If you have heartburn once in a while, maybe after eating a big meal or a dish loaded with tomatoes or citrus, you might reach for an over-the-counter (OTC) antacid. But if you have gastroesophageal reflux disease (GERD), you might be taking these medications too often. Or you might find they aren’t controlling your symptoms.
Lots of different medications can treat GERD. There are OTC and prescription options that work in different ways. Your health care provider can evaluate your symptoms and help you decide which medications are best.
We talked to Wahid Wassef, MD, a gastroenterologist with Banner – University Medicine, about the different types of medications you can try. “Medications for GERD fall into three main categories: antacids, H2 blockers and proton pump therapy,” he said.
This guide takes a deeper dive into these medication options for GERD.
Antacids
Antacids work quickly to relieve mild symptoms. “Antacids neutralize the acid content of the stomach,” Dr. Wassef said. “They are not very strong, and they act for a short period of time.”
You can buy antacids without a prescription. They contain common active ingredients, such as calcium carbonate, aluminum hydroxide and magnesium hydroxide, that help neutralize the acid in your stomach.
Antacids can treat your symptoms, although they don’t treat the underlying cause of your heartburn or reflux. They can be a good choice if you get heartburn every so often, but if you’re taking them more than two or three times weekly, you should talk to your health care provider.
Side effects from antacids are minor. Types that contain calcium can cause constipation and types that contain magnesium can cause diarrhea.
Common antacid brands include:
- Alka-Seltzer
- Di-Gel
- Milk of Magnesia
- Mylanta
- Tums
H2 blockers
H2 blockers (histamine H2-receptor antagonists) don’t just neutralize stomach acid like antacids do. They also reduce the amount of acid your stomach produces to give you more long-lasting relief.
“H2 blockers work by blocking the histamine channels in some of your stomach cells. They don’t completely block all acid production, but they are stronger than antacids and will last longer in the stomach,” Dr. Wassef said.
H2 blockers usually start to work 30 to 90 minutes after you take them. Many people take them with their first meal of the day. Some people also take a second dose with their evening meal or at bedtime.
You can buy OTC lower-dose H2 blockers. If you’re taking them most days for two weeks or longer, talk to your provider. You may need a prescription-strength version. Your provider may also want to evaluate you to be sure it’s GERD that is causing your symptoms and not another condition.
If you take medications for other health conditions, talk to your provider or a pharmacist before taking H2 blockers. H2 blockers can interact with other medications, so your provider may need to adjust your doses.
Side effects are usually minor. They can include diarrhea, constipation, fatigue, drowsiness, headache or muscle aches.
Common H2 blocker brands include:
- Pepcid (famotidine)
- Tagamet (cimetidine)
- Zantac (ranitidine)
Proton pump inhibitors
Proton pump inhibitors (PPIs) give you more powerful acid suppression. The proton pumps in your stomach produce acid, and PPIs limit how much they can make.
“PPIs are the strongest GERD medicines available. They completely stop all acid production in the stomach and last for up to 12 hours,” Dr. Wassef said.
Like antacids and H2 blockers, you can buy some types of PPIs over the counter. If you’re taking them on most days, talk to your provider. A prescription version might be a better choice.
PPIs can cause problems with vitamin D absorption and bone metabolism. If you need to take them for a long time, your provider might recommend vitamin D supplements.
Other side effects of PPIs are usually minor and can include headache, rash, dizziness, nausea, abdominal pain, flatulence, constipation and diarrhea. The risk of side effects increases the longer you use PPIs.
Common PPI brands include:
- Nexium (esomeprazole)
- Prevacid (lansoprazole)
- Prilosec (omeprazole)
Combination therapies
If you need to, you can take more than one of these medications to treat your GERD symptoms. For example, adding an H2 blocker to a PPI may give you better acid control and reduce nighttime acid symptoms. Or an antacid may help relieve symptoms before an H2 blocker starts to work.
Be sure to talk to your provider before combining different medications. Your provider can optimize your dose and recommend timing — some of these medications may not work as well if you take them too close together.
Other steps you can take
Lifestyle changes can also help reduce the symptoms of GERD. It’s a good idea to steer clear of foods that can trigger reflux, such as caffeine, citrus, tomatoes and alcohol. Eating smaller meals more often may help, as will losing weight.
You can also raise the head of your bed to reduce symptoms while you sleep, take steps to reduce stress and add some mild or moderate physical activity to your routine.
When to talk to a provider
“If you have heartburn symptoms once a week or less, or only when eating certain foods or meals, OTC medications will probably be sufficient,” Dr. Wassef said. But if you’re having symptoms most days or every day, you’ll want to see an expert.
“Be smart. If the symptoms are not responding to OTC medication, seek medical help. You may need stronger medications, or you may have a different condition that is mimicking the symptoms of GERD,” he said.
A provider can come up with a treatment plan that’s best for you. You’ll want to follow up with them regularly to make sure your symptoms are under good control.
The bottom line
If you have reflux symptoms, sometimes OTC medication is all you need. But if you’re having symptoms often or you have GERD, you may need prescription medication.
Antacids, H2 blockers and PPIs can all help get GERD symptoms under long term control. They all work differently and your provider may recommend taking them alone or in combination.
To find out more about how you can get control of GERD symptoms, talk to your health care provider or connect with a gastroenterologist at Banner Health.
