OTC Heartburn Medicines for GERD: Types, Uses & Side Effects

There are several over-the-counter heartburn medications available to relieve symptoms. If these don't work, talk to your doctor about other options, such as lifestyle changes. Your doctor may want to investigate whether gastroesophageal reflux disease, or GERD, is the cause of your symptoms.

Antacids neutralize stomach acid, relieving heartburn, sour stomach, acid indigestion, and stomach distress. Some antacids also contain simethicone, which aids in the elimination of gas. Some antacids contain chemicals that might cause diarrhea (magnesium) or constipation (aluminum).

Aluminum hydroxide gel 

Calcium carbonate (Alka Seltzer, Tums)

Magnesium hydroxide (magnesia milk) 

Gaviscon, Gelusil, Maalox, Mylanta, Rolaids, and Pepto-Bismol

Antacids should be taken exactly as prescribed by your doctor or according to the package label. If you use tablets, chew them thoroughly before swallowing for speedier relief.

To avoid overdosing or overusing antacids, make sure to follow the label guidelines. Depending on the substances, adverse effects may include constipation, diarrhea, changes in the color of bowel movements, and stomach cramps.

Drugs that reduce stomach acid production are classified into two types: histamine antagonists (H2 antagonists or H2 blockers) and proton pump inhibitors (PPIs).

Examples of H2 blockers available over the counter are:

Cimetidine (Tagamet HB)

Famotidine (Pepcid AC; Zantac 360)

Nizatidine (Axid or Axid AR)

Note: The H2 blocker ranitidine, which was used in previous Zantac formulations, was removed from the market in 2020 after it was discovered to constitute a carcinogen.

The proton-pump inhibitors esomeprazole (Nexium 24HR), lansoprazole (Prevacid 24HR), and omeprazole (Prilosec OTC) are available over the counter for 14 days to treat frequent heartburn (two or more times per week). These drugs are also available in higher strength prescriptions. Take them as directed on the package or as prescribed by your doctor.

If these treatments do not relieve your symptoms, or if your heartburn symptoms worsen or last for more than two weeks, you should consult your doctor.

Pepcid Complete combines the acid-neutralizing properties of an antacid with the acid-reducing effects of an H2 blocker. Zegerid OTC contains a proton pump inhibitor and sodium bicarbonate.

Hydrogen blockers. H2 blockers, in prescription form (typically at larger doses than over-the-counter forms), can often ease heartburn and treat reflux, especially if you've never had it before. These medications are especially effective in treating heartburn, although they may not be as effective in treating esophagitis (esophageal inflammation) caused by GERD.

Histamine causes acid production, particularly after meals, hence H2 blockers should be taken 30 minutes before meals. They can also be given at bedtime to reduce acid production. Examples of prescribed H2 blockers:

Cimetidine (Tagamet HB)

Famotidine (Pepcid AC; Zantac 360)

Nizatidine (Axid or Axid AR)

Headache, abdominal pain, diarrhea, nausea, gas, sore throat, runny nose, and dizziness are some of the possible side effects. 

Proton pump inhibitors. Depending on the cause of your heartburn or reflux, your doctor may prescribe pharmaceuticals that block acid production more efficiently and for longer periods of time than H2 blockers, known as proton pump inhibitors. PPIs are best taken 1 hour before a meal. They include:

Dexlansoprazole (Dexilant)

Esomeprazole (nexium)

Lansoprazole (prevacid)

Omeprazole (Prilosec or Zegerid)

Pantoprazole (protonix)

Rabeprazole (Aciphex)

Most clinicians do not feel that one proton pump inhibitor is considerably more successful than others in treating GERD. These drugs are also effective at preserving the esophagus from acid, allowing esophageal inflammation to recover.

Headache, diarrhea, abdominal pain, bloating, constipation, nausea, and gas are some of the possible side effects.

Promotional agents. These function by activating the muscles of the gastrointestinal tract, which may help prevent acids from remaining in the stomach for too long, and tightening the lower esophageal sphincter, which reduces reflux into the esophagus. Metoclopramide (Reglan) is a progestogen that is occasionally used to alleviate heartburn caused by GERD. Reglan can cause major side effects such as sleepiness, tiredness, diarrhea, restlessness, and mobility issues. Vonoprazan (Voquezna), a potassium-competitive acid blocker (PCAB), was recently approved by the FDA. It treats GERD by inhibiting acid secretion in the stomach.

All of these over-the-counter medications, to varied degrees, can help reduce heartburn symptoms. If you experience more severe heartburn symptoms that these pills do not relieve, or if you've been taking them for more than two weeks, contact your doctor. You may require stronger prescription medication and tests to determine what is causing your symptoms.