Antacids treat heartburn by weakening the acid in your stomach and work quickly to treat mild symptoms. They come in liquid, capsule and chewable tablet form. Many use different combinations of magnesium, calcium and aluminum mixed with hydroxide or bicarbonate ions to neutralize acid.
Pros: Antacids that contain calcium carbonate can provide extra calcium in your diet.
Cons: They don't control heartburn symptoms for very long. And they don't address any of the underlying causes of heartburn. They should not be used for more than two weeks without seeing your doctor. The can cause diarrhea or constipation depending on how they're formulated. Antacids containing sodium bicarbonate might not be a good choice for people on low-sodium diets.
Over-the-Counter: Rolaids, Tums
Mucosal Protective Drugs
These medications, available by prescription and over the counter, protect the stomach from acid by coating it. The effects can last from 30 minutes to 2 hours.
Pros: They tend to work quickly, but only work on existing acid, not preventing future acid production.
Cons: Some of these medications contain aluminum which can cause problems in people with impaired kidney function, specifically the elderly. The aluminum can also cause low phosphate levels, which leads to fatigue and muscle weakness.
Over-the-Counter: liquid antacids (Mylanta and Maalox), bismuth subsalicylate (Pepto-Bismol)
Prescription Strength: sucralfate (Carafate), misoprostol (Cytotec)
H-2 Receptor Blockers
Histamine type 2 receptor antagonists (also known as H-2 receptor blockers) cause the stomach to produce less acid. They come in dissolvable tablet, chewable tablet and capsule forms. They're available in both over-the-counter and prescription strength versions.
Pros: Effectively decrease acid production.
Cons: It may take a day or more before this kind of medicine starts working. Side effects include headache, constipation, diarrhea, nausea, vomiting. They should not be used for more than 2 weeks without the supervision of a doctor. Smoking decreases the effectiveness of H-2 receptor blockers by increasing stomach acid. H-2 drugs can also interact with alcohol causing an increase in blood alcohol levels.
Over-the-Counter: cimetidine (Tagamet HB), famotidine (Pepcid AC, Calmicid, Fluxid, Mylanta AR), nizatidine (Axid) or ranitidine (Zantac, Tritec, Wal-Zan)
Prescription Strength: cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), ranitidine (Zantac)
Proton Pump Inhibitors
PPIs cause the stomach to produce less acid. They come in tablet or capsule form. They work best when taken about 30 minutes before the first meal of the day. They're available in both over-the-counter and prescription strength versions.
Pros: Allows the esophagus to heal by reducing the exposure to acid. Have been shown to be more effective than H-2 receptor blockers.
Cons: Very overweight people have been shown to not respond as well to PPIs. Must be taken every day whether you have symptoms or not. May cause increase the odds of developing diarrhea or pneumonia. Long-term use may increase the risk of osteoporosis and hip fractures.
Over-the-Counter: lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Losec, Omesec, Zegerid)
Prescription Strength: esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), dexlansoprazole (Dexilant)