The Best Heartburn Medicine
The best heartburn medicine should provide fast, effective relief from stomach acid. We talked to doctors and dug into clinical research to figure out the difference between antacids, H2 blockers, and proton pump inhibitors — and we learned that the best treatment depends on the severity of your symptoms. Our top picks are well-known brands that offer everything from occasional after-meal relief to a 2-week course of treatment for severe heartburn.
Crunchy, fruit-flavored tablets that use calcium carbonate to neutralize stomach acid. Good for mild, occasional heartburn.
Strawberry chews that are a little more expensive than Tums but come in portable packs of six for sticking in a bag or purse.
Stronger than an antacid, Zantac stops your stomach from producing acid and can be taken before meals as prevention.
A potent option for heartburn that doesn’t respond to other over-the-counter medications, though it requires a 2-week course of treatment.
The Best Heartburn Medicine
If you’re hunting for the best heartburn medicine, then you’re already familiar with that burning sensation in the middle of your chest that accompanies too many servings of pizza or Thanksgiving dinner. Heartburn, or gastroesophageal reflux disease (GERD), occurs when stomach acid backs up into your esophagus. It’s an extremely common health issue, affecting about 20 percent of the US population — but fortunately, you’ve got plenty of treatment options.
Antacids treat symptoms by neutralizing stomach acid and are the best option for first-time hearburn sufferers. Our favorite antacids are Tums Ultra Strength 1000, with 1,000 mg of heartburn-relieving calcium carbonate per tablet. A bottle of 72 tablets runs about $9. If you want a portable option for a purse or bag, we also liked Rolaids Ultra Strength Soft Chews, which come in chewing gum-sized packs, at $17 for 72 chews.
If you’ve tried antacids for a few days are are still experiencing symptoms, we’d suggest H2 blockers. More powerful than antacids, H2 blockers prevent stomach acid from being made in the first place. Our pick for this class of drugs is Zantac 150. It relies on ranitidine to do its work — one of the oldest and best-known H2 blockers — and came highly recommended by our experts. A box of 8 tablets costs about $5.
Proton Pump Inhibitors (PPIs) are the heavy artillery of the heartburn world. Like H2 blockers, they prevent your stomach from producing acid, but they’re more potent and can cause dependency if used for extended periods of time. They’re best reserved for cases where nothing else seems to be working. For this category, we’d suggest Nexium 24HR. The active ingredient, esomeprazole, is a newer member of the PPI class that got high marks from our experts for efficacy, though you’ll have to commit to a 2-week course of treatment. A box of 42 capsules runs about $20.
How We Found the Best Heartburn Medicine
We started by rounding up all the brands we could find that were available through pharmacies, online retailers (like Amazon and Vitacost), or chain grocery stores like Walmart. We found 66 heartburn remedies in all, including chewable tablets, liquids, gummies, and capsules.
Then we dug into active ingredients.
Antacids, H2 blockers, and PPIs all protect against heartburn using different mechanisms — which means each group relies on a separate class of drugs.
If you’re shopping for antacids, you’ll run into active ingredients like calcium carbonate, magnesium hydroxide, and bismuth subsalicylate. Most of these ingredients are at least moderately effective at neutralizing stomach acid, but we learned that sodium bicarbonate (baking soda) is a dud. While found in many Alka Seltzer products, research shows it’s not very effective at neutralizing acid — and its high sodium content is another turn-off. So we cut it from the running.
When it comes to H2 blockers, you’ll encounter three options: cimetidine, ranitidine, and famotidine. These prevent heartburn by blocking your body’s response to histamine type 2 (the chemical that tells your stomach to produce acid). Research suggests all three ingredients are about equally effective — but we learned that cimetidine has been linked to gynecomastia (breast enlargement) in men in rare cases. It’s also more likely to interfere with a number of prescription medications than famotidine or ranitidine.
PPIs are more potent than H2 blockers, but otherwise similar: They stop your stomach from producing acid. Three common options are lansoprazole, omeprazole, and esomeprazole. Esomeprazole — approved by the Food and Drug Administration in 2001 — is the newest, but has a slew of impressive research behind it: In one study, it was found to promote faster healing than lansoprazole, and in another, a single dose of esomeprazole was found to be more effective than a double dose of omeprazole. So we focused exclusively on esomeprazole-based medications, ditching other active ingredients.
When we had a choice, we opted for maximum strength.
We researched recommended dosages to further narrow our pool of contenders. Usually, this meant we opted for “max strength.” Take Zantac, an H2 blocker: It’s available in both 75 mg and 150 mg tablets, but 150 mg turned out to be the widely recommended amount.
