There are three main categories of OTC heartburn treatment. Each class has its own advantages and disadvantages. Some work by neutralizing stomach acid, while others act to protect the lining of the stomach and esophagus. How they work depends on their active ingredients.
The best known class of drugs for aiding heartburn is the antacids. Some examples include Tums, Rolaids, and Mylanta. The active ingredients of antacids include minerals such as Magnesium and Calcium Carbonate. They neutralize acid in the stomach and are fast-acting therefore providing instant relief. In addition some can be a supplemental source of calcium. Antacids make sense for occasional heartburn from over-indulgence or eating spicy foods. They are inexpensive compared to other heartburn treatments.
Another class of drugs that you can buy OTC for heartburn is the histamine 2 (H2) blocker. Drugs such as Tagamet (generic is cimetidine), Pepcid-AC (famotidine) and Zantac (ranitidine) make up this class. They reduce the amount of acid the stomach produces by blocking histamine, a chemical that tells your body to make acid. H2 blockers can be used for up to 2 weeks for short- term relief of heartburn. They are stronger than antacids and their effects last longer, for 8 to 12 hours. They also help to heal the esophageal lining, but not as well as another potent class of heartburn meds called proton pump inhibitors (PPI).
PPIs block an enzyme in the stomach lining that produces acid. They also help to heal the lining of the esophagus more effectively than the H2 blockers. Both H2 blockers and PPIs are available OTC as well as by prescription. These drugs are expensive, so buying the generic or store brand is a way to save money. In addition, if you have a good prescription plan, your copay may be less than what you would pay for the OTC version. Some examples of PPIs available OTC are Prilosec OTC (omeprazole), Prevacid (lansoprazole) and Zegerid OTC, which is a combo of omeprazole and sodium bicarbonate to help with the absorption of omeprazole. Although very effective, unlike antacid PPIs take a while to work. You may not feel better for 24 hours or longer after starting a regiment. 85% of people with erosive esophagitis, a condition in which the lining of the esophagus is irritated or inflamed, are healed when they take a PPI.
It is important that you read the label carefully on any medication that you choose. Each product may have age limits, time limits for self care, warnings and dosing information.
We just discussed the drugs available to treat heartburn yourself. But treating heartburn involves more than just popping a pill. Lifestyle changes and avoiding certain food triggers work in tandem with medication. Raising the head of your bed using bricks under the head board (not just piling on the pillows) works thanks to gravity keeping the acid from rising up into the esophagus while you sleep. Cutting out caffeine and chocolate, avoiding spicy, fried or tomato-based foods, avoiding alcohol, and quitting smoking (as if you needed another reason!), may reduce or eliminate symptoms.
So when is it time to see the doctor? If you have any of these red flags: pain or difficulty swallowing, vomiting, unexplained weight loss, or persistent abdominal pain, call your doctor right away. If you have occasional heartburn, which most of us do, it’s ok to take OTC meds. But if you are getting it regularly or if it is severe, your “heartburn” may be masking a more serious condition.
- Vanessa Andricola, B.S., Pharm, D.