For quick heartburn relief, over-the-counter antacids like Tums or Maalox work within minutes. If your heartburn comes back frequently, longer-acting options like H2 blockers or proton pump inhibitors (PPIs) reduce acid production for hours or even a full day. The right choice depends on how often you get heartburn, how fast you need relief, and how long you need it to last.
Antacids: Fastest Relief
Antacids are the go-to for occasional heartburn that hits after a big meal or a glass of wine. Their active ingredients, typically calcium carbonate, magnesium hydroxide, or aluminum hydroxide, work by directly neutralizing the acid already sitting in your stomach. You’ll feel better within minutes, which is their biggest advantage. The tradeoff is that relief only lasts a few hours, so they’re best for short, predictable episodes rather than all-day symptoms.
Common brands include Tums (calcium carbonate), Maalox, and Mylanta. They’re widely available, inexpensive, and don’t require a buildup period. You take one when you need it and move on.
One thing to keep in mind: antacids containing aluminum or magnesium can interfere with how your body absorbs other medications, including iron supplements, certain antifungal drugs, and some antibiotics. If you take other medications regularly, space them at least one to two hours apart from your antacid dose.
H2 Blockers: Longer-Lasting Protection
If antacids wear off too quickly or you find yourself reaching for them multiple times a day, H2 blockers are the next step up. Famotidine (Pepcid) is the most common one available over the counter. Instead of neutralizing acid that’s already there, H2 blockers reduce how much acid your stomach produces in the first place.
The downside is speed. H2 blockers take about an hour to kick in, so they won’t rescue you mid-episode the way an antacid will. But once they start working, the effects last roughly four to ten hours. That makes them a good choice when you know heartburn is coming, like before a meal that usually triggers symptoms, or when you need overnight relief.
PPIs: Strongest Acid Suppression
Proton pump inhibitors, sold as omeprazole (Prilosec) and lansoprazole (Prevacid) among others, are the most powerful over-the-counter option. They shut down acid production more completely than H2 blockers and keep stomach acid suppressed for 15 to 21 hours a day, compared to about eight hours for an H2 blocker.
PPIs are not designed for quick relief. They can take one to four days of daily use to reach full effect. The FDA approves OTC PPIs for a 14-day course, used up to three times per year. They’re meant for people dealing with frequent heartburn (two or more days per week), not the occasional post-pizza flare.
If you find yourself needing PPIs repeatedly or beyond those 14-day windows, that’s a signal to talk with a healthcare provider. Long-term PPI use has been loosely linked to reduced absorption of calcium, vitamin B12, and a modestly increased fracture risk in some studies. However, the overall safety profile is considered good, with fewer than 1% to 2% of people experiencing side effects significant enough to stop treatment. Large reviews have found that none of these associations hold up under the most rigorous analysis, so the risks appear small, but they’re worth knowing about if you’re considering months of continuous use.
How to Choose Between Them
The simplest way to think about it: antacids are reactive, H2 blockers are preventive for a few hours, and PPIs are preventive for the long haul. Here’s how they compare:
- Antacids: Work within minutes, last a few hours, best for occasional heartburn
- H2 blockers: Work within one to three hours, last four to ten hours, good for predictable or nighttime heartburn
- PPIs: Take one to four days for full effect, suppress acid for most of the day, designed for frequent heartburn over a 14-day course
You can also combine approaches. Taking an antacid for immediate relief while waiting for an H2 blocker to kick in is a common and reasonable strategy.
Lifestyle Changes That Actually Help
Medications handle the symptoms, but a few habit changes can reduce how often heartburn shows up in the first place. Two interventions have the strongest evidence behind them: losing weight if you’re carrying extra pounds, and not lying down after eating. Gravity is your friend when it comes to keeping acid in your stomach, so staying upright for two to three hours after a meal makes a noticeable difference for many people.
If nighttime heartburn is your main problem, elevating the head of your bed by about six inches (using a wedge pillow or bed risers, not just extra pillows) helps keep acid from traveling up your esophagus while you sleep. Sleeping on your left side also helps, because of how your stomach is positioned relative to the esophagus.
Common trigger foods vary from person to person, but the usual suspects include coffee, alcohol, tomato-based foods, chocolate, fatty or fried meals, and spicy dishes. Paying attention to your own patterns matters more than memorizing a generic list.
Heartburn During Pregnancy
Heartburn is extremely common during pregnancy, especially in the second and third trimesters. Calcium-based antacids like Tums are generally considered a safe first option, but the picture gets more complicated with other medications. The risk to the fetus tends to be highest during the first trimester, and safety depends on the specific ingredients and dosage. If lifestyle adjustments and antacids aren’t enough, a provider can recommend prescription options that are safe for pregnancy.
When Heartburn Signals Something More
Occasional heartburn is common and usually harmless. But if it’s happening frequently enough to affect your daily life, it may have progressed to gastroesophageal reflux disease (GERD), which can damage the lining of your esophagus over time. Persistent acid exposure can cause narrowing of the esophagus, making it physically harder to swallow food and drinks.
Difficulty swallowing, heartburn that doesn’t improve with over-the-counter treatment, or unexplained weight loss alongside reflux symptoms are all signs worth getting evaluated. Frequent heartburn that responds well to medication still warrants a conversation with a provider to make sure nothing else is going on underneath.