Pepcid vs. Prevacid for Heartburn and Gastric Ulcer: Important Differences and Potential Risks.

Key takeaways

Famotidine (Pepcid AC) and lansoprazole (Prevacid) are both used to treat conditions related to excess stomach acid, but they belong to different medication classes. Famotidine is a histamine-2 (H2) antagonist, which works by lowering the amount of acid released in the stomach. It starts working within an hour and is available both over-the-counter and by prescription. On the other hand, lansoprazole is a proton pump inhibitor (PPI) that blocks acid from being pumped into the stomach, taking about three days to fully kick in. Famotidine is typically taken twice a day, while lansoprazole is usually taken once daily. Famotidine can cause side effects like headache, dizziness, and constipation, whereas lansoprazole might lead to diarrhea and belly pain, with long-term use potentially causing bone fractures and low magnesium levels. Lansoprazole is also available in a form that can be sprinkled on food, which can be helpful if you have trouble swallowing pills.

Famotidine

(Pepcid)

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Lansoprazole

(Prevacid)

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Summary for Pepcid

Prescription or over-the-counter

Famotidine (Pepcid) is a type of acid reducer called a histamine-2 (H2) antagonist. It helps treat problems caused by too much stomach acid. Over-the-counter famotidine (Pepcid or Pepcid AC) can help with heartburn in people who are 12 and up. Prescription-only famotidine is for people with more ongoing stomach acid problems and stomach or gut ulcers. This medication is taken by mouth once or twice a day. It usually starts to work within an hour and lasts several hours. Side effects include headache, dizziness, and constipation.

Indications for Pepcid

Over-the-counter famotidine:
- Prevention and relief of heartburn (gastroesophageal reflux disease or GERD)
Prescription famotidine:
- Stomach ulcers
- Intestinal ulcers
- Heartburn (GERD)
- Erosive esophagitis (inflammation of the esophagus) due to GERD
- Other conditions that cause too much stomach acid (e.g., Zollinger-Ellison syndrome)

Pros and Cons for Pepcid

Pros

Available over the counter (OTC) for heartburn
Effects can last for up to several hours after taking
Generally well-tolerated with few side effects and risks
Can take with antacids if needed (e.g., calcium carbonate (Tums))

Cons

Can take 1 to 3 hours to fully work
OTC version not for children under 12 years old
Higher risk of certain side effects in older adults and people with kidney problems
Might not work as well as proton pump inhibitors (PPIs) for relieving heartburn and healing stomach ulcers

Common Side Effects for Pepcid

Headache
Dizziness
Constipation
Diarrhea

Warnings for Pepcid

Confusion and other side effects related to the nervous system in some people
Masking of possible stomach cancer

Summary for Prevacid

Prescription or over-the-counter

Lansoprazole (Prevacid) a proton-pump inhibitor (PPI). It treats heartburn, gastroesophageal reflux disease (GERD), and other similar conditions by lowering the amount of acid produced in the stomach. Lansoprazole (Prevacid) is available over the counter (OTC) for adults only, while providers can prescribe lansoprazole (Prevacid) for children and adults. Lansoprazole (Prevacid) is taken by mouth, typically once daily for most conditions. Although there aren't many noticeable side effects on a day-to-day basis, long-term use of lansoprazole (Prevacid) can raise certain risks like bone fractures.

Indications for Prevacid

For adults only:

Frequent heartburn (2 or more days a week) - OTC only
Stomach or duodenal ulcer
Lower the risk of duodenal ulcer caused by Helicobacter pylori (H. pylori) infection
Lower the risk of stomach ulcer due to nonsteroidal anti-inflammatory drugs (NSAID)
Other medical conditions that cause too much stomach acid (e.g., Zollinger-Ellison syndrome)

For adults and children:

Pros and Cons for Prevacid

Pros

Can continue to use with antacids, such as calcium carbonate
Available as over-the-counter and lower-cost generic options
Capsules can be opened and sprinkled over soft foods (e.g., applesauce, yogurt)
Typically few to no noticeable day-to-day side effects

Cons

Takes about 3 days for the medication to fully kick in, so not the best choice for immediate heartburn relief
Might cause or worsen lupus
Long-term use might weaken bones and raise the risk of bone fracture
Can lower magnesium and vitamin B12 levels

Common Side Effects for Prevacid

Diarrhea (4%)
Belly pain (2%)

Warnings for Prevacid

Risk of hiding symptoms of a more serious problem
Sudden kidney problems
Severe infectious diarrhea
Bone fractures
Skin reactions
Lupus
Low vitamin B12 and magnesium levels
Interaction with other medications
Caution use in people with phenylketonuria (PKU) - orally disintegrating tablets only