Over-the-Counter Medications for Heartburn Relief

Here's Medicine You Can Take Without a Prescription

Man dropping antacid into a glass of water
 Steven Errico/Getty Images

The morning after an indulgent evening of lasagna, cabernet, and cheesecake, you wake up with regret -- and a bad case of heartburn. Mumbling, "I can't believe I ate the whole thing," you head to the drugstore. But the vast array of over-the-counter (OTC) medications can be enough to give you a headache, too. Here are some pointers.

Over-the-Counter Antacids

Active ingredients: Sodium bicarbonate (baking soda), calcium carbonate, aluminum hydroxide, magnesium carbonate and/or magnesium hydroxide

Common brand names: Tums and Maalox chewable tablets (calcium carbonate), Maalox liquid (aluminum hydroxide and magnesium hydroxide with simethicone for gas relief) and Ultra Xcid (calcium carbonate and magnesium hydroxide)

How they work: Antacids neutralize the acids in your stomach for almost immediate, short-term relief of mild, infrequent heartburn.

Typical dosage: Calcium carbonate is taken in tablet form. The typical recommended dosage is 1 to 4 tablets at a time (up to 2,000 mg per dose), but no more than 15 tablets a day, depending on the brand. One dose of Maalox liquid is equal to 2 to 4 teaspoonfuls and should be restricted to no more than 16 teaspoons per day. Ultra Xcid, a newer product, is creamy and can be easily squeezed out of the tube onto a regular teaspoon; 1 to 2 teaspoons is the maximum recommended dosage per day.

Important information: Calcium carbonate can cause constipation and reduce the effects of other medications.

Aluminum hydroxide may not be a good choice for kidney patients.

H2 Blockers

Generic drug names: Famotidine, cimetidine, ranitidine

Common brand names: Pepcid AC (famotidine), Tagamet (cimetidine), Zantac (ranitidine)

How they work: H2 blockers decrease the quantity of acid your stomach makes to prevent heartburn or provide slower, but longer-lasting relief in mild-to-moderate cases.

Typical dosage: One to four tablets a day, depending on the brand, to relieve heartburn as needed.

Important information: If you have liver or kidney problems, ask your physician before taking famotidine. Tell your physician if you have kidney or liver disease, diabetes, asthma, immune system issues and/or bone marrow suppression before taking cimetidine. Check with your physician before taking ranitidine if you have kidney or liver disease, or any of the nervous system and skin disorders known as porphyria.

Taking antacids within 1 hour of ingesting famotidine may decrease its effectiveness. Higher-dose H2 blockers, such as Zantac Maximum Strength (ranitidine), are for heartburn that has progressed beyond mild. Some combinations, such as Pepcid Complete, include both an H2 blocker (famotidine) and antacid (calcium carbonate and magnesium hydroxide) for fast and longer-term relief.

If you still have heartburn after taking a maximum dosage of antacids or H2 blockers for 2 weeks, contact your physician for treatment.

Proton pump inhibitors (PPIs)

Active ingredient: Omeprazole

Common brand names: Prilosec OTC is the only non-prescription PPI available.

How they work: Prevents frequent, moderate heartburn by keeping the body from producing as much acid.

Omeprazole is the most effective over-the-counter medication for heartburn relief, according to the National Heartburn Alliance.

Typical dosage: Take one pill every day for 2 weeks to prevent heartburn. The first time you take omeprazole, it may be as many as 4 days before you notice its effects. It can be taken in conjunction with antacids for fast relief. Even after you get better, you must continue the full 14-day course of the medication for continued prevention.

Important information: If you need to repeat the 2-week regimen more frequently than every 4 months, you should see your physician.

For more information on the link between PPIs, like Nexium, and risk of fractures, check out this article.

Omeprazole interacts negatively with many other drugs and substances, including the blood thinner Coumadin (warfarin); anxiety and insomnia reliever, Valium (diazepam); anti-seizure medication, Dilantin (phenytoin); and iron supplements.

Finally, there is a fourth substance found in Pepto-Bismol and Kaopectate (i.e., bismuth subsalicylate), which is sometimes used to treat heartburn. Check with your pharmacist if you are unsure what OTC heartburn medication to take or if you have questions about adverse effects or drug interactions.

Original article edited by Naveed Saleh, MD, MS, on 2/28/2016.


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