All of your burning questions about heartburn treatment, answered

Maybe you just ate a big plate of spaghetti marinara with a side of french fries. Or a late dinner and went to bed soon after. Or maybe, you didn’t do anything at all. 

There are many different things that can cause it, but either way, it’s there. Again. That burning, acidic feeling bubbling in your chest and rising up your throat. 

You’re not alone. Acid reflux–also known as heartburn or gastroesophageal reflux disease (GERD)– affects more than 20% of the U.S. population, according to the National Institute of Health. 
One popular option for treating chronic, uncomfortable symptoms is esomeprazole (known by the brand name Nexium). First patented by AstraZeneca in 1993, Nexium was later approved for over-the-counter in 2014 and then released as generic forms in 2015. In 2017 it became the 88th most commonly prescribed Rx in the US, selling over nine million prescriptions.

However, Nexium is just one of many treatment options for acid reflux. In fact, there are so many, it’s really easy to get confused and overwhelmed. That’s why we created a comprehensive guide to all of your medication options when it comes to dealing with acid reflux. 

Antacids

Antacids are available over-the-counter, and they provide the fastest short-term relief for symptoms of acid reflux. There are a variety of options, including calcium carbonate (Tums), sodium carbonate (Alka-seltzer), magnesium trisilicate (Gaviscon), magnesium hydroxide (Milk of Magnesia), aluminum hydroxide (Alternagel, Amphojel), bismuth subsalicylate (Pepto-Bismol), aluminum-magnesium hydroxide-simethicone (Gelusil, Mylanta), and aluminum hydroxide (Maalox). All of them work by neutralizing and decreasing acid in the stomach. 

Sometimes, antacids are not enough and you might have an underlying medical condition. These red flags might mean you need stronger treatment than just OTC antacids: 

  • Symptoms aren’t responding to the antacid 
  • Symptoms last longer than a week or two
  • Nausea and vomiting
  • Diarrhea
  • Food gets stuck in your throat
  • Difficulty swallowing
  • Rectal bleeding
  • Unexplained weight loss

Pharmacist tip: Always take antacids with food or a light snack. Taking an antacid on an empty stomach will only provide 30 – 60 minutes of relief. Taking them with food extends that time period to three hours. 

H2-Receptor Antagonists (H2-RAs)

H2-receptor blockers work by blocking one type of stomach cells that release acid. This helps prevent excess acid from pooling in your stomach in the first place, which then allows for any damaged tissue to heal. When taken properly, they can reduce acid by as much as 70% over a 24 hour period. Whereas antacids often work immediately, H2-RAs typically provide relief within 15 – 30 minutes, and the benefits typically last up to 12 hours. 

Typically, they are not used as a long-term option and are recommended for a few weeks before you need a check-in with your doctor. 

Some examples of H2-RAs include nizatidine (Axid), famotidine (Pepcid), and cimetidine (Tagamet).

Famotidine and cimetidine are available OTC and with a prescription, while nizatidine is only available with a prescription. While the OTC version can sometimes be cheaper, there are fewer strengths available.

Proton-pump inhibitors (PPIs)

Like H2-RAs, Proton-pump inhibitors work by blocking stomach acid from being produced. However, unlike H2RAs, PPIs are meant for long-term relief by reducing acid. They typically take an hour to start working, with the peak effect happening after 1 – 4 days of consistent usage. That’s when the major benefits (such as healing ulcers) occur. 

Some examples include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), and dexlansoprazole (Dexilant). 

Esomeprazole, lansoprazole, and omeprazole are all available both OTC and with a prescription, with some restrictions on what strengths are available OTC.

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Dr. James Kim

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