5 Best Heartburn Medicines - Feb. 2023 - BestReviews (2023)

Believe it or not, sometimes we do eat the whole thing. Occasional food indiscretions, especially with spicy or acidic dishes, can lead to a painful but temporary discomfort known as heartburn or acid reflux. For many years, the strongest cures for these ailments were only available by prescription, and often expensive. Fortunately, the FDA has approved a number of advanced heartburn-relief medicines for over-the-counter sales, including some of the best-known brands on the market. Now heartburn relief is available at your nearby drugstore, no prescription required.

If you’re looking for a powerful pill-size ally in the fight against heartburn and acid reflux, we at BestReviews have created this shopping guide to walk you through the sometimes challenging process of finding exactly the right medication to meet your particular needs.

Here’s what you need to know the next time your favorite pizza or spicy taco decides not to play fair.

Types of OTC heartburn medicines

There was a time when the most common OTC remedies for heartburn were either chalky antacids or medicinal effervescent tablets. Anything stronger was usually very expensive, available only by prescription, and reserved for those who were diagnosed with bleeding ulcers or other serious digestion-related conditions.

In the 1980s, the U.S. Food and Drug Administration (FDA) started approving OTC versions of several of these medications. Here are the three most popular types available without a prescription:

Acid neutralizer

Acid neutralizers use chemical bases, such as calcium carbonate, to reduce the stomach’s acidity level. When a base interacts with an acid, the pH level moves closer to neutral, thus reducing the effects of stomach acid on the esophagus. Antacids provide almost immediate relief because they interact directly with stomach acids, unlike the medicines described below, which must first enter the bloodstream. The soothing effects of antacids can be short-lived, however. Common antacids include Tums, Rolaids, and Alka-Seltzer.

Proton pump inhibitor (PPI)

The human stomach naturally balances its acidic level through a network of proton pumps. Certain foods can overstimulate these pumps, and the result is a highly acidic stomach. This can trigger heartburn if the acid is regurgitated into the esophagus. A PPI permanently blocks the production of acid through these pumps, which in turn reduces the level of acid in the stomach and minimizes the damage caused by reflux. PPIs take longer to reach maximum effectiveness but provide longer-term relief. Popular brands include Nexium, Prilosec, and Prevacid.

Histamine 2 receptor antagonist (H2RA)

Commonly known as histamine blockers, these heartburn medications work by blocking a form of histamine from ordering more acid production in the stomach. If the stomach doesn’t receive this command, the proton pumps don’t release more acid. A less acidic stomach means less damage to the esophagus during reflux, thus reducing the painful burning sensation associated with heartburn, acid reflux, and gastroesophageal reflux disease (GERD). The proton pumps aren’t affected in any way, unlike the effects of a PPI. Common brands include Pepcid, Tagamet, and Zantac.

Heartburn medicine factors to consider

When shopping for a new heartburn medicine, there are a number of important factors to consider. Some consumers might only need short-term relief from occasionally eating trigger foods. Others might need a longer-term treatment for chronic acid reflux, GERD, or a sensitive stomach. It isn’t unusual to experiment with different types of heartburn medicines in order to find the one that brings the most reliable relief. Here are some important factors to consider while looking:

Relief onset time: While traditional antacid brands offer relief in seconds or minutes, H2RAs and PPIs generally take hours or even days. This delay isn’t necessarily a bad thing since these medicines provide longer-term relief. When comparing H2RAs and PPIs, keep in mind that H2RAs usually have a faster onset time, but the effects of PPIs last longer. If faster relief of an occasional bout of heartburn is the goal, try an H2RA first. For more frequent acid reflux, a PPI might be more appropriate.

Mechanism: Different types of heartburn medicine use different mechanisms to address the same basic problem. Antacids chemically neutralize stomach acids but don’t affect acid production. H2RAs enter the bloodstream and block acid production. PPIs actually shut down acid production. Consumers should consider the severity and frequency of their heartburn symptoms and shop accordingly.

Side effects and drug interactions: Even traditional antacid tablets or liquid medications can have some unpleasant side effects if used for a long time, such as constipation or diarrhea. Both H2RAs and PPIs can reduce the effectiveness of certain prescription drugs because they affect digestion. PPIs, especially when used for a long time, have been known to affect the absorption of essential vitamins and minerals, notably calcium. Consult with a medical professional before starting a treatment plan involving H2RAs or PPIs.

Safety: At one point, both H2RAs and PPIs were only available by prescription because of their potency and long-lasting effects. These medicines eventually became so popular that the FDA approved them for OTC sales. When the original patents expired, less-expensive generic versions became available.

Few experts doubt the effectiveness of OTC H2RAs and PPIs when used as short-term acid reducers. These medications work exactly as designed. However, a number of users have reported some serious side effects as a result of long-term use. These anecdotal reports raise some legitimate concerns about the safety of these products, but manufacturers and the FDA have performed stringent studies and concluded these heartburn medicines are safe when used as directed.

