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What should I take for heartburn?

Antacids, H2 blockers, PPIs — our pharmacists explain the options

Heartburn medicine

Call it heartburn, indigestion or acid reflux — most of us are familiar with that burning feeling in the chest that sometimes follows a big meal or a spicy pizza. Heartburn means that stomach acid has backed up into your esophagus, where it doesn’t belong. It’s usually nothing serious, but it can be uncomfortable.

Fortunately, pharmacies stock plenty of safe, effective remedies — so many, in fact, that it can be confusing trying to figure out which one is right for you. So, we asked some pharmacists for help. Here’s a rundown on the three classes of heartburn remedies, courtesy of The Portland Clinic pharmacy team.

Antacids

Antacids — such as Tums, Rolaids, Maalox and Mylanta — are the fastest-acting heartburn relievers. They take effect in less than five minutes by quickly neutralizing acid in the stomach. For mild heartburn after a meal, antacids offer quick relief that lasts about 20-30 minutes. They come in a variety of strengths, so check labels for dosing information. In general, you shouldn’t use antacids more than four times a day. If you find yourself reaching for them frequently, it might be time to try a different one or to switch to one of the stronger remedies.

H2 blockers

Pepcid, Tagamet and Zantac are some of the more well-known H2 blockers, so called because they block a chemical called histamine that prompts the stomach to make acid. They take longer than antacids to bring relief — about 30-45 minutes — but the relief lasts 4-10 hours. H2 blockers can be used to relieve mild or moderate heartburn, or to prevent it when you anticipate heartburn (for example, you can take them 30-60 minutes before a big holiday meal). You also can combine H2 blockers with antacids for quicker relief. Just don’t take H2 blockers more than twice a day, or for more than two weeks if you use them regularly.

Proton pump inhibitors (PPIs)

Prilosec, Prevacid and other PPIs also reduce stomach acid, but they do it by preventing certain cells from pumping acid into the stomach. They take 2-3 hours to take effect but offer the longest-lasting relief — about 12-24 hours. PPIs are the best option for more frequent heartburn (more than twice a week), or when H2 blockers don’t provide enough relief. They’re most effective when taken daily for 14 days (but not longer), 30-60 minutes before your first meal of each day.

When over-the-counter remedies aren’t enough

Over-the-counter heartburn remedies are meant for short-term relief of mild to moderate heartburn only. Anytime heartburn is severe or doesn’t respond to self-care within a few weeks, it should be evaluated by a health care provider. Heartburn that is frequent and ongoing, or that comes with other symptoms such as difficulty swallowing, shortness of breath, continuous nausea or chronic hoarseness, also should be checked out.

Simple strategies to prevent heartburn

If heartburn is happening more often than you’d like, a little prevention could go a long way. Here are some strategies that might help:

  • Eat smaller meals.
  • Cut back on foods and drinks that can cause heartburn: alcohol, caffeine, carbonated beverages, chocolate, fatty foods, citrus fruits and juices, garlic, onions, mint and spicy foods.
  • Ask your pharmacist if other medications you take could be aggravating heartburn.
  • Stop or reduce smoking.
  • Drop a few pounds if you are overweight.
  • Wear clothes that are loose around the waist.
  • Avoid lying down within three hours of meals.
  • If heartburn hits at night, elevate the head of your bed 6-8 inches.