Prescription and OTC Heartburn Remedies

I remember clearly the first time I realized that my heartburn was probably a symptom of a more serious condition. I was sitting at my desk at work sipping on a cup of coffee, trying to wake up, when I felt a searing pain in my chest. It was as if the coffee in my mug had turned into battery acid!

I reached for the Tums that I always had with me and chewed a couple. The pain decreased but the burning sensation returned later in the day. That night, I took some Pepto and went to sleep. I was rudely awoken after midnight with a burning in the back of my throat that make me cough until I was hoarse.

A few days later, I sat in my doctor's office describing my symptoms. She diagnosed my heartburn as possibly gastroesophageal reflux disease (GERD) and ordered a barium swallow and X-Ray to determine the amount of damage there was to my esophagus.

The culprit turned out to be a hiatal hernia and she prescribed a proton pump inhibitor (PPI) to decrease the amount of acid in my stomach. In a few short days, I had tried three different common heartburn remedies. (In the end, the PPI worked well to manage my symptoms.)

Finding Heartburn Relief
For the relief of occasional heartburn caused by eating spicy foods or simply eating too much, an antacid is usually a good bet. But if you find yourself reaching for the Tums or Pepto several times a week, it's time to visit your doctor to discover if you have a more serious condition like GERD or a peptic ulcer.
Treating chronic heartburn typically requires a stronger medicine like an H-2 receptor blocker or a proton pump inhibitor. Over-the-counter-strength versions of many of these drugs are readily available these days, but it's best to discuss your options with a doctor or pharmacist before diving in.
If over-the-counter remedies prove ineffective, your doctor can prescriber stronger versions of H-2s and PPIs, or even a less common prescription called a prokinetic agent. Before heading to the pharmacy or to your doctor's office, read below to learn about the pros and cons of each kind of treatment.
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)
Prokinetic Agents
Prokinetics work by strengthening the lower esophageal sphincter (LES) and causing the stomach to empty faster. They're only available by prescription.

Pros: Actually helps strengthen the LES.

Cons: Side effects include fatigue, sleepiness, depression and anxiety.

Prescription: metoclopramide (Reglan), bethanechol (Urecholine)

This article has been reviewed and approved by Becky Hand, Licensed and Registered Dietitian.

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