The main concern with PPIs is the mechanism that reduces stomach acid production. Instead of neutralizing the acid chemically like an antacid or blocking the production signal like an H2RA, a PPI disables the acid-producing proton pump itself. Over time, many of these proton pumps shut down permanently, making it challenging for the stomach to produce beneficial levels of acid when required. Some long-term users of PPIs develop serious medical conditions as a result, but physicians and manufacturers strongly discourage the long-term use of these products.

Did you know?

Many antacid tablets take effect immediately, but some PPI-type heartburn medicines can require one to three days to reach peak performance levels.

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Heartburn medicine prices

When formerly prescription-only PPIs, such as Nexium, first arrived on the market, the price point was notoriously high compared to OTC antacids. The selling point was its effectiveness: PPIs or H2RAs had the power to provide long-term relief of major symptoms as opposed to taking chalky tablets every few hours or preparing a very medicinal-tasting beverage.

The consumer market has changed considerably in recent years, and now generic forms of PPIs and H2RAs can be found in the same price range as antacid tablets or multi-symptom liquid medicines. You can expect to pay from less than $5 to $15 and up for heartburn medicines.

Inexpensive: For under $5, you’ll find a wide assortment of traditional carbonate-based antacid tablets. These medicines do have their limitations in terms of long-lasting symptom relief, but they work quickly without having to enter the bloodstream. Some smaller travel-size packets containing one or two H2RAs or PPIs might also be found in this price range.

Mid-range: Between $5 and $15 is where generic versions of higher-end H2RAs and PPIs share shelves with premium versions of traditional antacids. H2RAs are generally less expensive than PPIs, so consumers can find generic and store-brand H2RAs more readily at this price, but it pays to know the generic name of formulas associated with both types. When shopping for generic or store brand versions, pay close attention to the packaging. Many include comparisons to brand name H2RAs or PPIs.

Expensive: At over $15, the PPI brands become more prominent. Premium H2RAs with advanced formulas can be found, too, often sold in bulk packaging. The brand name PPIs might also be promoted as “full prescription strength,” although this is a matter of debate. Some PPIs intended for long-term use are still prescription only and are stronger than their OTC counterparts.

Tips

• Allow enough time for the medication to start working. Unlike an antacid tablet or liquid, both H2RAs and PPIs require time to enter the bloodstream and do their work. Some users experiencing severe heartburn pain could be disappointed by the elapsed time between treatment and relief.

• Anticipate the need for preventative heartburn relief. The best time to take an H2RA or PPI is hours ahead of a meal or other occasion when spicy foods may be served. While a traditional antacid tablet can provide temporary and immediate relief after an overindulgence, H2RAs and PPIs are designed to prepare the stomach for trouble ahead of time.

• Know your trigger foods. Many people learn over time which types of foods or beverages could possibly lead to acid reflux, indigestion, or heartburn. Recognizing potential digestive or acidity issues ahead of time and taking proper precautions can help prevent the onset of painful symptoms.

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• Don’t combine H2RAs and PPIs. While it’s generally safe to use a traditional antacid or liquid for more immediate relief, you should never take an H2RA and a PPI at the same time. These medications perform two entirely different tasks, and combining them won’t enhance their effectiveness. An H2RA, especially in chewable tablet form, is often viewed as the next progression from traditional antacids. If an H2RA doesn’t provide relief, consider ramping up to a PPI.

• Seek medical advice if symptoms worsen. Sometimes frequent and severe heartburn symptoms indicate a much more serious medical condition. Most users do experience relief after taking either an H2RA or PPI, but there could be an undiagnosed or underlying medical situation that needs to be addressed by professionals. Don’t increase the dosage or frequency of a heartburn medication if there is no significant relief over a period of days.

FAQ

Q. I take quite a few prescriptions medications every day. Will an H2RA or PPI have a negative interaction with any of them?

A. Yes, there might be some issues with drug interaction with certain H2RA and PPI heartburn medicines, so it’s important to discuss this with a medical professional before taking a new OTC medication. The OTC formulation strength itself shouldn’t be problematic for most users, but the active ingredients might reduce the effectiveness of other medications or affect the absorption of vitamins and minerals.

Q. I just took a PPI heartburn pill for my acid reflux, but I’m still in a lot of discomfort. Can I take an antacid tablet or a medicated effervescent drink while I’m waiting for the PPI to kick in?

A. In most cases, it’s perfectly safe to use a fast-acting antacid in combination with an H2RA or PPI. The two medications have different mechanisms and treat different conditions. However, we don’t recommend taking an antacid and a PPI or H2RA at the same time. If you require immediate pain relief from acid reflux or a sour stomach, wait at least 15 minutes before taking an antacid tablet, liquid medicine, or effervescent drink.

Q. If I start taking an H2RA or PPI for my acid reflux, will I have to keep taking that same medicine for all future incidents? I don’t want to become addicted or dependent.

A. Over-the-counter heartburn medicines are intended for short-term relief of occasional acid reflux or other digestive issues. They aren’t habit-forming or addictive by design. Some users might prefer to use the same brand because of its reliable results or effectiveness, but the stomach doesn’t build up a tolerance. You can switch between an antacid, H2RA, and PPI for different types of heartburn or acid reflux conditions.