In April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. They made this recommendation because unacceptable levels of NDMA, a probable carcinogen (or cancer-causing chemical), were present in some ranitidine products. People taking prescription ranitidine should talk with their doctor about safe alternative options before stopping the drug. People taking OTC ranitidine should stop taking the drug and talk with their healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, a person should dispose of them according to the product’s instructions or by following the FDA’s guidance.
To treat acid reflux, a person has several over-the-counter (OTC) and prescription options to choose from. Medications for acid reflux offer either fast acting or long-term relief to the pain. In some cases, a doctor may recommend using combinations of medication.
This article looks at the different types of medicine for acid reflux, how to take them, and when to see a doctor.
According to the American College of Gastroenterology (ACG), acid reflux or gastroesophageal reflux (GER) occurs when acid from the stomach flows into the esophagus.
The result is a burning sensation in the middle of the chest. It may also cause an acidic taste in the mouth and burning in the throat. A person may experience these symptoms for a few hours. People may know this sensation as heartburn.
Although many people experience heartburn occasionally, if it occurs two or more times a week, they may have gastroesophageal reflux disease (GERD).
A person experiences heartburn when stomach fluids remain in the esophagus long enough to damage its lining.
When treating acid reflux, doctors attempt to:
- relieve pain and other symptoms
- help the esophagus heal
- prevent future episodes of heartburn and damage
Some lifestyle changes the ACG recommend include:
- changes in diet to avoid foods that aggravate the condition
- sleeping or lying with an elevated head
- avoiding alcohol and tobacco products
- avoiding eating for up to 2–3 hours before bed
- maintaining a moderate weight
- wearing looser fitting clothes
There are a few different types of OTC medications for acid reflux:
According to one 2020 article, antacids work by neutralizing the acid present in a person’s stomach.
According to the United Kingdom’s National Health Service (NHS), antacids can provide relief from symptoms for a couple of hours. However, they do not treat the underlying cause of acid reflux, and the NHS do not recommend long-term use.
Some examples of antacids include:
- calcium carbonate (Tums)
- sodium bicarbonate (Alka-Seltzer)
- magnesium trisilicate (Gaviscon)
- aluminum hydroxide (Maalox)
A pregnant person can safely take antacids that contain aluminum salts.
Though they are generally safe for short-term use, there are some risks associated with taking antacids continually.
Chronic use of aluminum hydroxide antacids may increase the risk of toxicity in infants and those experiencing renal failure. Symptoms may include:
- fecal impaction
- stomach cramps
- magnesium deficiency
Chronic use of calcium carbonate may result in:
- abdominal pain
- dry mouth
H2 receptor blockers
H2 receptor blockers are a type of medication that researchers initially developed for treating peptic ulcers.
The body can rapidly absorb H2 blockers, providing acid-suppression that can last several hours.
According to a 2018 article in the journal, LiverTox, H2 receptors block histamine type 2 receptors in the stomach.
By blocking the receptors, the medication slows or reduces the amount of acid the stomach produces.
The ACG state that H2 blockers improve heartburn symptoms and help the esophagus lining to heal. However, this may require a higher dosage.
According to the International Foundation for Gastrointestinal Disorders, H2 receptor blockers include:
- famotidine (Pepcid)
- nizatidine (Axid)
- cimetidine (Tagamet)
- ranitidine (Zantac)
Since April 2020, the FDA have requested the removal of ranitidine from the market in the United States due to the unacceptable levels of NDMA, which is a potential carcinogen.
Those who are taking ranitidine should stop taking it and talk to a healthcare provider about an alternative medication. They should dispose of the product as per the product’s instructions.
Some potential side effects of H2 blockers include:
- muscle aches
Proton pump inhibitors
Proton pump inhibitors (PPI) are a type of medication that reduces the amount of acid a person’s stomach makes.
The state that PPIs are more effective than H2 blockers. They can also heal the esophageal lining.
The Food and Drug Administration (FDA) state that a person can take OTC PPIs for 14 days, up to three times a year.