Meanwhile, standard and max-strength antacids turned out to have the same dosage limits. Tums Regular Strength 500 mg antacid tablets instructed us to take up to 15 per day. Tums Ultra Strength 1000 mg tablets told us to take up to seven. Either way, you’re capping out at 7,000 milligrams. So we opted for Ultra Strength, assuming that people would prefer to chew through as few tablets as possible to achieve heartburn relief.
Then we looked for the medications that were the most palatable.
For our H2 and PPI finalists, we looked at how easy packaging was to open and whether the size and shape of the pills would make swallowing difficult. We also compared dosages, looking for formulas that required as few pills as possible.
Our testing for antacids was more involved: Since these medicines often require chewing, our testers recorded the taste and texture of each product, prioritizing the most palatable formulas. Tablets and chews easily beat out liquid antacids at this stage: The liquids had a viscous texture that was hard to swallow. Rolaids Ultra Strength Liquid was described by one tester as “sickly sweet — exactly what I’m always afraid medicine will taste like.” The chews and tablets, by contrast, garnered several comparisons to candy, from Starbursts and Skittles to Smarties.
Our Picks for the Best Heartburn Medicine
Best for Mild Heartburn
The first criterion for a top-rated antacid is effectiveness, and Tums’ active ingredient — calcium carbonate — hits the mark, with “very high” acid-neutralizing powers (per the International Foundation for Gastrointestinal Disorders). Each Tums Ultra Strength tablet delivers 1,000 mg of calcium carbonate, and you can take up to seven daily. Our experts all recommend that antacids be used as soon as you feel symptoms of indigestion. “Antacid doses can be repeated multiple times throughout the day if symptoms continue,” added Dr. John R. Dobbs, pharmacist and managing partner at online pharmacy ApothiCare 360.
When you have to chew your medication, taste is another consideration. And here, too, Tums Ultra Strength 1000 pulled ahead of the pack. It’s medicine, so we hesitate to call it “tasty,” but the Assorted Berries flavor we tried reminded us of Smarties. The tablets have a crunchy texture and a sweet, tangy flavor. Testers also reported less of an aftertaste than options like Rolaids Ultra Strength Tablets, which left a gritty mineral residue behind. We also appreciated that our bottle of Tums came with a five-year shelf-life, making it easy to keep antacids on hand even if you only need them occasionally. A bottle of 72 tablets retails for around $9.
Runner-Up for Mild Heartburn
Rolaids Ultra Strength Strawberry Softchews were voted “best tasting antacid” by our testers (“like a very sweet Starburst,” one reported). They also offer the highest dose of calcium carbonate of all our finalists, at 1,330 mg per chew. While pricier than Tums, at $17 for 72 chews, they’re also extremely convenient: They come in chewing gum-sized packs of six that are easy to fit in a purse or briefcase.
Best for Moderate Heartburn
If you’ve taken antacids for two or three days and had no success, it may be time to move on to a more potent treatment. Our choice for best H2 blocker is Zantac 150. Each dose provides 150 mg of ranitidine, an ingredient that came highly praised by our experts. “Ranitidine is the most commonly used over-the-counter H2 blocker, and it has a very safe side effect profile,” said Dr. Gregg Kai Nishi, bariatric surgeon and assistant clinical director of surgery at UCLA. In fact, ranitidine is generally considered safe enough even for pregnant women.
A box of 8 tablets retails for about $5, and you can take two doses per day for up to two weeks. Unlike antacids, which can only treat existing symptoms, Zantac can both treat and prevent heartburn. For prevention, Dr. Dobbs recommended that, “H2 blockers be taken prior to meals or at set times during the day, such as before breakfast and at bedtime.” Each tablet is roughly the size of an ibuprofen pill, with Zantac’s signature five-sided design.
The National Institutes of Health (NIH) report that side effects “are uncommon, usually minor” for ranitidine and include things like headache, drowsiness, and constipation. But Dr. Carson Liu, bariatric/foregut surgeon and former assistant professor of clinical surgery at UCLA, added this caution: “When you shut off the acid with a heartburn remedy like an H2 blocker or PPI, you’re shutting off the symptoms. If that reflux process continues, it can lead to chronic reflux disease and issues that range from sleeping problems to chronic cough and asthma.” In other words, if your symptoms come back as soon as you stop treatment, don’t keep taking H2 blockers (or PPIs) indefinitely. Go see your doctor.
