What medications treat gastroesophageal reflux disease (GERD)?

Dr. Jeanne Morrison, PhD
Family Practitioner

Most people treat the first symptoms of gastroesophageal reflux disease (GERD) and heartburn with over-the-counter medications, such as antacids and drugs that reduce or prevent the production of stomach acid. These include H2 receptor antagonists that decrease acid production (common brand names include Zantac, Tagamet and Pepcid) and proton pump inhibitors that block acid production (common brand names include Prilosec, Nexium, and Prevacid). Foaming agents that contain antacids (a common brand name is Gaviscon) can also be used to coat the stomach. However, if you have been treating your symptoms with over-the-counter medications for more than two weeks, you should contact your doctor to discuss your symptoms. Also, you should be aware that the U.S. Food and Drug Administration (FDA) has issued a warning about a possible increased risk of hip, wrist and spine fractures in people who take over-the-counter proton pump inhibitors to treat GERD and heartburn. The greatest risk of fractures was found in people over 50 years of age who took high doses or took the medication for over a year.

Many over-the-counter medications treat GERD through different ways. There are antacids, which neutralize acid, and medications that coat the lining of the stomach. Newer medications help reduce or stop the production of acid, such as Zantac and Pepcid.

There are three categories of drugs that are used to fight gastroesophageal reflux disease (GERD):

  • First are tablets, liquids and chewables such as Tums, Rolaids, and Mylanta that have been traditionally over the counter remedies. They have been used historically but they have very limited stopping power and have to be used frequently.
  • The next category of drugs include H2Blockers. They work by activating the secretion of acid.
  • Today, the medications most frequently used are proton pump inhibitors (PPIs). Nexium, Prevacid, Prilosec, Protonix, Aciphex are the dominant players. But to be honest, in spite of the manufacturers’ claims, they have “different names but the same game.” They work by inhibiting the release of acid in the stomach by reducing the production of acid. Therefore, very little acid is secreted to cause irritation. The end result is that there is no heartburn.

Most of the time, when taken in the face of an accurate diagnosis, at the right dose and dosing interval, most patients can manage their GERD successfully. A new issue has emerged with the offering of these medications over the counter without a prescription. Many patients cannot resist treating themselves. There are two problems with this. First, if the patient does not have GERD, this could delay treatment for a totally different problem. Second, the patient could have complications from GERD that they do not know about. Both of these behaviors can lead to poor patient outcomes because they have not been evaluated. Remember, “Don’t self medicate, get yourself a check-up date."

Should symptoms of gastroesophageal reflux disease (GERD) persist, over-the-counter antacids may decrease discomfort. Antacids, however, only work for a short time and for this reason, they have a limited role in treating reflux disease. Histamine H2 receptor antagonists (such as cimetidine, ranitidine, nizatidine and famotidine) decrease acid production in the stomach. These medications work well for treating mild reflux symptoms and are quite safe, with few side effects. They are available over the counter at a reduced dose, or at a higher dose when given by prescription by your doctor.

Proton pump inhibitors (such as omeprazole, lansoprazole, dexlansoprazole, pantoprazole, esomeprazole and rabeprazole) are all highly effective in treating reflux symptoms. These medications act by blocking the final step of acid production in the stomach and are typically taken once or twice daily prior to meals. For reflux symptoms that occur frequently, proton pump inhibitors are the most effective medical treatment. These medications typically work well, are safe and have few side effects. There may possibly be an increased risk of certain side effects with high doses or with long-term use (over one year), however. You should discuss this with your doctor if you require long-term use or high doses.

Prokinetics, or medications that stimulate muscle activity in the stomach and esophagus, are sometimes provided for the treatment of reflux disease. The only available drug in the market is metoclopramide, which has little benefit in the treatment of reflux disease and has some side effects, some of which can be serious.

Ms. Ashley Koff, RD
Nutrition & Dietetics Specialist

Lots of medications are available today to help combat gastroesophageal reflux disease (GERD)—a condition in which the liquid content of the stomach regurgitates (backs up, or refluxes) into the esophagus—both over-the-counter and by prescription. But if we just turn to a drug, we may be missing something. The body's normal function is not to reflux (unless it is helping us in a moment of trauma to avoid choking or to get rid of something that it detects as bad for us). If you are having reflux routinely it means that the body is seriously trying to tell you something. It could be that you're producing too much stomach acid, but a lot of people actually have too little acid in the stomach. Too much food or eating too quickly? Food intolerances? Gravity working against you (lying down after eating)? As you can see, there are many things that could be factors, and medication addresses just one—reducing the acid. So if it isn't your specific problem or your entire problem, you may not get the full fix.

Mom Energy: A Simple Plan to Live Fully Charged

More About this Book

Mom Energy: A Simple Plan to Live Fully Charged

From celebrated dietitian Ashley Koff and fitness trainer to the stars Kathy Kaehler comes Mom Energy, an exciting new way for moms to tap into their own natural and renewable sources of...

Continue Learning about GERD

7 Ways to Fight GERD
7 Ways to Fight GERD
Sometimes the signs of acid reflux are unmistakeable -- from searing heartburn to sour-tasting acid burbling up in your throat. Sometimes the signs ar...
Read More
Who is a good candidate for endoscopic surgery for GERD?
Dr. Robin Miller, MDDr. Robin Miller, MD
When medical management fails and severe GERD symptoms persist, patients may want to consider surger...
More Answers
Are GERD and heartburn serious?
Diana MeeksDiana Meeks
Occasional heartburn is very common and rarely serious, but frequent heartburn can be a symptom of g...
More Answers
How Is GERD Treated?
How Is GERD Treated?

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.