Heartburn hits hard - that burning feeling in your chest, the sour taste in your throat, the sleepless nights. If you’ve ever reached for a bottle of Tums, Pepcid, or Prilosec without a prescription, you’re not alone. In fact, over 60 million Americans deal with heartburn at least once a month. And in New Zealand, where spicy food, coffee, and late-night snacks are part of daily life, it’s just as common. The good news? You don’t always need a doctor to find relief. Over-the-counter (OTC) heartburn meds come in three main types: antacids, H2 blockers, and proton pump inhibitors (PPIs). Each works differently, lasts a different amount of time, and suits different kinds of heartburn. Knowing which one to pick - and when - can save you from unnecessary side effects and wasted money.
Antacids: Fast but Short-Lived Relief
Antacids are the OG of heartburn relief. They’ve been around since the 1800s, and you’ve probably used them without thinking. Tums, Rolaids, and Milk of Magnesia all fall into this category. They work by neutralizing stomach acid right where it’s causing trouble - no waiting, no buildup. Just chew or swallow, and you’ll feel better in under two minutes.
How fast? Studies show antacids like calcium carbonate (the main ingredient in Tums) start working in 30 to 120 seconds. That’s why they’re perfect for sudden heartburn after a big meal or spicy taco night. But here’s the catch: they don’t last. Most only work for 30 to 60 minutes. If your heartburn keeps coming back, you’ll be reaching for another tablet - and soon, you’re downing five or six a day.
That’s not always safe. Too much calcium carbonate can cause constipation or, over time, lead to rebound acid hypersecretion. That means your stomach starts making even more acid after the antacid wears off - making your heartburn worse. Magnesium-based antacids like Milk of Magnesia can cause diarrhea. Aluminum-based ones may cause constipation. So if you’re using antacids more than twice a week, it’s time to think about something else.
Best for: Occasional heartburn (less than once a week), quick fixes, no planning needed.
Worst for: Nighttime heartburn, frequent symptoms, long-term use.
H2 Blockers: The Middle Ground
If antacids are a quick bandage, H2 blockers are like turning down the heat on your stove. They don’t neutralize acid - they tell your stomach to make less of it. The most common OTC H2 blockers are famotidine (Pepcid AC), cimetidine (Tagamet HB), and nizatidine (Axid AR). They started as prescription drugs in the 1970s and became available over the counter in the 1990s.
They take longer to work than antacids - about 60 to 90 minutes - but they last much longer: 8 to 12 hours. That makes them ideal if you know heartburn is coming. Take one 30 to 60 minutes before dinner if you know spicy food triggers you. Or take one before bed if nighttime heartburn keeps you awake.
Studies show H2 blockers reduce stomach acid by about 60 to 70%. That’s less than PPIs, but enough to stop most mild-to-moderate symptoms. And unlike PPIs, they don’t require days to build up. One dose can help you sleep through the night.
But here’s the problem: your body gets used to them. After two or three weeks of daily use, their effectiveness drops. A 2021 study in Alimentary Pharmacology & Therapeutics found that H2 blockers lose up to half their power after continuous use. That’s why they’re not meant for daily, long-term treatment. They’re meant for predictable, occasional flare-ups.
Also, they can interfere with other meds. Cimetidine, in particular, affects how your liver processes drugs like warfarin and phenytoin. If you’re on blood thinners or seizure meds, talk to your pharmacist before using H2 blockers.
Best for: Predictable heartburn (1-2 times a week), pre-meal prevention, nighttime relief.
Worst for: Daily use beyond two weeks, people on certain prescription meds.
PPIs: The Heavy Hitters
Proton pump inhibitors - omeprazole (Prilosec OTC), esomeprazole (Nexium 24HR), lansoprazole (Prevacid 24HR) - are the strongest OTC heartburn meds you can buy without a prescription. They don’t just reduce acid. They shut it down. By blocking the acid-producing pumps in your stomach lining, they cut acid production by 90 to 98%. That’s why they’re the go-to for frequent heartburn.
But they’re not fast. Don’t expect relief within an hour. It takes 24 to 72 hours for PPIs to reach full effect. That’s why people get frustrated - they take one on Monday, feel no difference, and assume it’s broken. But if you take it every day for three to five days, you’ll notice a huge drop in symptoms.
That’s why they’re only approved for 14 days of continuous use. The FDA requires this warning on every bottle. Why? Because long-term use comes with real risks. Studies link daily PPI use to higher chances of:
- Clostridium difficile infection (1.7x higher risk)
- Low magnesium levels (FDA warning since 2011)
- Vitamin B12 deficiency (1.5x higher risk after two+ years)
- Increased hip fracture risk (35% higher with long-term, high-dose use)
- Chronic kidney disease (23% higher risk with over a year of use)
And here’s a common mistake: taking PPIs with orange juice. The acid in citrus can destroy the enteric coating that keeps the pill from dissolving in your stomach. That means the drug won’t work. Always take PPIs with water, 30 to 60 minutes before breakfast. That’s when your acid pumps are waking up - and that’s when the drug needs to be in your system to block them.