Best for Intense Heartburn
PPIs are the most potent form of heartburn relief. Our top pick, Nexium 24HR, is a newer (though best-selling) medication whose active ingredient, esomeprazole, has received praise for more effective relief than older PPIs like lansoprazole (found in Prevacid) and omeprazole (found in Prilosec). “All PPI medications heal the esophagus at about the same rate by the eighth week of treatment,” said Dr. Liu, “but esomeprazole seems to relieve heartburn symptoms faster at five days into therapy.”
For full effect, you will have to commit to a 2-week course of treatment: 1 capsule a day for 14 days. But the easy-open bottle contains extremely small capsules — about the size of a Benadryl — making Nexium 24HR easy to swallow even if you normally have trouble with pills. For about $20, you get 42 capsules.
How soon can you expect relief? “PPIs take longer than H2 blockers and antacids, around three hours,” said Dr. Sam Malloy, medical director at Dr.Felix.co.uk, an online medical service and pharmacy in the United Kingdom. “And it’s important to take these medicines before you eat, as the process of digestion is what activates them. Taking them before breakfast yields the best results.”
PPIs do come with long-term risks you should be aware of: “People don’t realize that you can become dependent on taking acid blockers forever, especially PPIs. If you skip a dose of a PPI, you could experience the worst heartburn of your life,” Dr. Liu warned us.
Dr. Dobbs agreed. “Even though people end up taking PPIs for years, the medication has been shown to change the pH of your stomach, potentially causing serious health effects. Studies have shown that long-term use of PPIs can increase your risk of developing kidney disease, osteoporosis, community-acquired pneumonia, and developing a bacterium called C. diff., which can cause severe diarrhea. Long-term use could also deplete nutrients in your body.” In other word, stick to the two-week course recommended on the back of the bottle, and if symptoms come back shortly after, it’s time to talk to your doctor.
Did You Know?
Heartburn symptoms can be confused with other medical issues.
Many visitors to the ER complain of chest pain and a possible heart attack until tests reveal that it’s heartburn, according to Dr. Nishi. “When we see upper abdominal pain, two possibilities at the top of the list are GERD or gallbladder problems.”
But the flipside is also true: Sometimes heartburn symptoms can mask more serious problems. Medline Plus, an NIH-run service, recommends that you see your doctor immediately if you experience symptoms like nausea, vomiting, bleeding, or persistent pain that doesn’t improve.
More medicine isn’t always better.
When it comes to H2 blockers and PPIs, “it is very dangerous to exceed the prescribed dose,” warned Dr. Svetlana Kogan, integrative physician and author of Diet Slave No More! “This can knock out acid production in the stomach entirely, leading to undigested proteins and possible malabsorption of vital nutrients, vitamins, and minerals. In addition, the cytochrome P450 — a place in the liver where medication gets processed — will be overwhelmed, and you may experience side effects that include all the things listed on your medication’s paper insert: headache, nausea, osteoporosis — a full two-page list.”
As long as you’re following the recommended dosage, this shouldn’t be an issue. But if none of the medications you try seem to be working, don’t just keep popping pills. Take it as a sign that you should talk with your doctor.
There’s relief for pregnant women with heartburn.
Heartburn is common during pregnancy, according to the Mayo Clinic, because pregnancy hormones can cause the esophageal valve to relax, allowing stomach acid to irritate the esophagus. Antacids are typically safe for pregnant women, though it’s always a good idea to check with your doctor. If antacids don’t help, “over-the-counter H2 blockers are usually the first line of action for pregnant women,” said Dr. Malloy, “but PPIs are often prescribed if the symptoms persist.”
The best way to treat heartburn is to avoid getting it.
All of our experts agreed that heartburn can be reduced — and possibly avoided altogether — by making lifestyle changes. Losing weight and moderating your consumption of fatty foods, alcohol, coffee, and chocolate will help. If you smoke, try to quit. Dr. Kogan also offered these specific tips:
- Use two pillows to elevate your head above your stomach at night, keeping stomach acid from entering your esophagus.
- Do not eat anything one hour prior to bedtime. (Three hours is even better, according to Dr. Nishi.)
- Avoid acid-producing foods, including coffee and caffeinated tea, chocolate, tomatoes, eggplants, lemons and limes, and spicy or salty foods.
- Avoid nuts and mints — both increase lower esophageal sphincter pressure and allow the reflux of acid into your esophagus and throat.
“There’s also a link between heartburn and GERD and stress levels, so try to take time out to relax if you’re developing these kinds of symptoms,” suggests Dr. Malloy.