Acid reflex medicine: OTC options for your symptoms

Healthcare providers often recommend over-the-counter acid reflux medications as first-line treatments for occasional indigestion and acid reflux. There are several different types of medications available. Talk to your healthcare provider about which treatments may be best for you.

View antacids

Sold under brand names like Tums, Mylanta, Pepto-Bismol and Rolaids, antacids are available over the counter. Using active ingredients like alginate, aluminum hydroxide, calcium carbonate, magnesium hydroxide, magnesium trisilicate or sodium bicarbonate, they relieve heartburn by buffering and neutralizing stomach acid.

Usage and benefits

Healthcare providers often recommend antacids for the treatment of occasional heartburn and acid reflux. Antacids come in chewable and liquid forms. They relieve common heartburn and acid reflux symptoms, such as burning in the chest, an acidic taste in the mouth, a full or bloated feeling, and mild stomach and chest pain.

One key benefit of antacids is that they tend to work quickly when taken to relieve heartburn and acid reflux symptoms. You can also take them within an hour of eating to reduce the risk of heartburn.

Potential drawbacks and side effects

Antacids are short-acting and typically don’t aid in the healing of irritation in the esophagus due to acid reflux. As a result, they’re typically not a good choice for people who experience chronic acid reflux or for those who have gastroesophageal reflux disease (GERD).

Because they can affect the absorption of some medications, individuals who take certain drugs may not be able to use antacids safely. In addition, antacids aren’t generally recommended for children under the age of 12 or for people who:

• Follow low-sodium diets
• Are pregnant or may become pregnant
• Have heart failure, high blood pressure, kidney disease or liver disease

Antacids can cause side effects, such as:

• Abdominal discomfort
  
• Constipation or diarrhea
• Gas
• Headaches
• Vomiting and nausea

Less commonly, antacid use may lead to serious health complications, such as changes in the blood, bones or nervous system. Some people who frequently take antacids may develop acid rebound, a condition that occurs when the body overproduces stomach acid, making acid reflux symptoms worse.

View H2 blockers

Also called histamine-2 (H2) antagonists, H2 blockers ease heartburn through a different mechanism than antacids. When you eat, your body releases the hormone histamine-2, which binds to receptors in your stomach and causes it to secrete acid. H2 blockers interrupt this process by binding to the H2 receptors. In turn, this reduces acid levels in the stomach.

In the U.S., there are two main H2 blockers available over the counter:

• Cimetidine (Tagamet)
• Famotidine (Pepcid)

Usage and benefits

Healthcare providers typically recommend H2 blockers for people who experience occasional acid reflux and for the treatment of stomach ulcers. They come in pill and powder form, and you can generally take them when you develop acid reflux symptoms or an hour before eating to lower the likelihood of heartburn.

While they usually don’t work as rapidly as antacids, H2 blockers typically begin to relieve heartburn and other acid reflux symptoms within 30 to 60 minutes. The biggest advantage of H2 blockers compared to antacids is that they usually continue to provide benefits for longer, with effects lasting anywhere from four to 10 hours. They are most useful when taken before a reflux trigger, such as eating. 

Potential drawbacks and side effects

H2 blockers may help heal inflammation in the esophagus caused by reflux. However, they may not help with healing as much as proton pump inhibitors (PPIs). Women who are pregnant or may become pregnant and those with kidney or liver problems may not be able to safely take H2 blockers. These medications may interact with certain drugs, such as blood thinners and some antidepressants.

The most common side effects of H2 blockers are:

• Abdominal discomfort
• Constipation
• Diarrhea
• Dry mouth
• Fatigue
• Headaches
• Muscle aches

In rare cases, H2 blockers may cause confusion, slurred speech or other neurologic side effects. People 50 and over and those with kidney or liver problems have a higher risk for developing these side effects.

View proton pump inhibitors

Commonly called PPIs, proton pump inhibitors reduce the amount of acid in the stomach to relieve acid reflux symptoms. They work by interfering with the activity of hydrogen-potassium ATPase pumps in the stomach, which play a role in the production of stomach acid.

There are four PPIs available over the counter in the U.S.:

• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Omeprazole (Prilosec)
• Omeprazole/sodium bicarbonate (Zegerid)

Usage and benefits

PPIs come in pill form. You usually take them 30 minutes to an hour before your first meal of the day for two to eight weeks. However, your healthcare provider may provide other instructions. 

Healthcare providers usually recommend proton pump inhibitors (PPIs) for people with GERD and H. Pylori bacterial infection. When taken daily for a few weeks, the drugs not only help relieve acid reflux symptoms, but they may also allow irritation in the esophagus to heal. PPIs may also be used to treat stomach and duodenal ulcers.

Potential drawbacks and side effects

PPIs usually don’t begin relieving heartburn symptoms until 24 hours after the first dose. As a result, they’re generally not recommended for occasional heartburn or acid reflux relief.

Pregnant women and those who may become pregnant typically shouldn’t take PPIs. In addition, they may interfere with some medications, including blood thinners.

Side effects that may occur while taking PPIs include:

• Abdominal discomfort
• Constipation
• Diarrhea
• Dizziness
• Dry mouth
• Fever
• Gas
• Headaches
• Lightheadedness
• Skin itching and rashes
• Vomiting

Less commonly, PPIs may cause serious health complications. Because they may change how your body absorbs nutrients like calcium and vitamin B12, they may lead to nutritional deficiencies or an increased risk for bone fractures. They may also increase the likelihood of developing certain kidney problems and bacterial infections caused by Clostridioides difficile (C. diff).

Published July 2024.