Common Over-the-Counter Products for Acid Reflux

Acid Reflux and Heartburn

Acid reflux is a common but infrequent issue that many Americans experience in their lifetimes. Acid reflux is characterized by the acid in your stomach coming up your throat and causing a burning sensation. It can happen to anyone at any time, though there are certain people and lifestyles in which it occurs more commonly. This includes those who are overweight, over 40 years old, and those who eat foods that are high in fat. While some risk factors are unavoidable, there are lifestyle changes you can make to reduce the frequency you are experiencing acid reflux.

Learn more about possible lifestyle changes you can make to help prevent acid reflux and GERD

The uncomfortable burning sensation in acid reflux is often called 'heartburn'. Heartburn is named this because it feels like a kind of burning in your chest, since the bottom of your throat and your heart are oriented near each other. This is uncomfortable but doesn't necessarily always cause damage if it's infrequent. However, when acid reflux is happening regularly, more than twice per week for multiple months, it then becomes a medical condition called gastroesophageal reflux disease (GERD). While acid reflux and heartburn can be self-treated by over the counter (OTC) products, GERD must be investigated and treated by your healthcare provider.

GERD is more serious because the reflux of acid back up into your throat can cause serious damage if it’s happening regularly. Because of this, GERD needs to be treated by prescription medication, such as pantoprazole, omeprazole, esomeprazole, or famotidine.

What are Antacids?

One of the most common relievers of heartburn and acid reflux is antacids. Antacids don’t treat the underlying problem, but they do relieve the pain. They are made of very “basic” chemicals (the opposite of acidic), such as calcium carbonate, aluminum hydroxide, magnesium hydroxide, and/or sodium bicarbonate. When something comes into contact with something acidic, such as acid in the stomach, a reaction called neutralization occurs. This results in the stomach acid becoming a more neutral liquid. That way, if acid is refluxing into your throat, an antacid will ensure that this liquid no longer burns. It doesn’t take the acid away from the stomach, but it makes the reflux less painful.

Antacids should not be used to treat GERD

Since it’s not addressing the problem, antacids should not be used to treat conditions like GERD that are ongoing. Antacids don’t prevent all damage from being done, as you usually take one when you already feel the pain. It’s also a very short-term relief of symptoms, only treating the acute problem but not preventing the issue from returning. That’s why they are good for occasional heartburn but are not a solution for long-term issues such as GERD.

Things to Consider when taking Antacids

There are a number of types of antacids, differing by the active ingredient or combination of active ingredients. However, there are many things that all antacids have in common. Antacids are all known to cause a decrease in absorption of some medications, such as tetracycline antibiotics and digoxin. This can be avoided if you take these medications more than 2 hours away from antacids.

Different Types of Antacids

Most antacids come in two forms: chewable tablets and liquid solutions.

Many people prefer the chewable tablets since they are convenient to keep on hand for sudden onset-heartburn. However, the liquid forms are slightly stronger and have a faster onset. In terms of side effects and efficacy, most antacids are similar, though they do differ in certain respects.

Calcium Carbonate Antacids—‘Tums’

Calcium carbonate is a common component in antacids and is the main active ingredient in over-the-counter products such as “Tums”. The typical regular strength tablets contain 500 mg of calcium carbonate, which is 200 mg of actual calcium.

Pros

• Calcium carbonate antacids have the added bonus of calcium supplementation. Even if you aren’t low on calcium, it can still be beneficial to have that extra calcium supplementation when taking these antacids.
  This is the preferred antacid for people who are predisposed to be low on calcium, such as people with kidney dysfunction.
• Inexpensive (a pack of 100 tablets costs roughly $7).
• Most potent type of antacid.

Cons

Most of the cons for taking calcium carbonate antacids are associated with long-term use. These antacids are not supposed to be used long-term, and if you find yourself needing antacids for a period longer than 2 weeks, it’s very important to stop taking antacids and speak with your healthcare provider about treating the cause of this recurrent need.

• If you take over 1500 mg of calcium per day for many consecutive days, it is possible to “overdose” on calcium. If taken as directed, this is unlikely, but is still a possibility.
• If used regularly, large amounts of calcium can lead to low phosphate levels in your body.
• Side effects: constipation (this is a common side effect when taking large amounts of calcium long-term), belching, flatulence (gas)
• May actually cause an increase in stomach acid production over time

Magnesium Salts—‘Milk of Mangesia’

Magnesium-based antacids, such as milk of magnesia, are not as commonly used. Milk of magnesia and its generics contain 800 mg of magnesium per 10ml of solution.

