Exploring 9 Alternatives to Omeprazole, From H2 Blockers to Natural Products
Key takeaways:
Omeprazole (Prilosec) is a proton pump inhibitor (PPI). Like other PPIs, it treats gastroesophageal reflux disease (GERD) and other related health conditions.
Histamine-2 antagonists (H2 blockers), antacids, and stomach protectants, like sucralfate and misoprostol, are possible alternatives to omeprazole. Some of these medications can even be taken in combination with omeprazole.
Natural remedies, such as dietary changes and herbal products like licorice supplements, may also hold the key to improving your digestive health.
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Table of contents
Do you take omeprazole (Prilosec) for acid reflux or gastroesophageal reflux disease (GERD) symptoms? Omeprazole is helpful for many people, but it’s not the only option out there. Whether you're dealing with side effects or looking for something more natural, there are alternatives that could work just as well — or even better.
From other medications to more natural products, this article will guide you through nine alternatives to omeprazole that are worth considering. Keep reading to discover if they might be good options for you.
1. Other PPIs
Omeprazole is in a class of medications known as proton pump inhibitors (PPIs). They work by blocking parietal cells — the cells that make stomach acid — from working.
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There are six PPIs available in the U.S.:
Omeprazole
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Dexlansoprazole (Dexilant)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)
Changing up your PPI may help you get the results you’re looking for. All PPIs are effective at treating GERD. But there are some slight differences between them.
For example, some PPIs — namely omeprazole, esomeprazole, and lansoprazole — are available over the counter (OTC) at low doses. This is in addition to the prescription-strength versions. Other PPIs are only available with a prescription, regardless of the dose.
Some PPIs, such as pantoprazole, also come in an injectable form that can be given through an IV. This is handy if you need to receive a PPI in the hospital but are unable to take medication by mouth.
2. Zegerid
Zegerid is a combination of two medications: omeprazole and the antacid sodium bicarbonate. The antacid portion of Zegerid helps ensure that stomach acid doesn’t destroy omeprazole before it has a chance to work. Stand-alone antacids are discussed more later on.
Zegerid is available OTC and as a generic prescription product. Although Zegerid is absorbed in the blood faster than omeprazole alone, it hasn’t been shown to relieve heartburn symptoms any faster.
Keep in mind: Zegerid contains sodium. So it might not be the best option for people adhering to a low-sodium diet.
3. H2 blockers
H2 blockers, or histamine-2 antagonists, are another option for treating GERD. They work by blocking the chemical histamine in the stomach. This interrupts the process that produces stomach acid.
H2 blockers aren’t as effective as PPIs, but they don’t take as long to kick in either. In fact, they can begin working within 1 hour. For some people, this makes them a great choice for relief from less frequent or intense heartburn.
When it comes to H2 blockers, there are three to choose from: cimetidine (Tagamet HB), famotidine (Pepcid), and nizatidine. Famotidine and cimetidine are readily available OTC and also come in higher-dose, prescription-only versions.
Good to know: Cimetidine has several potential drug interactions. Before taking it, be sure to talk to a pharmacist about any other medications you take. They may recommend an alternative H2 blocker, such as famotidine, to prevent interactions.
4. Antacids
Antacids are often the go-to choice for on-the-spot heartburn relief. Antacids contain calcium, magnesium, and/or aluminum. They target the acid that’s already in your stomach to neutralize its effect.
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There are several OTC antacids available, including:
Tums (calcium carbonate)
Rolaids (calcium carbonate / magnesium hydroxide)
Mylanta (aluminum hydroxide / magnesium hydroxide / simethicone)
Maalox (aluminum hydroxide / magnesium hydroxide / simethicone), which is only available as a generic medication
All antacids work similarly; one isn’t necessarily more effective than another. Although they’re not considered as effective or long-lasting as PPIs and H2 blockers, antacids generally work faster. That means an antacid may be your quickest route to symptom relief.
5. Metoclopramide
Metoclopramide (Reglan) is another prescription-only medication that’s FDA approved to treat GERD symptoms like heartburn. It’s a prokinetic agent, meaning that it increases the speed that food moves through the gut and relieves stomach-related symptoms. It can be especially helpful for GERD caused by gastroparesis. Gastroparesis causes food to travel through the gut slower than usual.
Metoclopramide isn’t a preferred medication for GERD, though. Metoclopramide is sometimes linked to a serious movement disorder called tardive dyskinesia. It’s generally reserved for people who can’t find relief with other medications.
6. Vonoprazan
Vonoprazan (Voquezna) is in a newer class of medications called potassium-competitive acid blockers (PCABs). It blocks stomach acid from being released to improve GERD symptoms.
In clinical studies, vonoprazan was just as effective as PPIs for treating GERD-related symptoms caused by erosive esophagitis. In fact, it worked faster to heal serious symptoms in a 2-week period than the PPI lansoprazole. It also managed symptoms better over a 6-month period.
