What’s the Best Heartburn Treatment?

two prescription bottles with pills next to them
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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Over the counter medications for heartburn and GERD (gastroesophageal reflux disease) come in two flavors: H2 blockers and proton pump inhibitors (PPIs) like Prilosec (omeprazole) and Nexium (esomeprazole).

If you are struggling with heartburn or reflux and want to start treating the symptoms on your own, you can start with an H2 blocker.

Here’s what you need to know.

What should I start with?

With mild symptoms occurring less than twice a week you can start with a low dose H2 blocker like Zantac, Pepcid, or Tagamet once a day. In addition, you’ll want to make changes in diet and lifestyle: no late night eating, elevate your head in bed at night, and so on). If symptoms persist, you can increase the dose of these medications to twice a day for two weeks.

How do H2 blockers like Zantac work?

They all work to decrease acidity in the stomach. Zantac (ranitidine), Pepcid (famotidine) and Tagamet (cimetidine) work by inhibiting histamine at the H2-receptors of cells in the stomach called parietal cells. This in turn inhibits gastric acid secretion—which lowers the acidity in your stomach.

Is one H2 blocker better than the others?

Studies show fewer heartburn symptoms with ranitidine (Zantac) than cimetidine, and ranitidine lowers acidity more than cimetidine. Ranitidine has also been compared to famotidine in studies, and works much better in the first 2.5 hours after it’s taken. So, Ranitidine appears to edge out the others here in many studies.

All three work better when taken on an empty stomach, without food.

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Can I take an antacid too?

H2 blockers work better than antacids but yes—if you need to take something for very quick relief these are an option. Antacids don’t do anything to prevent GERD but they can be used on-demand for symptom relief. Common antacids contain a combination of magnesium (Mylanta, Maalox, milk of magnesia) or calcium carbonate (Tums) and provide relief of heartburn within five minutes. However, they only work for 30 to 60 minutes.

Should I keep taking my Zantac, Tagamet, or Pepcid if they’re helping?

No. A very important thing to know about all of the H2 blockers listed above is they don’t work well after 2-6 weeks. The stomach adjusts and they become much less effective. So they are not good for maintenance therapy for heartburn or GERD.

Ok, Zantac, Tagamet and Pepcid aren’t working, now what?

If after a couple weeks of taking these your symptoms of GERD persist, stop them and start with a once daily proton pump inhibitor (PPI). These include Prilosec (omeprazole), Protonix (pantoprazole), and Nexium (esomeprazole), 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.

Dr O.

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