For occasional heartburn, an over-the-counter antacid like Tums or Rolaids will neutralize stomach acid and bring relief within minutes. If heartburn hits you more than twice a week or antacids aren’t cutting it, stronger options like H2 blockers and proton pump inhibitors (PPIs) reduce acid production at the source. The right choice depends on how often your heartburn strikes and how long you need relief.
Antacids: Fastest Relief
Antacids are the simplest option. They work by directly neutralizing the acid already in your stomach rather than preventing its production. You’ll find them as chewable tablets or liquids under brands like Tums, Rolaids, Mylanta, and Pepto-Bismol. The active ingredients vary: calcium carbonate, magnesium hydroxide, aluminum hydroxide, and sodium bicarbonate are the most common. Relief typically starts within minutes.
The tradeoff is that antacids wear off relatively quickly, usually within one to three hours. They’re ideal for the occasional flare after a heavy meal or a glass of wine, but they aren’t designed for daily, ongoing use. Calcium-based antacids can cause constipation, while magnesium-based ones may have the opposite effect. If you’re reaching for antacids more than a couple of times a week, it’s worth stepping up to a longer-acting option.
H2 Blockers: Longer-Lasting Protection
H2 blockers reduce stomach acid production by blocking histamine receptors on the cells that make it. Famotidine (Pepcid) is the most widely available OTC version. An older option, cimetidine, provides about four to five hours of significant acid suppression at the standard 200 mg dose, taken up to twice daily.
H2 blockers take longer to kick in than antacids, typically 30 to 60 minutes, but they last considerably longer. That makes them a good choice when you know heartburn is coming, like before a meal you expect will cause trouble, or when you need overnight relief. Some people use an antacid for immediate comfort and an H2 blocker to keep symptoms from returning.
PPIs: The Strongest Option
Proton pump inhibitors like omeprazole (Prilosec) and lansoprazole (Prevacid) are the most powerful acid suppressors available without a prescription. They block the pump that produces stomach acid in the first place, rather than just dampening the signal. The American Gastroenterological Association considers PPIs more effective than H2 blockers for both healing irritated tissue in the esophagus and controlling symptoms.
PPIs are not quick fixes. It can take up to four days before they reach full effectiveness, and they need to be taken daily to maintain their benefit. You take them once in the morning, before eating, for a 14-day course. They’re designed for frequent heartburn (two or more days per week), not the occasional episode after pizza.
Long-term PPI use carries some risks worth knowing about. Chronic use has been linked to reduced absorption of calcium, magnesium, and vitamin B12. The FDA has warned that PPIs may increase the risk of bone fractures in the hip, wrist, or spine. There’s also an association with higher rates of kidney disease and gut infections, particularly C. diff. None of this means PPIs are dangerous for a standard two-week course, but it’s a reason not to stay on them indefinitely without medical guidance.
Lifestyle Changes That Actually Help
What you take matters, but what you do between doses matters too. Several non-drug strategies have solid evidence behind them.
- Stop eating three hours before bed. Lying down with a full stomach lets acid flow back into your esophagus. A three-hour buffer gives your stomach time to empty.
- Elevate the head of your bed six to eight inches. Use bed risers or a foam wedge under your upper body. Stacking pillows doesn’t work because it bends you at the waist without creating the gradual incline you need. Gravity keeps acid where it belongs.
- Lose weight if you carry extra pounds. Excess abdominal weight pushes up on the stomach and forces acid toward the esophagus. Even modest weight loss can reduce heartburn frequency.
- Identify your triggers. Fatty, greasy, and spicy foods are common culprits. Citrus, chocolate, coffee, and alcohol bother many people. Everyone’s triggers are slightly different, so paying attention to patterns is more useful than following a generic list.
Heartburn During Pregnancy
Heartburn is extremely common during pregnancy, especially in the second and third trimesters. Antacids are generally the first choice because they work locally in the stomach without much systemic absorption. H2 blockers are also considered an option. Johns Hopkins Medicine advises avoiding both antacids and H2 blockers during the first trimester as a precaution. Cutting back on greasy, spicy, and acidic foods, eating smaller meals, and not lying down right after eating can reduce how often you need medication at all.
When Chest Pain Isn’t Heartburn
Heartburn and a heart attack can feel surprisingly similar. Both cause chest discomfort, and heart attacks frequently produce nausea and what feels like indigestion. If your chest pain comes with pressure that spreads to your jaw, neck, or arms, shortness of breath, a cold sweat, or sudden dizziness, call 911. Women are more likely than men to experience the less obvious symptoms like jaw pain, back pain, and nausea rather than classic crushing chest pressure.
Even if chest pain goes away on its own after a few hours, the Mayo Clinic recommends following up with a provider. Both heartburn and a developing heart attack can produce symptoms that fade temporarily. Gallbladder attacks and esophageal spasms can also mimic heartburn, particularly after fatty meals or with pain that shifts to the shoulders and neck.
Choosing the Right Approach
Your frequency is the best guide. If heartburn shows up once or twice a month after an obvious trigger, keep antacids on hand and address it in the moment. If it happens a few times a week, an H2 blocker taken before meals or at bedtime gives you a longer window of protection. If you’re dealing with heartburn on most days, a two-week PPI course combined with lifestyle changes is the standard starting point. When that two-week course ends and symptoms return, or if over-the-counter options aren’t controlling things, that’s the point where a provider can evaluate whether something more is going on.