Since heartburn is an easily recognizable symptom (although at times it can be confused with angina pectoris, or heart pain), it is a natural for self-medication. And there are many over-the-counter products to treat it. Those products can be divided into three categories--antacids, histamine-2 receptor blockers (H2 blockers), and proton-pump inhibitors (PPIs)--that vary in how they work, how quickly they work, how long they work, and how well they work.
If your heartburn occurs occasionally and unexpectedly, as is apt to happen to many of us once or twice this holiday season, your best bet is a simple antacid such as generic or store-brand versions of Maalox, Mylanta, Rolaids, or Tums. They come in various dosage forms--liquid suspensions, tablets that you chew or swallow, effervescent solutions, and chewing gum--from which you can choose. They all work in a few minutes by neutralizing the acidity in the esophagus. Their effect lasts up to a few hours, plenty long enough for reflux symptoms to have ceased.
If you know from bitter experience to expect heartburn in certain situations ("I love pizza, but it always gives me agita"), take an H2 blocker beforehand, which stops histamine from stimulating stomach acid production. There are four available, formerly only by prescription but now over the counter as well as generically: cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75, Zantac 150). They all start working in 30 minutes to 1 hour and one dose can last up to 12 hours. One product, Pepcid Complete, combines famotidine with an antacid for both immediate and longer-term relief.
When heartburn happens more than once or twice a week, taking antacids several times a day is much too labor-intensive, and even continuous twice-daily use of H2 blockers may not be very effective. At that point, more complete blockage of stomach acid production is called for. Enter PPIs, which actually block the mechanism in the stomach cells that releases acid into the stomach. The first of those to be approved, omeprazole, is available over the counter as Prilosec OTC. It may take days for these medications to provide complete relief, so they are not appropriate for occasional or intermittent heartburn. If there is no improvement from Prilosec OTC or your symptoms recur after a 14-day course, medical evaluation is mandatory.
This article first appeared in the December 2007 issue of Consumer Reports on Health.
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