Key takeaways:
Antacids, histamine-2 antagonists (H2 blockers), and proton pump inhibitors (PPIs) are the best over-the-counter (OTC) medications for heartburn.
Antacids provide quick relief but don’t last long. H2 blockers and PPIs can take more time to work, but their effects last longer. The best OTC heartburn medication depends on your symptoms as well as the other medications you’re taking.
If heartburn doesn’t improve, or if you need to take an OTC heartburn medication for more than 2 weeks, it’s time to see a healthcare professional.
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You just finished eating a delicious, cheesy slice of deep-dish pizza. As you lie back on the couch to watch television, you suddenly feel a burning sensation in your chest. This may be a classic sign of heartburn — a symptom of acid reflux. Acid reflux happens when your stomach contents flow backward into your esophagus (the tube that carries food from your mouth to your stomach).
More than 60 million Americans experience heartburn at least once a month. Thankfully, there are many medications available to relieve heartburn. And you can find several effective options over-the-counter (OTC) at your local drugstore. Keep reading to learn more about the best OTC antacids for acid reflux and other OTC heartburn relief medications.
What OTC medications are available for acid reflux and heartburn relief?
There are three main groups of OTC medications for acid reflux. They work in different ways, which we’ll discuss below.
Antacids
As mentioned, heartburn symptoms happen when stomach contents flow back towards the esophagus. The burning sensation you might feel is because the contents of your stomach are acidic. Antacids provide relief by neutralizing your stomach acid.
Antacids usually work quickly — often within minutes. It’s recommended to take antacids within 1 hour after eating or immediately when heartburn symptoms occur. But their effects might not last long, usually for just about 1 hour.
One thing to keep in mind with antacids is that they can affect how well other medications are absorbed. You may need to take other medications 1 hour before or 4 hours after taking antacids. This is why it’s a good idea to have your pharmacist or prescriber check your medication list before taking an antacid. They can let you know if there are any interactions to know about.
There are many different OTC antacids for acid reflux. They usually contain calcium, aluminum, magnesium — or some combination of these. Antacids come in different forms, including chewable tablets, liquids, and gummies.
Common OTC antacids for acid reflux include:
Tums (calcium carbonate)
Milk of Magnesia (magnesium hydroxide)
Rolaids (calcium carbonate / magnesium hydroxide)
Mylanta (aluminum hydroxide / magnesium hydroxide / simethicone)
These OTC antacids all work similarly well for acid reflux. Products with simethicone are helpful if you have gas or bloating along with heartburn. Otherwise, you can choose whatever flavor or dosage form you prefer. But if you need to take an antacid for more than 2 weeks at a time or your symptoms haven’t improved, it’s time to see a healthcare professional.
Histamine-2 antagonists
OTC histamine-2 antagonists (H2 blockers) can treat or prevent heartburn symptoms.
H2 blockers work by blocking histamine-2 receptors (binding sites) in your stomach. This lowers the amount of acid made there. H2 blockers usually start working within 1 to 3 hours after you take them, and can provide relief for several hours. They work best if you take them before you eat or drink anything that may cause heartburn. But you can take them after you start having symptoms, too. OTC H2 blockers are available as tablets and capsules.
The most common OTC H2 blockers include:
Famotidine (Zantac 360, Pepcid AC)
Cimetidine (Tagamet HB)
If you take H2 blockers for a long time, they may not work as well as they did at first. Over time, your stomach adapts to the medication, which can limit their benefit. If you need an H2 blocker daily for longer than 2 weeks, talk to a healthcare professional. There could be a more serious issue behind your symptoms.
Proton pump inhibitors
Proton pump inhibitors (PPIs) are another OTC heartburn medication. They work by blocking an enzyme (protein) in stomach cells. This enzyme is known as the “proton pump.” The proton pump helps the stomach make acid. By blocking it, PPIs lower acid levels in the stomach.
PPIs take longer than antacids or H2 blockers to improve heartburn symptoms. It can take about 3 days for PPIs to have a noticeable effect. So they typically work better to prevent frequent heartburn than to treat an occasional episode.
PPIs are available OTC as tablets, capsules, and orally disintegrating tablets. Common PPIs include:
Omeprazole (Prilosec OTC)
Esomeprazole (Nexium 24HR)
Lansoprazole (Prevacid 24HR)
You should only take an OTC PPI for 2 weeks at a time up to 3 times each year unless otherwise directed to by a healthcare professional. Taking them longer or more often than directed can lead to harmful side effects. More on this later.
Is one OTC medication better than the others for heartburn?
When it comes to which OTC acid reflux medication is best, it depends on your heartburn symptoms and how frequent they are.
Antacids are good options for heartburn symptoms that occur once in a while. This is because they work quickly to provide relief when needed.
H2 blockers and PPIs block the production of acid in your stomach. So they’re a better option to help prevent or treat frequent heartburn.
Keep in mind that all OTC heartburn medications can interact with other medications you’re taking. So it’s a good idea to check with your pharmacist or prescriber to see if one option is safer for you than another based on your current medication list.
What about OTC medications for GERD?
