In April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. This recommendation was made because unacceptable levels of NDMA, a probable carcinogen (cancer-causing chemical), were found in some ranitidine products. If you’re prescribed ranitidine, talk with your doctor about safe alternative options before stopping the drug. If you’re taking OTC ranitidine, stop taking the drug and talk with your healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, dispose of them according to the product’s instructions or by following the FDA’s guidance.

Ranitidine, brand name Zantac, is now marketed as Zantac 360, which contains a different active ingredient (famotidine). Famotidine is in the same class as ranitidine and works the same way but has not been found to contain unacceptable levels of NDMA.

Heartburn is an uncomfortable sensation caused by acid traveling from the stomach to the esophagus and mouth. The acid causes a burning sensation to spread through the chest.

Most people experience heartburn due to irritation from foods or drinks. If they lie down immediately after eating, the acid usually comes up more easily.

Most of the time, heartburn isn’t cause for concern and will go away with time. Because it can mimic other more concerning medical symptoms like a heart attack, it’s important to know how to recognize it.

Heartburn can range from mildly irritating to extremely uncomfortable. The following are some heartburn symptoms:

  • burning and discomfort behind the breastbone
  • burning that radiates from atop the stomach up to the neck
  • pain that worsens when you change your posture, such as bending forward or lying down
  • sour taste in the throat
  • symptoms that occur 30 to 60 minutes after you’ve had something to eat
  • symptoms that usually worsen when you eat certain foods, such as:
    • alcohol
    • chocolate
    • coffee
    • tea
    • tomato sauce

Sometimes, a person has heartburn symptoms that are out of the ordinary. People have reported discomfort in the:

  • lungs
  • ears
  • nose
  • throat

Some people also have heartburn that feels like chest pain. The chest pain may be so bad it makes you worry you’re having a heart attack.

Research estimates between 17 and 45 percent of pregnant women experience heartburn in pregnancy. The frequency of heartburn usually increases by trimester.

In the first trimester, around 39 percent of women with heartburn had symptoms, while 72 percent had heartburn symptoms in the third trimester.

A number of factors increase the risk of heartburn in pregnant women. This includes reduced pressure in the lower esophageal sphincter that separates the esophagus from the stomach. This means acid can pass from the stomach to the esophagus more easily.

The growing uterus also puts extra pressure on the stomach, which can worsen heartburn. Some of the hormones that help women maintain their pregnancy can also slow down digestion, increasing the risk of heartburn.

There aren’t a lot of long-term complications related to heartburn in pregnancy. Pregnant women just usually experience it at higher rates than non-pregnant women.

Sometimes, heartburn symptoms are more severe than when a woman isn’t pregnant.

Heartburn and indigestion may have a lot of symptoms in common, but they aren’t the same thing.

Doctors also call indigestion dyspepsia. This is a symptom that causes pain in the upper part of the stomach. A person with indigestion may also have symptoms like:

  • burping
  • bloating
  • nausea
  • general abdominal discomfort

Foods you eat cause both heartburn and indigestion. However, indigestion is the result of foods irritating the stomach and its lining. Heartburn is the result of acid refluxing up from the stomach.


A person with gastroesophageal reflux disease (GERD) can have both indigestion and heartburn as part of their symptoms.

GERD is a chronic form of acid reflux that can potentially damage the esophagus. Being overweight, smoking, and having a hiatal hernia increases a person’s risk for GERD.

Sometimes, heartburn can cause symptoms that are out of the norm or feel so extreme you worry it’s a heart attack.

But not all heart attacks result in the classic, crushing chest pain you see on television and in movies. Here’s how to tell the difference between the two:

  • Heartburn usually causes symptoms after you eat. A heart attack doesn’t seem to be related to foods you ate.
  • Heartburn usually causes a sour taste in your mouth or feeling acid rise in the back of your throat. A heart attack may cause stomach pain, including nausea and overall abdominal pain.
  • Heartburn usually starts as burning in the top part of the stomach that moves up into the chest. A heart attack usually causes pressure, tightness, or pain in the chest that may go to the arms, neck, jaw, or back.
  • Heartburn is usually relieved by antacids. Heart attack symptoms aren’t.

In addition to a heart attack, some people may mistake the following conditions for heartburn:

  • esophageal spasm
  • gallbladder disease
  • gastritis
  • pancreatitis
  • peptic ulcer disease

If you aren’t sure if your symptoms are heartburn or something else, it’s best to seek emergency medical attention.

If you experience frequent heartburn episodes, there are several lifestyle changes you can make to reduce your symptoms. Here are some examples:

  • Avoid foods known to trigger heartburn, such as:
    • spicy foods
    • chocolate
    • alcohol
    • caffeine-containing items
  • Elevate the head of your bed to keep acid from coming up your throat.
  • Refrain from eating less than 3 hours before bedtime.
  • Take over-the-counter (OTC) heartburn-relief medications, such as:
    • famotidine (Pepcid)
    • cimetidine (Tagamet)

Losing weight if you’re overweight may also help you reduce your heartburn symptoms.

Treatment when pregnant

Pregnancy can be a challenging time for heartburn treatments, because you can’t take all the medications you may have once taken due to concerns over harming the baby.

For example, most pregnant women can resolve their symptoms taking medications like Tums, Rolaids, or Maalox. But many doctors don’t recommend taking magnesium-containing antacids like these during the third trimester over concerns it may affect labor contractions.

Also don’t take Alka-Seltzer. It contains aspirin, which can increase bleeding risks during pregnancy.

However, making some lifestyle changes may provide relief:

  • Eat small, frequent meals throughout the day.
  • Eat slowly, and chew each bite thoroughly.
  • Refrain from eating 2 to 3 hours before bed.
  • Refrain from wearing tight-fitting clothing.
  • Use pillows to support your head and upper body to reduce acid reflux when sleeping.

If heartburn symptoms persist, talk to your doctor about other treatment options.

If OTC medications aren’t treating your heartburn, talk to your doctor.

In rare instances when you can’t manage heartburn with medications, a doctor may recommend surgery to reduce the risk that acid will reflux up from the stomach.

If you can’t tolerate OTC medications for heartburn, your doctor can recommend other options.

While most people experience heartburn from time to time after a big meal or after eating certain foods, the symptom can resemble a lot of other conditions.

If you’re especially worried it could be a heart attack, seek emergency medical attention. Otherwise, lifestyle changes, such as diet modifications and taking OTC medications, can usually relieve symptoms.

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