Pros

• Benefit of magnesium supplementation
• Liquid antacid forms have very fast onset
• Inexpensive; $8 for a 355 ml bottle (at least 23 doses)

Cons

• Not very potent
• Should be avoided in those with kidney disease and limited in the elderly due to the risk of developing hypermagnesemia (too much magnesium)
• Potential for overdose of magnesium
• Diarrhea is a very common side effect
• Liquid form is less convenient and isn’t usually carried around—more of an “at home” remedy

Aluminum Hydroxide/Magnesium Carbonate Antacid Mixes—‘Gaviscon’

The mix of aluminum hydroxide and magnesium carbonate in antacids is common, as they are thought to compliment each other. This combination comes in generic and brand name products. The brand name “Gaviscon” comes in a tablet (160 mg aluminum hydroxide and 105 mg magnesium carbonate) and a liquid (with 508 mg aluminum hydroxide and 475 mg magnesium carbonate per 10 ml).

Pros

• The aluminum and magnesium are thought to counteract the side effects of constipation and diarrhea, respectively, to ideally result in unaffected bowel movements.

Cons

• Diarrhea still usually occurs as a side effect, as the magnesium is more potent.
• Any antacid containing aluminum should not be used in infants.
• Should not be used in patients with kidney failure.
• Can lead to hypophosphatemia (low phosphate) with long-term use.

Antacids Containing Simethicone—‘Mylanta’

Some antacids have an extra ingredient called simethicone. Simethicone doesn’t neutralize the acid like the other two ingredients, but instead works as an “anti-gas” ingredient, relieving some of the uncomfortable symptoms of gas that are often associated with both heartburn and even the use of antacids. They come in generic and brand forms and as both liquid and chewable tablets. The brand “Mylanta” has a one-tablet product that contains a mix of 1000 mg calcium carbonate, 270 mg magnesium hydroxide, and an additional ingredient 80 mg of simethicone.

The main pro of using this medication if the added benefit of the simethicone. Otherwise, the pros and cons are the same as other antacids containing the same mix of basic compounds.

Sodium Bicarbonate Antacids —‘Alka-Seltzer’

A slightly less commonly used antacid in modern times is those made with sodium bicarbonate, such as the branded “Alka-Seltzer”. This antacid is for very occasional use and should, in general, be avoided because of the high sodium content. It must be avoided in those with kidney disease, high blood pressure, heart disease, pregnancy, and many other conditions. It can cause side effects such as belching, flatulence, abdominal distension, and even lead to a condition called “alkalosis”, which can be very dangerous.

OTC Acid Supressing Products

There are also over the counter products that prevent the production of acid rather than neutralize it like antacids do. There are two main types: proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs).

What are OTC PPIs?

PPIs are medications that work to stop the pump that is responsible for releasing acid into your stomach. These medications are available as both prescription and OTC products. The over-the-counter products come in three main forms, Prevacid (lansoprazole), Nexium (esomeprazole), and Prilosec (omeprazole). Each of these PPIs has a slightly different active ingredient, but they work in the same way.

Even as OTC products, PPIs have a lot of possible interactions and side effects. Because of this, it’s recommended to speak with a pharmacist or healthcare provider about your symptoms before starting the course. It’s also important to remember that these products take 1-4 days to start working, so they are not for immediate relief of symptoms but rather to treat the issue.

How OTC PPIs should be used

These medications are available as OTC products only when used as indicated on the package labels. These medications are indicated for slightly more frequent heartburn (over 2 days per week) and acid reflux and are intended to treat the issue and prevent this from reoccurring. All three products are indicated for 14-day courses of one tablet/capsule per day for 14 days. You are also able to repeat this course a maximum of once every 4 months (3x per year).

If your acid reflux is not controlled within the 14 days or is recurring more than every 4 months, it’s important to speak to your healthcare provider about seeking a prescription medication to control your condition and prevent long-term damage.

To learn more about prescription PPIs, read our blogs on omeprazole, pantoprazole, esomeprazole, and lansoprazole.

What are OTC H2RAs (H2 Blockers)?

Another option for an OTC product that works to prevent the production of acid, is H2RAs. These medications work by stopping the signalling that usually tells your stomach to make more acid. This is just preventing the production of acid at a different step in the process than PPIs, but they also have different characteristics. OTC H2RAs are indicated for more short-term use, with directions to take one tablet 30 minutes to immediately before consuming food or drink that may bring on heartburn. They can be taken a maximum of twice in 24 hours. Two common OTC H2RAs are Tagamet (cimetidine) and Pepcid (famotidine)

This contrasts OTC PPIs in a number of ways, most significantly with the onset and duration of treatment. OTC H2RAs are used as needed in order to prevent heartburn, unlike PPIs which require a longer course to resolve frequent heartburn. OTC H2RAs also don’t have the same limit to the frequency in which you can take them per year, unlike OTC PPIs. However, if you find yourself requiring OTC H2RA heartburn treatment or prevention frequently, you should speak with your healthcare provider about any possible underlying issues.

Learn more about the differences between PPIs and H2RAs