Written By: Mark Rogers, Pharm. D
Proton Pump Inhibitors (PPIs)
The drugs available as OTC in this category includes the brands Prilosec, Nexium, Protonix (I recommend buying the generic equivalent to save $$). PPIs are the most effective heartburn drugs available OTC, but with a few caveats. They require a day or two to reach full effect & provide significant relief. As such, they should be taken on a routine basis, not just as needed when you have a bout of heartburn. This means PPIs are recommended for chronic heartburn or stomach ulcer sufferers. They are also most effective when taken on an empty stomach, 30-60 minutes prior to your first meal of the day. Headache and diarrhea are the most common side effects. Of note: Nexium and Protonix may be moderately more effective than Prilosec, the first PPI on the market.
The recommended drugs available as OTC in this drug category are famotidine (Pepcid) and ranitidine (Zantac). Both are good options for mild-to-moderate heartburn. Famotidine is typically taken once a day, while ranitidine is twice a day. Like PPIs, H2 blockers are most effective when taken on a routine basis. However, they typically start providing relief within an hour, so can also be used as needed for heartburn. H2 blockers are well tolerated, with headache being the most common side effect. Compared to PPIs, H2 blockers are less potent and less effective for moderate-to-severe chronic heartburn.
Antacids are the original treatment for heartburn & indigestion, with brands like Tums and Rolaids. Antacids are effective for mild, occasional GI upset, as they start providing relief almost immediately. For chronic heartburn issues, they are not recommended. While well tolerated, antacids do have some potentially significant drug interactions with other medications.