What’s the Best Treatment for Acid Reflux? Antacids vs. H2 Blockers vs. Proton-Pump Inhibitors

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Medications for acid reflux, heartburn, and GERD (gastroesophageal reflux disease) come in three flavors: H2 blockers, proton-pump inhibitors (PPIs), and antacids. They all work differently and are geared towards either prevention or quick relief. If you’re struggling with reflux and want to start treating the symptoms yourself, here’s what you need to know:

H2 blockers — start here

H2 blockers are short-term preventative medications that decrease stomach acid. They block histamine, one of the body’s inflammatory agents, from stimulating the stomach to produce acid.

How should I take an H2 blocker?

If you have mild reflux symptoms that occur less than two times a week, you can start with a low dose of one of the following H2 blockers: ranitidine (Zantac), famotidine (Pepcid), or cimetidine (Tagamet). All three work better when taken on an empty stomach, without food. And remember: H2 blockers are only good for short-term use.

Any treatment for acid reflux should be accompanied by diet and lifestyle changes. Aim for no late night eating, elevating your head in bed at night, getting enough sleep, and so on. If symptoms persist, you can increase the dose of these medications to twice a day for two weeks.

Once your acid reflux improves, stop the medication. It’s very important to know that almost all H2 blockers don’t work well after two to six weeks. The stomach adjusts and they become much less effective.

Which H2 blocker is the best?

Ranitidine (Zantac). Compare to cimetidine (Tagamet), ranitidine is better at lowering acidity and relieving heartburn symptoms. With respect to famotidine (Pepcid), ranitidine has been shown in research to work faster. So, ranitidine appears to edge out the others here.

Proton-pump inhibitors — when H2 blockers don’t help

If after a couple weeks of taking H2 blockers your acid reflux symptoms still aren’t letting up, stop them and try a proton-pump inhibitor (PPI) once daily. These include omeprazole (Prilosec), pantoprazole (Protonix), and esomeprazole (Nexium), all now available with a prescription or over the counter. If your symptoms are under control using a PPI, continue taking it for 8 weeks. If your symptoms are not controlled, this is where you’ll come see us, your primary care doctors.

Antacids — for quick relief

Yes, you can take antacids too.

H2 blockers and proton-pump inhibitors work better than antacids, but if you need something for very quick relief, antacids are an option. Antacids don’t do anything to prevent GERD, but they can be used on demand for symptom relief.

Common antacids contain calcium carbonate (Tums, Rolaids) and/or magnesium (Mylanta, Maalox, milk of magnesia), and provide relief of heartburn within five minutes. However, they only work temporarily — for 30 to 60 minutes tops.

Dr O.

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