Gastroesophageal reflux disease (GERD) is a more serious form of acid reflux. You shouldn’t treat GERD on your own with OTC medications. That’s because there could be other causes of frequent heartburn that require different treatment.
That being said, PPIs are considered the first-choice treatment for GERD. H2 blockers are also effective for GERD, but they’re typically reserved for those who can’t tolerate PPIs. Antacids work for occasional heartburn, but they don’t treat or prevent GERD.
What side effects can you expect from OTC heartburn treatments?
OTC heartburn medications cause different side effects. As mentioned, they can also interact with other medications you’re taking. It’s a good idea to discuss these risks with your healthcare team before starting an OTC heartburn medication.
Common side effects of antacids, H2 blockers, and PPIs are listed below.
| Antacids | H2 blockers | PPIs | |
|---|---|---|---|
| Potential side effects |
|
|
|
More severe side effects can occur with these medications too.
Antacids with calcium can cause kidney stones, and antacids with aluminum can cause weaker bones (osteoporosis) if you take them too often.
H2 blockers can have serious side effects for people with kidney or liver problems and those over age 50. In rare cases, confusion, slurred speech, and hallucinations can occur. This seems to be most common with cimetidine, but can happen with any H2 blocker. Talk to a healthcare professional if you have any kidney or liver issues before starting an H2 blocker.
Taking PPIs for a long period of time (more than 4 months) has also been linked to more serious side effects. These include:
Clostridioides difficile (C. diff) diarrhea
Higher risk of fractures (especially in the hip, wrist, and spine)
It’s best to take OTC heartburn medications at the lowest effective dose and for the shortest amount of time needed to reduce the risk of serious side effects. As mentioned, you shouldn’t take any OTC heartburn medication for more than 2 weeks at a time without a healthcare professional’s OK.
When should you see a healthcare professional for heartburn?
If you’re having heartburn more than two to three times a week, or your symptoms worsen or don’t improve with OTC medications, it’s time to seek medical care. These can be signs of a more serious health condition, such as GERD or peptic ulcer disease (PUD).
These conditions can worsen without proper treatment, even if you’re able to mask the symptoms with OTC heartburn medications. A healthcare professional can help determine exactly what’s going on and the best treatment plan moving forward.
Good to know: Heartburn symptoms can also resemble signs of a heart attack. Both can cause chest pain, but a heart attack can also cause trouble breathing, lightheadedness, and sweating. Still, if you’re unsure what’s causing your symptoms, it’s best to call 911 or seek emergency care.
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Frequently asked questions
Water is your best bet when you have heartburn — it lowers stomach acid quickly after you drink it. Some evidence also suggests that chamomile tea and aloe vera juice may help with acid reflux. It’s also common to hear that drinking milk or apple cider vinegar helps with heartburn, but there’s no evidence that either of these drinks actually work. You should also avoid drinks such as coffee, soda, and alcohol, which can worsen heartburn symptoms.
It’s generally fine to combine an antacid with an H2 blocker or a PPI. In fact, some OTC heartburn medications are sold as combination treatments, such as Pepcid Complete (famotidine / calcium carbonate / magnesium hydroxide). But you shouldn’t take an H2 blocker and a PPI at the same time without a healthcare professional’s OK.
Pepcid and Tums are both effective options for occasional acid reflux. Both can relieve your symptoms quickly, but Pepcid may last a bit longer. If you have heartburn often, Pepcid is a better choice to help prevent symptoms. But if you need to take it for more than 2 weeks, it’s time to see a healthcare professional.
Water is your best bet when you have heartburn — it lowers stomach acid quickly after you drink it. Some evidence also suggests that chamomile tea and aloe vera juice may help with acid reflux. It’s also common to hear that drinking milk or apple cider vinegar helps with heartburn, but there’s no evidence that either of these drinks actually work. You should also avoid drinks such as coffee, soda, and alcohol, which can worsen heartburn symptoms.
It’s generally fine to combine an antacid with an H2 blocker or a PPI. In fact, some OTC heartburn medications are sold as combination treatments, such as Pepcid Complete (famotidine / calcium carbonate / magnesium hydroxide). But you shouldn’t take an H2 blocker and a PPI at the same time without a healthcare professional’s OK.
Pepcid and Tums are both effective options for occasional acid reflux. Both can relieve your symptoms quickly, but Pepcid may last a bit longer. If you have heartburn often, Pepcid is a better choice to help prevent symptoms. But if you need to take it for more than 2 weeks, it’s time to see a healthcare professional.
The bottom line
Over-the-counter (OTC) heartburn medications include antacids, histamine-2 antagonists (H2 blockers), and proton pump inhibitors (PPIs). Antacids provide quick relief, but it isn’t long-lasting. H2 blockers and PPIs take more time to work, but have longer-lasting effects and can prevent acid reflux from occurring. So they’re typically better for more frequent heartburn symptoms.
All OTC heartburn medications have side effects and drug interactions to consider. The best OTC heartburn medication depends on your symptoms as well as the other medications you’re taking. If you need to take heartburn medication for more than 2 weeks or your symptoms worsen, it’s time to see a healthcare professional.
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