What Is the Best OTC Drug for GERD (Acid Reflux)?

It's easy to grab over-the-counter (OTC) heartburn remedies at a drugstore, and these are often the first line of defense against GERD. A glance down the pharmacy aisle shows a vast array of choices, including antacids, histamine-2 (H2) antagonists, and proton pump inhibitors (PPIs). These drugs help neutralize or reduce stomach acid.

If you have frequent heartburn, you may have gastroesophageal reflux disease (GERD), or acid reflux. GERD is a condition in which stomach acid routinely backs up into the esophagus. Other symptoms include coughing and nausea. It's important to contact a healthcare provider if you develop severe symptoms like bleeding, hoarseness, and loss of appetite.

You may wonder what product will provide the best results. Antacids can immediately treat acid reflux, while H2 antagonists and PPIs take some time to work. The latter drugs, however, can help heal the esophagus. Read on to learn more about OTC options to treat acid reflux symptoms.

What Is Acid Reflux?

GERD, or acid reflux, causes stomach contents to flow backward up the esophagus. The esophagus is a tube through which food flows from your mouth to your stomach. Stomach contents can flow backward if the muscle at the end of the esophagus does not close.

You may develop symptoms like heartburn and an unpleasant taste in your mouth. Stomach contents are acidic, so they can irritate the esophagus.

Other acid reflux symptoms include:

• Chest pain
• Dry cough
• Hoarseness
• Trouble swallowing

OTC Drugs To Treat Acid Reflux 

Medications are available over the counter to treat mild acid reflux symptoms. Options include antacids, H2 antagonists, and PPIs.

Antacids

One of the best-known classes of drugs for treating acid reflux is antacids. These drugs include Tums, Rolaids, and Mylanta (aluminum hydroxide, magnesium hydroxide). Antacids contain salt from minerals like magnesium or compounds, such as calcium carbonate, that neutralize acids in the stomach.

Antacids are fast-acting and immediately relieve acid reflux symptoms, especially heartburn. They might be used for rare episodes of heartburn. 

If you have frequent acid reflux and take antacids often, you might need more potent treatment. Antacids suppress acid and will make you feel better faster, but they do not heal the lining of the esophagus. The acid churned out by your stomach can erode the lining of the esophagus over time, which could cause Barrett's esophagus. This precancerous disorder can lead to esophageal cancer.

Standard antacids like Mylanta are relatively safe. Some people who use them may experience diarrhea and constipation, but there are not many side effects.

Histamine-2 (H2) Antagonists

Another class of heartburn drug that you can buy over the counter is an H2 antagonist. There are prescription and OTC H2 antagonists. You can find Tagamet HB (cimetidine) and Pepcid AC (famotidine) in the drugstore.

These drugs are stronger than antacids and more long-lasting. H2 antagonists reduce the amount of acid your stomach produces by blocking histamine. Your body releases this compound when you encounter an allergen. H2 antagonists also help heal the esophageal lining to some extent.

You can use them for up to two weeks for short-term acid reflux relief. The drug works for four to 10 hours. Some people take H2 antagonists twice daily, which can be helpful for mild acid reflux.

H2 antagonists are relatively safe. Side effects may include:

• Abdominal pain
• Constipation
• Diarrhea
• Drowsiness
• Fatigue
• Headache

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors (PPIs) have been available over the counter in the United States since 1989. Options include Prevacid 24HR (lansoprazole), Nexium 24HR (esomeprazole), Prilosec OTC (omeprazole), and Zegerid OTC (omeprazole, sodium bicarbonate).

PPIs block an acid-producing enzyme in the lining of the stomach. A study published in 2022 found that the success rate was 34.4% to 80.8% among those who took PPIs. The success rate ranged from 10.4% to 51.7% in placebo groups.

These drugs also help heal the lining of the esophagus more effectively than H2 antagonists. Some evidence suggests that people with erosive esophagitis can possibly be healed when they take a PPI. Erosive esophagitis causes the lining of the esophagus to become visibly irritated or injured.

PPIs take time to work, unlike antacids. Some people may not feel better until a few days after taking them. Side effects may include diarrhea or stomach pain.

What Is the Best OTC Drug To Take for Acid Reflux?

The best OTC drug for acid reflux depends on your symptoms. Antacids are generally the drug of choice to treat mild acid reflux. They neutralize stomach acid to provide immediate relief.

H2 antagonists and PPIs, on the other hand, may take longer to work. These drugs may be more helpful if you have frequent heartburn. Both H2 antagonists and PPIs decrease the amount of acid your stomach makes and may heal the lining of the esophagus. PPIs might be more effective for more severe acid reflux symptoms.

Things To Consider 

It's important not to combine antacids, H2 antagonists, and PPIs without consulting a healthcare provider. If you take other medications, you should also talk to a healthcare provider to determine potential interactions.

Make sure you keep all medications out of reach of children. Store them in a cool, dry place. Hot and humid temperatures, such as in a bathroom, can make these drugs less effective.

OTC vs. Prescription Acid Reflux Drugs

Talk to a healthcare provider if you think you need a stronger medication to treat acid reflux. Prescription drugs have higher doses than ones available over the counter. If you have severe symptoms, you may require a prescription. Prescription-strength PPIs, for example, can help reverse damage to the esophagus.

When To Contact a Healthcare Provider

Treating acid reflux involves more than just taking a pill or munching on antacids. These drugs work in tandem with lifestyle changes, such as cutting out alcohol and caffeine, consuming small, more frequent meals, and quitting smoking. Other ways to reduce heartburn include not eating after three hours before you sleep and propping your head up while you sleep.

Talk to a healthcare provider if you have frequent or severe acid reflux symptoms. You might need prescription drugs to treat symptoms and prevent complications that require further treatment.

Contact a healthcare provider if you have:

• Bleeding
• Choking
• Feeling full quickly after eating
• Hoarseness
• Loss of appetite
• Unexplained weight loss
• Vomiting frequently

You'll also want to call a healthcare provider whenever your symptoms change in character. It might be time to seek medical attention, for example, if you used to have heartburn but now feel like food is stuck in your chest.

Acid reflux symptoms can be similar to those of a heart attack. Heart attack signs include shortness of breath, chest discomfort, nausea, and lightheadedness. Get medical attention right away if you think you might be experiencing a heart attack rather than acid reflux.

A Quick Review

You can treat heartburn caused by acid reflux, when stomach contents flow backward up the esophagus, with over-the-counter (OTC) drugs, such as antacids, H2 antagonists, and PPIs. Antacids work quickly by neutralizing stomach acid. H2 antagonists and PPIs need more time to work but may help heal the esophagus.

Talk to a healthcare provider if you have severe acid reflux symptoms. They can prescribe a stronger medication to help alleviate symptoms.