Market data shows PPIs dominate the OTC heartburn space - they make up nearly half of all sales, even though they’re more expensive ($12-$20 per pack vs. $3-$6 for antacids). But generic versions now make up 68% of PPI sales, bringing the cost down to as low as $5 for a 14-day course. Brands like Curist offer bioequivalent versions at 80% less than name brands.
Best for: Frequent heartburn (two or more days a week), persistent symptoms, nighttime acid reflux.
Worst for: First-time users expecting instant relief, people using them longer than 14 days without medical advice.
Which One Should You Choose?
It’s not about which is “best.” It’s about which fits your life.
Here’s a simple guide:
- Less than once a week? Start with an antacid. Chew a Tums when it hits. No need to overthink it.
- Once or twice a week, but you can predict it? Try an H2 blocker. Take Pepcid AC 30 minutes before your trigger meal or bedtime.
- Two or more days a week? Go with a PPI. But only for 14 days. If it helps, talk to your doctor before restarting.
Many people combine them. A 2023 study found 68% of frequent heartburn sufferers use an antacid along with a PPI - the antacid for instant relief, the PPI for long-term control. That’s smart. But don’t use antacids as a crutch for PPIs. If you’re relying on Tums every day, your heartburn isn’t being managed - it’s being masked.
What to Avoid
There are three big mistakes people make:
- Using PPIs for immediate relief. They don’t work fast. If you need relief now, grab an antacid. Don’t waste your PPI.
- Taking PPIs after meals. They’re designed to block acid before it’s made. Take them before breakfast, not after lunch.
- Using them longer than 14 days. The FDA says no. If your heartburn comes back after stopping, you need a doctor - not another bottle.
Also, avoid mixing H2 blockers with alcohol. It can reduce their effectiveness. And don’t take antacids within two hours of other medications - they can block absorption of antibiotics, thyroid meds, or iron supplements.
When to See a Doctor
OTC meds are great for occasional heartburn. But if you’re using them regularly, something deeper might be going on. See a doctor if:
- Heartburn happens three or more times a week
- You have trouble swallowing
- You lose weight without trying
- Your chest pain feels like pressure or spreads to your arm or jaw
- You’ve been on PPIs for more than 14 days without relief
These could be signs of GERD, a hiatal hernia, or even heart problems. Don’t assume it’s just acid. The FDA says 15 million Americans have daily heartburn - and many of them are self-medicating without realizing they need real treatment.
Final Thoughts
Heartburn is common, but it’s not harmless. The right OTC medicine can make life easier - if you use it right. Antacids for quick fixes. H2 blockers for planned flare-ups. PPIs for frequent, persistent symptoms - but only for two weeks at a time. And never forget: if you’re relying on these pills every day, it’s time to talk to someone who can help you get to the root of the problem.
Can I take antacids and PPIs together?
Yes, but not at the same time. Take the PPI first thing in the morning, 30 to 60 minutes before breakfast. If you get breakthrough heartburn later, you can take an antacid like Tums. Just wait at least two hours after the PPI to avoid interference. This combo works well for many people who need both immediate and long-term relief.
Why do PPIs take so long to work?
PPIs don’t neutralize acid - they shut down the acid-producing pumps in your stomach lining. Those pumps are only active when you eat. So the drug needs time to reach the pumps, bind to them, and block them permanently. It takes 24 to 72 hours for most of the pumps to be turned off. That’s why you need to take it daily for several days before feeling full relief.
Is it safe to take PPIs for more than 14 days?
The FDA says no - unless a doctor tells you to. Long-term use increases risks like kidney disease, bone fractures, and nutrient deficiencies. If your heartburn returns after 14 days, see a doctor. You may need tests for GERD, H. pylori infection, or other conditions. Self-treating beyond 14 days without medical advice can mask serious problems.
Can H2 blockers stop working over time?
Yes. After two to three weeks of daily use, your body can develop tolerance to H2 blockers. Studies show their acid-suppressing power drops by up to 50%. That’s why they’re best for occasional use - like before a known trigger meal. If you need daily relief for more than two weeks, switch to a PPI (for 14 days) or see a doctor.
Are generic PPIs as good as brand names?
Yes. Generic omeprazole, esomeprazole, and lansoprazole are bioequivalent to brand names like Prilosec and Nexium. The FDA requires them to deliver the same amount of active ingredient at the same rate. Generic versions cost 80% less - often under $5 for a 14-day course. Save your money - the generic works just as well.
What’s the safest OTC heartburn medicine?
For occasional use, antacids like Tums are safest - they have the fewest long-term risks. For frequent heartburn, PPIs are most effective but carry more risks if misused. H2 blockers are a middle ground. The safest approach is to use the weakest effective medicine for the shortest time needed. Always follow label instructions, and talk to a pharmacist if you’re unsure.
Next Steps
If you’ve been using OTC heartburn meds for more than a few weeks, it’s time to pause and assess. Keep a symptom journal for a week: note what you ate, when heartburn hit, and what you took. Bring it to your doctor or pharmacist. You might discover patterns - like wine after 7 p.m. or late-night pizza - that are easier to fix than any pill.
For now, choose the right tool for your symptoms. Don’t reach for the strongest drug just because it’s popular. And never ignore warning signs. Heartburn is common - but it shouldn’t be normal.
