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. About 60 million Americans deal with heartburn at least once a month. For many, OTC meds are the first line of defense. But not all heartburn pills are the same. Antacids, H2 blockers, and PPIs work in completely different ways, and picking the wrong one can mean wasted money, missed relief, or even long-term risks.
How Antacids Give Fast, Short-Term Relief
Antacids are the OG of heartburn remedies. They’ve been around since the 1800s. Think Tums, Rolaids, Milk of Magnesia. These work by neutralizing stomach acid right where it’s burning - like pouring baking soda on a fire. You feel relief fast: often in under a minute. That’s why they’re perfect for sudden, occasional heartburn after a spicy meal or too much coffee.
But here’s the catch: their effect lasts only 30 to 60 minutes. If you’re having heartburn twice a week or more, antacids won’t cut it. You’ll be popping tablets all day. And it’s not just inconvenient - too many antacids can cause side effects. Calcium carbonate (found in Tums) can lead to rebound acid production. After the acid gets neutralized, your stomach sometimes overcompensates and makes even more. That’s why 30% of users report worse symptoms a few hours later.
Also, antacids can mess with other meds. If you take blood pressure pills, antibiotics, or thyroid meds, don’t crush a Tums right after. Wait at least two hours. The minerals in antacids bind to those drugs and stop your body from absorbing them. That’s not just a myth - it’s FDA-approved labeling.
H2 Blockers: Slower But Longer Lasting
If antacids are fire extinguishers, H2 blockers are like turning down the gas valve. They don’t neutralize acid - they tell your stomach cells to make less of it. Drugs like famotidine (Pepcid AC), cimetidine (Tagamet HB), and nizatidine (Axid AR) block histamine, a chemical that signals acid production.
They take longer to work - about an hour - but last 8 to 12 hours. That makes them ideal for predictable heartburn. Planning a big dinner? Take one 60 to 90 minutes before you eat. Worried about nighttime heartburn? A dose at bedtime can keep you asleep. Studies show H2 blockers reduce acid by 60-70%, which is enough for most people who get heartburn once or twice a week.
But there’s a downside. After two or three weeks of daily use, your body can start to adapt. The effect fades. That’s why many users say, “It worked great at first, then stopped helping.” A 2021 study in Alimentary Pharmacology & Therapeutics confirmed this tolerance effect. H2 blockers also interact with warfarin and phenytoin, so if you’re on blood thinners or seizure meds, check with a pharmacist before using them.
PPIs: The Heavy Hitters - Powerful, But With Risks
Proton pump inhibitors (PPIs) are the strongest OTC heartburn meds you can buy without a prescription. Omeprazole (Prilosec OTC), esomeprazole (Nexium 24HR), and lansoprazole (Prevacid 24HR) shut down the final step of acid production - the proton pumps in your stomach lining. They block up to 98% of acid, which is why they’re the go-to for people with heartburn two or more days a week.
But they don’t work fast. It takes 24 to 72 hours to reach full effect. If you take a PPI after a heartburn flare-up, you’ll be disappointed. You need to take it daily, first thing in the morning, 30 to 60 minutes before breakfast. That’s when your stomach’s acid pumps are waking up. Take it after eating? It won’t work as well. The enteric coating can even break down if you take it with orange juice - a common mistake.
And here’s the big warning: FDA rules say you should only use OTC PPIs for 14 days in a row, no more than once every four months. Why? Long-term use is linked to real risks. A 2023 Johns Hopkins study found a 23% higher chance of chronic kidney disease with daily use over a year. The FDA has also flagged increased risks of hip fractures, low magnesium, vitamin B12 deficiency, and even a rare but serious kidney inflammation called interstitial nephritis. There’s also a 1.7x higher risk of C. diff infection - a nasty gut bug that can cause severe diarrhea.
Still, for people with frequent heartburn, PPIs are life-changing. A 2022 JAMA Internal Medicine study showed they reduced symptoms in 90% of users over 14 days, compared to 65% with H2 blockers. But they’re not for everyone. Don’t use them if you only get heartburn once a week. And never use them as a crutch for poor diet or overeating.
Which One Should You Choose?
It’s not about what’s cheapest or most popular - it’s about what matches your symptoms.
- 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? Try an H2 blocker. Take Pepcid AC 60 minutes before meals you know will trigger it. It’s more cost-effective than PPIs and avoids long-term risks.
- Two or more days a week? Consider a PPI - but only for 14 days. If you still feel burning after two weeks, see a doctor. You might have GERD, a hiatal hernia, or another issue that needs real diagnosis, not just more pills.
And if you’re using more than one type? You’re not alone. A 2023 survey found 68% of frequent heartburn sufferers combine antacids with PPIs - using the PPI for daily control and the antacid for sudden flare-ups. That’s smart. But don’t mix them at the same time. Wait at least an hour between doses.
What Users Actually Say
Real people have real experiences. On Amazon, Tums has a 4.7-star rating from nearly 28,500 reviews. Most praise the speed: “Saved me after tacos.” But many also say, “I’m back on it every day - it doesn’t last.”
Pepcid AC gets 4.5 stars. Users love nighttime relief. But a lot say, “It worked for two weeks, then stopped.” That’s the tolerance effect in action.
Prilosec OTC has 4.3 stars. People who need daily relief swear by it. But 67% of negative reviews say, “It took days to work - I thought it was broken.” They didn’t know it’s not a quick fix.
Reddit users in r/gerd are blunt: “PPIs work, but only if you take them before food, every day, like clockwork.” And they’re right. Timing matters more than the brand.
When to See a Doctor
OTC meds are great for occasional heartburn. But if you’re relying on them too often, it’s a red flag. See a doctor if:
- Your heartburn lasts more than two weeks, even with OTC meds
- You have trouble swallowing or feel food getting stuck
- You’re losing weight without trying
- You’re vomiting blood or your stool looks black and tarry
- You’re using PPIs more than once every four months
These aren’t just “bad heartburn” signs - they could point to Barrett’s esophagus, ulcers, or even esophageal cancer. The FDA estimates 15 million Americans have daily heartburn. Many don’t realize that’s not normal.
Bottom Line: Match the Medicine to the Problem
Heartburn meds aren’t one-size-fits-all. Antacids are your emergency tool. H2 blockers are your preventative tool. PPIs are your intensive care tool - powerful, but only for serious cases and short bursts.
Don’t just grab the biggest bottle on the shelf. Ask yourself: How often does this happen? When does it strike? How long does it last? That’s the real guide. And if you’re unsure, talk to your pharmacist. They’re trained to help you pick the right one - no prescription needed.