Large numbers of Americans use over-the-counter (OTC) drugs to treat minor gastrointestinal problems such as infrequent heartburn, according to the American College of Gastroenterology (ACG). In fact, OTC medicines are often among the initial treatments for heartburn, acid reflux, and other symptoms of gastroesophageal reflux disease (GERD).
Your doctor may recommend incorporating OTC treatments if your symptoms don’t improve within a few weeks of trying diet and lifestyle modifications. The ACG reports that, in many cases, a combination of lifestyle modifications and proper use of OTC medicines can effectively manage heartburn.
There are three types of medicines available over-the-counter that may be helpful in controlling GERD symptoms: antacids, H2 blockers, and proton pump inhibitors (PPIs).
Antacids are often recommended as initial treatment to help soothe minor heartburn and acid reflux because they work quickly by neutralizing stomach acid. Many OTC medicines combine different antacids using three basic salts—aluminum, magnesium, and calcium—with bicarbonate or hydroxide ions.
OTC brands of antacids include:
OTC antacids are available as liquids, gums, and chewable or dissolving tablets. Some doctors may recommend that you take antacids along with either H2 blockers or PPIs. Antacids sometimes cause side effects like diarrhea and constipation, particularly when used too frequently.
These medicines reduce acid production in your stomach, which lowers your chance of getting heartburn. While they act less quickly than antacids (they usually start to work within an hour), they can provide relief from symptoms for a longer time period.
H2 blockers are available both as an OTC product and in stronger formulations by prescription. Some OTC H2 blockers include:
- cimetidine (Tagamet HB)
- famotidine (Calmicid, Fluxid, Pepcid AC)
- nizatidine (Axid, Axid AR)
- ranitidine (Tritec, Wal-Zan, Zantac 25, Zantac 75, Zantac 150)
These drugs are effective for about half of those with GERD symptoms who use them, according to Temple University Hospital. HHS advises that H2 blockers can sometimes cause side effects such as headache, constipation, diarrhea, nausea, or vomiting.
PPIs block acid production, which can cause damage to the esophagus lining. PPIs are the most powerful drugs for reducing stomach acid production (according to The Merck Manual) and are usually the most effective treatment for GERD.
The National Institutes of Health (NIH) reports that these medicines are not only more effective than H2 blockers, but they can also relieve symptoms in almost everyone who has GERD.
While many PPIs are taken as prescription only, the following are available over-the-counter:
- lansoprazole (Prevacid 24 HR)
- omeprazole (Losec, Omesec, Prilosec OTC)
- omeprazole with sodium bicarbonate (Zegerid)
PPIs are taken in pill form and are most appropriate for people with more frequent heartburn, according to AAFP. PPIs have been associated with several side effects, including:
- abdominal pain
- upset stomach
Less common, but more serious side effects that are linked to PPI usage include an increased chance of pneumonia and bone fracture.
Any type of OTC medicine may cause harmful interactions with other, so talk to your doctor before starting an OTC drug. The American Academy of Family Physicians (AAFP) advises using only one antacid, H2 blocker, or PPI at a time—unless your doctor directs otherwise.
When OTC Isn’t
It’s important to note that the U.S. Food and Drug Administration (FDA) approved OTC forms of H2 blockers and PPIs at lower dosage levels than those available by prescription. The ACG emphasizes that these reduced-strength formulations have only been approved for temporary relief and minor discomfort caused by heartburn or other, occasional gastrointestinal symptoms.
OTCs aren’t recognized by FDA as sufficient treatment to heal esophageal damage caused by acid reflux. The FDA recognizes the ability to heal esophagitis only in certain prescription-strength medicines, such as PPIs.
Talk to your doctor if your heartburn or acid indigestion episodes are happening frequently and OTC treatments and lifestyle changes aren’t helping. A physician can help confirm your diagnosis and develop an appropriate treatment plan. Treatment may include the use of stronger medicines that are available only by prescription. Surgery may be necessary in severe cases that involve GERD complications.
Frequent episodes of heartburn or indigestion may be signs of a more serious problem that could worsen if not effectively treated. Contact your doctor if you use an OTC medicine for GERD more than twice a week, or if your symptoms don’t improve.