Prescription Drugs for Heartburn and Reflux

Frequent heartburn or gastroesophageal reflux disease (GERD) that occurs more than twice a week usually responds best to heartburn medicine that you take daily rather than just when you feel the heartburn. Most of the over-the-counter treatments are not meant to be taken daily for a long time. Check in with your doctor to see if you need a prescription medicine for your heartburn.

Histamine-2 (H2) Blockers for Heartburn and Reflux

In prescription form (usually higher doses than the over-the-counter versions), H2 blockers can generally relieve heartburn and treat reflux, especially if you’ve never had treatment before. These drugs are particularly useful at alleviating heartburn, but may not be as good for treating esophagitis (inflammation that occurs in the esophagus) that is the result of GERD.

Histamine stimulates acid production, especially after meals, so H2 blockers are best taken 30 minutes before meals. They can also be taken at bedtime to suppress nighttime production of acid. Examples of prescription H2 blockers:

• Cimetidine (Tagamet)
• Famotidine (Pepcid)
• Nizatidine

Side effects can include headache, abdominal pain, diarrhea, nausea, gas, sore throat, runny nose, and dizziness.

Note that the H2 blocker ranitidine was removed from the market in 2020 because it was found to contain cancer causing agents.

Proton Pump Inhibitors (PPIs) for Heartburn and Reflux

Depending on the source of your heartburn or reflux, your doctor can prescribe drugs that block acid production more effectively and for a longer period of time than the H2 blockers, namely the family of medications doctors call proton pump inhibitors. PPIs are best taken an hour before meals. They include:

• Dexlansoprazole (Dexilant)
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Omeprazole (Prilosec, Zegerid)
• Pantoprazole (Protonix)
• Rabeprazole (Aciphex)

Most doctors do not believe that one drug is significantly more effective than the others in managing GERD. These medications are also good for protecting the esophagus from acid so that esophageal inflammation can heal.

Side effects can include headache, diarrhea, abdominal pain, bloating, constipation, nausea, and gas.

Promotility Agents for Heartburn and Reflux

Promotility agents work by stimulating the muscles of the gastrointestinal tract, which may help prevent acids from staying in the stomach too long, and strengthening the lower esophageal sphincter, reducing reflux into the esophagus. Metoclopramide (Reglan) is a promotility agent occasionally used to treat heartburn associated with GERD. The side effects of Reglan can be serious and may include drowsiness, fatigue, diarrhea, restlessness, and movement problems.

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