postmenopausal, or have been treated for a Clostridium difficile (C. diff) infection in the past. Talk to your healthcare provider before taking any OTC heartburn medication.

Which Heartburn Medication is Best?

There’s no one-size-fits-all medication for any ailment. You’ll want to talk to your healthcare provider about whether an OTC antacid, H2 blocker, or proton pump inhibitor (PPI) is best for you. They’ll talk about how severe your symptoms are, how frequently you experience them, and whether your goal is immediate relief, prevention, or to reduce severity of symptoms. 

How to Use Heartburn Medication Safely

Before starting any new medication, talk to your healthcare provider to ensure that it’s safe to use. If you do start using one of these medications, it’s important to take it exactly as directed on the label.

Do not exceed the amount or timing recommended. If your symptoms continue even after taking medication, reach out to your provider.

What is Heartburn and Acid Reflux?

Heartburn can be a symptom of many different conditions, including gastroesophageal reflux disease (GERD), acid reflux, and pregnancy.  Generally, heartburn is an uncomfortable burning feeling in your chest that can move up and down your throat.

Other signs of heartburn can include:

• Regurgitation, or the feeling of fluid or food coming up into the chest
• Chest pain or burning that worsens when lying down or bending over
• Bitter, hot, sour, or acidic taste in the mouth
• Pain or discomfort that appear after a large or spicy meal
• Difficulty swallowing
• Pain that can move into your throat, but doesn’t usually radiate to your shoulders, neck and arms

For some, heartburn is triggered by lifestyle and diet habits. You are more at risk for developing heartburn if you:

• Eat large portions of food
• Eat spicy, fatty, or greasy foods
• Eat acidic foods such as tomatoes or citrus
• Eat close to bedtime
• Drink large amounts of caffeinated, alcoholic, or carbonated drinks
• Experience stress
• Smoke
• Wear tight-fitting clothes

However, heartburn can also be caused by other conditions, including:

• Anxiety or depression
• Acid reflux 
• Gastroesophageal reflux disease (GERD)
• Pregnancy
• Hiatal hernia

Heartburn, acid reflux, and GERD

Though the terms are sometimes used interchangeably, heartburn, acid reflux, and GERD have distinct meanings. Heartburn refers to the symptom that can be caused by acid reflux or GERD.

Acid reflux refers to the condition when stomach acid flows back up into the mouth through the esophagus. This occurs when the valve at the end of the esophagus doesn’t close properly when food enters the stomach.

GERD is chronic acid reflux, a condition in which stomach acid persistently leaks back up into your esophagus. Everyone can get heartburn and acid reflux from time to time, but GERD is a chronic condition that can lead to more serious problems if not treated.

When to See a Healthcare Professional

Many cases of mild heartburn can be managed at home and with OTC medication. But if you experience any of the below symptoms, reach out to your doctor or healthcare provider immediately:

• Unintentional weight loss or loss of appetite
• Bloody vomit
• Frequent vomiting
• Black, tarry stool
• Severe, constant stomach pain 
• Difficulty swallowing that gets progressively worse
• Fatigue or weakness
• Shortness of breath, sweating, or chest pain that radiates to the neck, jaw, or arm
• Chest pain with stress or exertion
• Yellowing of the skin or eyes
• Heartburn symptoms that last longer than two weeks

How K Health Can Help

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