What medications treat heartburn?

You have lots of medication options for treating your heartburn symptoms. They range from relatively mild over-the-counter (OTC) remedies to stronger prescription medicines.

In addition to antacids, here are some examples of OTC and prescription options that may be ideal for treating your heartburn symptoms:

Bismuth subsalicylate: This OTC medication for nausea and diarrhea also helps relieve heartburn by coating the esophagus and acting as a barrier to stomach acids. People who cannot take aspirin should avoid bismuth subsalicylate.

Common brands of this kind of medication include the following:

• Bismatrol
• Pepto-Bismol
• Kaopectate

Acid blockers (H2 blockers): These medications relieve heartburn by reducing the amount of acid produced in the stomach. Acid blockers take longer to kick in than antacids, but they are also longer acting.

Common OTC brand names include the following:

• Axid AR (nizatidine)
• Pepcid AC (famotidine)
• Tagamet HB (cimetidine)
• Zantac 75 (ranitidine)

Pepcid Complete, which acts as an antacid as well as an acid reducer, is also available over the counter.

Common prescription brand names include the following:

• Axid (nizatidine)
• Pepcid (famotidine)
• Tagamet (cimetidine)
• Zantac (ranitidine)

Proton pump inhibitors (PPIs): These medications significantly reduce the production of stomach acid. They also help heal damage to the esophagus. Typically, only people with severe heartburn or GERD take PPIs. All but one PPI are available by prescription only.

Currently, the only OTC PPI available is:

• Prilosec OTC (omeprazole)

Common prescription PPIs include the following:

• Aciphex (rabeprazole)
• Nexium (esomeprazole)
• Prevacid (lansoprazole)
• Prilosec (omeprazole)
• Protonix (pantoprazole)
• Zegerid (omeprazole/sodium bicarbonate)

Promotility medications: These prescription medications improve the function of the digestive system, making heartburn symptoms less likely. Promotility medications are usually prescribed for a short time and are associated with side effects. Here are two options currently available:

• Reglan (metoclopramide)
• Urecholine (bethanechol)

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Nonstop advertising has acquainted most people with antacids, the least expensive treatment for heartburn. These work by reducing the acidity of refluxed material. But much more effective are the drugs known as the proton pump inhibitors (PPIs) such as omeprazole (Prilosec, Zegerid) and the H2-receptor antagonists -- also known as H2 blockers -- such as cimetidine (Tagamet) and ranitidine (Zantac). Some of these drugs are available over the counter. PPIs are more effective than either antacids or H2 blockers, but tend to be more costly and cause some unwanted side effects. In severe cases, physicians combine various antireflux drugs, such as over-the-counter antacids and H2 blockers, or PPIs and prokinetic drugs that increase gastric emptying. However, PPIs without additional medications are generally preferable to combinations.

Three types of medications are approved for symptoms of heartburn – antacids, H2-blockers and proton pump inhibitors.  Everyone knows antacids – Tums, Rolaids, Mylanta, and Maalox. Antacids work immediately to neutralize any acid which has refluxed up from the stomach into the esophagus causing symptoms. They are best for patients who infrequently have symptoms and need instant relief when symptoms occur (i.e. after a big plate of spaghetti with red sauce). The other medications on the market do not work as quickly as antacids, but are much more potent as they block the production and secretion of acid by the stomach. Zantac, Pepcid, and Axid are H2-blockers.These medications inhibit one of the three signaling systems which trigger the stomach to produce acid.  With some of the triggering mechanism blocked, the stomach does not make as much acid as it typically would and thus symptoms are lessened. These medications work great if taken a few hours before eating and will last up to 6 hours or so.  Finally, proton pump inhibitors (PPI) are the strongest acid medications as they actually block the acid pump in the cells of the stomach. Prilosec, Nexium, Protonix, Aciphex, Prevacid, and Dexilant are some brand names, and these medications truly raise the pH in the stomach by preventing acid from being produced. These medications work for 12-24 hours, but they take a few days to reach optimal levels.     

Beyond medications, diet is the most important treatment, though many consider this to be too cumbersome. Avoiding particular foods and changing eating habits is critical. Foods which classically trigger reflux / heartburn include: chocolate, coffee, tea, red sauces from tomatoes, spicy foods, red wine, and peppermints. Avoiding lying down within hours of the last meal and sleeping with a wedge beneath your head will help decrease nighttime symptoms. Finally, weight loss is also helpful in controlling symptoms.