Two OTC examples of PPIs include:
- omeprazole (Prilosec)
- lansoprazole (Prevacid)
Though generally safe and effective for long term use, there are potential side effects from using a PPI.
According to the International Foundation for Gastrointestinal Disorders, some potential side effects include:
- abdominal pain
If OTC medications are not effective, a person may consider talking to their doctor about prescription options.
Some prescription medications include:
Prokinetics are medications that help the stomach process food faster. According to the NIDDK, some examples include:
- metoclopramide (Reglan)
- bethanechol (Urecholine)
Though generally safe, prokinetics do not mix well with all medication.
They can also cause side effects such as:
- odd physical movement
Like the OTC versions, prescription-strength PPIs reduce the amount of acid the stomach produces. The difference tends to be in the strength of the dose and offering of approved medications.
Some examples of prescription-strength PPIs include:
- omeprazole (Prilosec)
- lansoprazole (Prevacid)
- rabeprazole (Aciphex)
- pantoprazole (Protonix)
- esomeprazole (Nexium)
- dexlansoprazole (Dexilant)
H2 receptor blockers
Similar to the OTC versions, H2 receptor blockers block histamine receptors in the stomach. This causes a reduction in the production of stomach acid.
The main differences in the prescription forms are an increase in the dose and strength.
The higher dose can help the esophageal lining to heal. According to the ACG, 50% of people who take prescription-strength H2 blockers twice a day stop experiencing symptoms. They can also help maintain remission in 25% of those with GERD.
A person may need to use a combination of medications to treat their acid reflux effectively.
Antacids, PPIs, and H2 blockers all work in slightly different ways, and according to the NIDDK, a person may need to try a combination of medication to help control symptoms.
A person should use caution when combining or taking multiple medications. A doctor can advise people on the safety of using acid reflux medications based on their health conditions and other medications.
Sometimes, certain medications may not create the desired effects. According to an older study, researchers found that taking H2 inhibitors with PPIs did not produce any greater effect in reducing symptoms.
The main difference between OTC and prescription-strength medication is the size of the doses.
A person should talk to their doctor about prescription medications if OTC medication is not working for them.
According to the ACG, different medications can provide different results:
|Drug||How do they work||Eliminate symptoms?||Heal esophagitis?||Help prevent GER from returning?|
|Antacids||Neutralize the acid||✓||x||x|
|H2 Blockers (OTC)||Mildly suppress the acid||✓||x||x|
|H2 blockers (prescription)||Moderately suppress the acid||✓||✓||✓|
|PPIs||Significantly suppress the acid||✓||✓||✓|
|Prokinetics||Helps the stomach empty quickly||✓||✓||✓|
Insurance plans may cover at least some of the cost of prescription medications, but they do not typically cover the cost of OTC medications.
According to Medicare, Part D helps pay for generic and brand-name drugs.
Medicaid may cover OTC and prescription mediation.
A person should talk to their doctor if they have persistent or frequent acid reflux.
Frequent or intense heartburn may be a sign a person has gastroesophageal reflux disease (GERD).
According to the NIDDK, GERD is a more severe form of GER. A person may need additional treatment, such as surgery, if medications and lifestyle changes do not work.
There are several medication options for people seeking to control their acid reflux.
Options include both OTC and prescription medications.
A person should talk to a doctor if they have frequent acid reflux that OTC and lifestyle changes do not appear to help.
A person should also talk to their doctor about taking new medication.
Which medications can people combine, and how can they do it safely?
Mixing over the counter medications (OTC) for GER are not recommended without medical advice. If taking an OTC H2 Blocker or OTC PPI, taking an occasional tablet or liquid antacids, such as Tums or Gaviscon, might be helpful. If you need to take the antacids frequently in addition to the OTC H2 Blocker or PPI, see your doctor for a thorough checkup. A person should only combine OTC strengths of an H2 Blocker and a PPI under their doctor’s direction.Alan Carter, PharmDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.