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Antacids, H2 Blockers and PPIs: Which Heartburn Medication is Right for Me?

If the home remedies and lifestyle changes didn’t help alleviate heartburn symptoms, you should consider treatment with heartburn medication.

There are three different options that are available to help prevent and relieve symptoms. Victor Wong, PharmD, a pharmacist in the Greater Toronto Area and teaching associate at the University of Toronto Faculty of Pharmacy will explain  how each of the medications are used to help you make the right decision.

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Heartburn medication infographic

Antacids

Form: Liquid, chewable tablet or dissolving tablet taken in response to heartburn

How they work: Antacids neutralize the stomach’s acid so that the esophagus is not irritated during acid reflux

Advantages: Antacids are fast acting; they can work within five minutes. They are perfect for mild and infrequent symptoms that dissipate quickly.

Disadvantages:  Short duration of relief, which may only last an hour; not a preventative measure

The pharmacist’s view: “Antacids work by neutralizing the existing acid in the stomach and turning it into a basic form. As antacids do not prevent heartburn their role is limited to intermittent, ad hoc, use for relief of heartburn symptoms.

Antacids begin to provide relief of short-acting heartburn within five minutes, but have a short duration of acid neutralizing effect of 30 to 60 minutes.”

H2 Blockers (H2RAs)

Form: Tablets

How they work: Histamine 2 stimulates the production of acid in your stomach. H2 blockers interrupt this process reducing your stomach’s acidity to help prevent irritation of your food pipe during acid reflux. Acid production is controlled for up to 12 hours.

Advantages: Long lasting (up to 12 hours acid control); effective in reducing frequency and severity of heartburn.

Disadvantages: Starts to work within one hour.  Stop use and consult your doctor if symptoms get worse or new symptoms develop or persist after 14 days of treatment. 

Proton Pump Inhibitors (PPIs)

Form: Tablets or liquid taken daily over an extended period of time.

How they work: PPIs treat heartburn by blocking the enzyme in the stomach that produces the excess acid that leads to heartburn, decreasing the chances of experiencing symptoms.

Advantages: Take PPIs for frequently occurring symptoms. If symptoms occur at night, the pain is severe or there are other complications, PPIs might be the best course of treatment for your heartburn.

Disadvantages: They may take 3-5 days to become fully effective; the 14-day dosing course should only be repeated every four months.