Which OTC Meds Treat Heartburn?

Over-the-counter medications for treating heartburn

Check out this answer from Consensus:

When choosing an OTC medication for heartburn, it is essential to consider the frequency and severity of symptoms. Antacids provide quick relief but are not suitable for frequent heartburn. H2RAs can be effective but may develop tolerance with repeated use. PPIs are the most effective for frequent heartburn, providing sustained acid suppression and symptom relief. NSAIDs like diclofenac may offer an alternative approach, although they are not commonly used for this purpose. Always consult with a healthcare professional to determine the most appropriate treatment for your specific condition.

Heartburn is a common condition characterized by a burning sensation in the chest, often caused by acid reflux. Over-the-counter (OTC) medications are widely used to manage this condition. This article explores various OTC medications available for treating heartburn, their mechanisms of action, and their effectiveness.

Antacids

Antacids are one of the most commonly used OTC medications for heartburn. They work by neutralizing stomach acid, providing quick but short-term relief.

Mechanism of Action

Antacids neutralize the acid in the esophagus, which can provide immediate relief from heartburn symptoms. However, they do not significantly affect gastric pH or prevent subsequent heartburn episodes2.

Effectiveness

Antacids are effective for transient relief but are not recommended for frequent heartburn due to their short duration of action2.

Histamine-2 Receptor Antagonists (H2RAs)

H2RAs, such as famotidine, reduce stomach acid production by blocking histamine receptors in the stomach lining.

Mechanism of Action

H2RAs inhibit the action of histamine on the stomach’s parietal cells, reducing acid production. However, they can rapidly develop tolerance with repeated use, known as tachyphylaxis9.

Effectiveness

While H2RAs can provide relief, their effectiveness diminishes with continuous use. They may provide symptom relief without significantly decreasing esophageal acid exposure2 9. Studies have shown that antacids like hydrotalcite can relieve symptoms faster than H2RAs like famotidine8.

Proton Pump Inhibitors (PPIs)

PPIs, such as omeprazole and esomeprazole, are highly effective for treating frequent heartburn by providing sustained inhibition of gastric acid production.

Mechanism of Action

PPIs block the enzyme responsible for acid secretion in the stomach, leading to a significant and prolonged reduction in stomach acid levels2.

Effectiveness

PPIs are superior to antacids and H2RAs for controlling gastric acid and treating frequent heartburn. A PPI dose of 20 mg is optimal for empiric treatment of frequent heartburn2. Studies have shown that individuals with greater improvements in intragastric acid suppression are more likely to achieve heartburn relief3. Additionally, OTC PPIs are safe for short-term use and do not pose significant health risks when used according to label instructions5.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Interestingly, some studies have explored the use of NSAIDs like diclofenac for heartburn relief.

Mechanism of Action

Diclofenac reduces acid-induced heartburn symptoms by inhibiting prostaglandin production in the esophagus6.

Effectiveness

Diclofenac has been shown to significantly reduce heartburn symptoms in healthy volunteers by attenuating acid-induced esophageal sensation6.