Several types of over-the-counter medications can relieve heartburn, and the best choice depends on how fast you need relief and how often symptoms occur. Antacids work within minutes for occasional flare-ups, while stronger acid-reducing options are better suited for frequent heartburn. Here’s what’s available and how each option compares.
Antacids: Fastest Relief
Antacids are the go-to for occasional heartburn because they work quickly, usually within minutes. They contain ingredients like calcium carbonate, magnesium hydroxide, or aluminum hydroxide that neutralize stomach acid on contact. Common brands include Tums, Rolaids, and Maalox. Liquid versions tend to work faster than chewable tablets.
The trade-off is that relief only lasts a few hours. Antacids are fine for the occasional bout of heartburn after a heavy meal, but they’re not designed for daily use. If you’re reaching for them more than twice a week, a different approach is worth considering.
Alginates: A Physical Barrier
Alginate-based products (like Gaviscon) work differently from standard antacids. When they mix with stomach acid, they form a gel-like raft that floats on top of your stomach contents, physically blocking acid from splashing up into your esophagus. One study found alginates were more effective than traditional antacids for treating reflux. They’re a good option if your heartburn tends to hit when you lie down or bend over, since they target that upward flow of acid directly.
H2 Blockers: Longer-Lasting Relief
H2 blockers, such as famotidine (Pepcid), reduce the amount of acid your stomach produces rather than just neutralizing what’s already there. They take about an hour to kick in, so they’re not ideal for immediate relief, but the effects last significantly longer than antacids. Taking one before a meal you know will trigger heartburn can prevent symptoms from starting.
You shouldn’t rely on H2 blockers continuously for more than two weeks without talking to a healthcare provider. If you need them that consistently, it’s a sign something else may be going on.
Proton Pump Inhibitors: Strongest Option
Proton pump inhibitors (PPIs) like omeprazole (Prilosec) and esomeprazole (Nexium) are the most powerful acid reducers available over the counter. They suppress acid production more aggressively than H2 blockers and are designed for people dealing with frequent heartburn, generally defined as two or more episodes per week.
PPIs don’t provide instant relief. It can take one to four days to feel the full benefit, so they’re not what you want for a one-time flare-up. They work best when taken daily for a set period, typically 14 days for over-the-counter courses. Concerns about long-term PPI use have made headlines over the years, including potential effects on bone density and nutrient absorption (particularly magnesium). The FDA has issued warnings about some of these risks, though high-quality studies have had trouble confirming a strong causal link. Still, the general guidance is to use them at the lowest effective dose for the shortest time needed.
Baking Soda: A Quick Home Fix
Dissolving half a teaspoon of baking soda (sodium bicarbonate) in a glass of water creates a basic solution that neutralizes stomach acid fast. It works, but it comes with important limits. Baking soda is high in sodium, which is a problem if you have high blood pressure, heart disease, or kidney disease. Don’t use it for more than two weeks, don’t combine it with large amounts of milk, and keep total daily intake under five teaspoons of the powder form. It’s a reasonable occasional remedy, not a regular strategy.
Ginger
Ginger has some preliminary evidence behind it for heartburn and related digestive symptoms. It appears to speed up gastric emptying, meaning food moves out of your stomach faster, which can reduce the pressure that pushes acid upward. Small studies have found improvements in symptoms like stomach burning, nausea, and fullness at doses around 1.5 to 3 grams per day. But these studies were small and lacked strong controls, so ginger is best thought of as a complement to other treatments rather than a standalone solution. Ginger tea or capsules are the most common forms.
Lifestyle Changes That Reduce Symptoms
What you take matters, but what you do between doses matters just as much. A few adjustments can cut the frequency of heartburn significantly:
- Elevate your head at night. Raising the head of your bed by about 20 centimeters (roughly 8 inches) using blocks or a wedge pillow helps keep acid in your stomach while you sleep. Extra pillows alone don’t work as well because they bend you at the waist rather than creating a gradual incline.
- Don’t eat within 2 to 3 hours of lying down. Gravity is your ally when you’re upright. Give your stomach time to empty before bed.
- Identify your triggers. Common culprits include spicy food, citrus, tomato-based sauces, chocolate, coffee, alcohol, and fatty or fried foods. You don’t necessarily need to avoid all of them, just the ones that consistently cause your symptoms.
- Wear loose clothing. Tight waistbands and belts increase pressure on your abdomen and can push acid upward.
- Eat smaller meals. A full stomach creates more pressure on the valve between your stomach and esophagus.
Heartburn During Pregnancy
Heartburn is extremely common during pregnancy, especially in the second and third trimesters. Antacids are generally considered the first-line option and are available as chewable tablets or liquids. H2 blockers are also considered safe for most pregnant women, though they’re best avoided during the first trimester as a precaution. If lifestyle changes and antacids aren’t enough, talk to your provider about the right next step for your situation.
When Heartburn Might Be Something Else
Heartburn and heart attack symptoms can overlap in uncomfortable ways. Typical heart attack signs include pressure or squeezing in your chest that spreads to your neck, jaw, or arms, along with shortness of breath, cold sweats, lightheadedness, or sudden fatigue. Women are more likely than men to experience jaw or back pain, nausea, and shortness of breath without the classic crushing chest pain. If your chest discomfort comes with any of these symptoms, treat it as an emergency.
Heartburn that doesn’t respond to over-the-counter treatment after two weeks, or that keeps returning after you stop medication, is also worth investigating. Persistent reflux can damage the lining of your esophagus over time, and a provider can determine whether you’re dealing with something beyond occasional heartburn.