Vonoprazan is available with a prescription but not OTC.
7. Sucralfate
Sucralfate (Carafate) is a prescription-only medication that’s more unique when it comes to treating issues related to stomach acid. It’s approved to treat ulcers in the small intestine. After being swallowed, sucralfate makes a sticky glob that protects damaged tissues and stops stomach acid and digestive enzymes from working. Ultimately, this means less GERD symptoms, too.
Taking sucralfate solely for GERD is considered off-label. However, according to the American College of Gastroenterology, it can be used safely for this purpose — even during pregnancy.
Good to know: Although it’s effective overall, sucralfate is notorious for binding to more than just acid. This sticky medication can bind to nutrients and other medications as well. Your pharmacist may advise you to separate when you take sucralfate from when you take other medications by several hours.
8. Misoprostol
Misoprostol (Cytotec) is a prescription-only medication that’s approved to prevent stomach ulcers caused by medications like nonsteroidal anti-inflammatory drugs (NSAIDs). It does this by helping the digestive system produce more mucus to protect itself from damage. Misoprostol also prevents digestive acid and enzymes from being released in the first place.
Although misoprostol might be useful for treating heartburn and other GERD symptoms in some cases, it isn’t considered as effective as PPIs or H2 blockers. Misoprostol also comes with some safety concerns. It should be avoided by women who are pregnant or may become pregnant. In fact, it can induce early labor and is prescribed for medical abortions.
9. Natural alternatives
When it comes to relief from heartburn symptoms, prescription and OTC medications aren’t the only way to go. Natural solutions could do the trick, too.
Some of the best natural remedies for managing GERD symptoms are small dietary changes. For instance, avoiding greasy or spicy foods and alcohol should aid your digestion and help keep your stomach happy. And consuming foods and beverages like apple cider vinegar, ginger, and milk may help prevent and control heartburn symptoms.
When it comes to herbal products, licorice supplements may help lessen symptoms of acid reflux. Just keep in mind that these remedies aren’t regulated the same way medications are and can have varying levels of quality and purity. Ask your pharmacist to point you in the direction of a reputable supplement brand.
Frequently asked questions
PPIs are generally safe to take for an extended period of time. But there are some potential risks to keep in mind. Long-term use of PPIs can lead to kidney problems and brittle bones. But, depending on your situation, your healthcare professional may still recommend that you take a PPI long term (more than 4 months).
Taking omeprazole long term can increase the risk of side effects such as weak bones, low magnesium, and low vitamin B12. It can also raise the risk of developing pneumonia. It is important to only take omeprazole for the length of time recommended by your healthcare professional.
Yes, there are certain situations in which taking a PPI and an H2 blocker together may be necessary. For example, if you’re taking a PPI but still have occasional GERD symptoms. But don’t double down on heartburn medications without talking to a healthcare professional first.
The bottom line
Omeprazole (Prilosec) is a proton pump inhibitor that treats gastroesophageal reflux disease (GERD) and other related health conditions. If you can’t or don’t want to take omeprazole, there are several omeprazole alternatives to consider. There are medications from other classes — such as H2 blockers, antacids, and stomach protectants — that have a similar effect. Natural solutions and herbal alternatives like licorice may also help some people get symptom relief. However, the right approach for you depends on your unique situation. Talk with a healthcare professional before adding a new medication or dietary supplement to your routine.
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References
Ahmed, A., et al. (2023). Proton pump inhibitors (PPI). StatPearls.
Di Pierro, F., at al. (2013). Outcomes in patients with nonerosive reflux disease treated with a proton pump inhibitor and alginic acid ± glycyrrhetinic acid and anthocyanosides. Clinical and Experimental Gastroenterology.
Garg, V., et al. (2022). Antacids revisited: Review on contemporary facts and relevance for self-management. Journal of International Medical Research.
Howden, C. W. (2006). Immediate-release omeprazole/sodium bicarbonate. Gastroenterology & Hepatology.
Kudaravalli, P., et al. (2024). Sucralfate. StatPearls.
McKesson. (2024). Sucralfate - sucralfate suspension [package insert].
MedlinePlus. (2017). Sucralfate.
MedlinePlus. (2018). Metoclopramide.
MedlinePlus. (2022). Taking antacids.
MedlinePlus. (2023). H2 blockers.
Nguyen, L., et al. (2009). Current and prospective pharmacotherapies in gastroesophageal reflux disease. Clinical Medicine Insights: Therapeutics.
Nugent, C. C., et al. (2024). H2 blockers. StatPearls.
Phathom Pharmaceutics. (2024). Voquezna - vonoprazan fumarate tablet [package insert].
U.S. Food & Drug Administration. (2015). Questions and answers on Zegerid OTC.
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