Gastroesophageal reflux disease (GERD) is common, affecting an estimated 18%–28% of people who live in North America. GERD is a condition that occurs when bile or stomach acid causes irritation in the esophagus, the hollow, muscular tube leading from the throat to the stomach.
People who have symptoms of acid reflux or heartburn more than twice a week may be living with GERD. Treating GERD often includes changes to diet and lifestyle, but medications are also sometimes needed.
Verywell / Jessica Olah
Medications
GERD may be treated with a variety of medications. There are both prescription and over-the-counter (OTC) drugs available. A combination of different drugs might be used to treat GERD, including both those that require a prescription and those available without one.
More than one drug may be needed at the same time (called combination therapy) to control symptoms. To ensure you are getting the right therapy, talk to your healthcare provider about your GERD symptoms, as well as any OTC medications you are using for it.
Antacids
Antacids are commonly used to treat heartburn. They work to neutralize stomach acid. Antacids don’t address the source of GERD, only the symptoms, so they are typically only used for short periods of time.
Some of the OTC antacids available to treat GERD include:
- Gaviscon (aluminum hydroxide and magnesium carbonate)
- Mylanta (aluminum hydroxide and magnesium hydroxide)
- Rolaids (calcium carbonate and magnesium hydroxide)
- Tums (calcium carbonate)
Proton Pump Inhibitors
Proton pump inhibitors (PPIs) are an often-used option for managing GERD. These medications work to treat the symptoms by blocking the production of stomach acid. With less stomach acid, there may be fewer symptoms of GERD.
A PPI may be prescribed by a medical professional, but some forms are available over the counter. It’s important to discuss your use of OTC PPIs with a healthcare provider because they are not meant to be used long term.
There are several different PPIs available to treat GERD. The formulations that are available without a prescription include:
- Nexium 24H (esomeprazole)
- Prilosec OTC (omeprazole)
- Prevacid 24H (lansoprazole)
- Zegerid OTC (omeprazole/sodium bicarbonate)
Some of the PPI brands that are available over the counter are also available in prescription forms. However, Aciphex (rabeprazole), Dexilant (dexlansoprazole), and Protonix (pantoprazole) are only available as a prescription:
- Aciphex (rabeprazole)
- Dexilant (dexlansoprazole)
- Nexium (esomeprazole)
- Prilosec (omeprazole)
- Prevacid (lansoprazole)
- Protonix (pantoprazole)
Histamine Blockers
Histamine blockers (H2 blockers or H2-receptor antagonists) are another class of medications used to treat GERD. H2 blockers, similar to PPIs, block signals from certain cells in the stomach that promote the production of stomach acid. This process reduces acid overall and may help reduce the symptoms of GERD.
H2 blockers may not be the first choice for treating GERD, but they might be used as a “step-down” therapy to treat certain aspects of GERD.
There are currently two H2 blockers approved for treating GERD. Two others, Zantac (ranitidine) and Axid (nizatidine), have been recalled by their manufacturers based on an advisory from the Food and Drug Administration (FDA) and are no longer on the market.
The H2 blockers that are currently available in both OTC and prescription strength are:
- Pepcid (famotidine)
- Tagamet (cimetidine)
- Zantac 360 (famotidine)
Zantac Recall
Zantac (ranitidine) was removed from the market in April 2020 due to unacceptable levels of a substance called N-Nitrosodimethylamine (NDMA) in the drug. NDMA is thought to cause cancer in humans. A new formulation containing the H2 blocker famotidine is available under the brand name Zantac 360.
Laboratory testing found NDMA in samples of Zantac. It also revealed that the levels of NDMA increased with time and temperature, meaning that the older the product, the higher the level of NDMA it might contain.
Prokinetic Agents
Prokinetic agents are not commonly used in the treatment of GERD, but they may be helpful for certain people. These drugs work to treat GERD by prompting the stomach to empty faster, strengthening the lower esophageal sphincter (LES). A strong LES helps prevent GERD from developing.
Prokinetic agents may not be helpful in lowering symptoms of GERD, however, and because there are concerns over potential adverse effects, prokinetic agents are only recommended for advanced disease or when there is another condition involved (such as gastroparesis).
Prokinetic agents include:
- Baclofen: Available as a generic; not FDA approved to treat GERD but may be used on an off-label basis
- Reglan (metoclopramide)
- Urecholine (bethanechol): Not FDA approved to treat GERD but may be used on an off-label basis
OTC vs. Prescription Drugs
Many of the medications for GERD began as prescription-only drugs before being made available over the counter. This speaks to the high prevalence of indigestion and heartburn and the need for people to treat these conditions quickly and easily. However, the medications that are available over the counter are also usually still available with a prescription at a higher dose.
It’s important to involve a healthcare professional in decisions about taking drugs to treat symptoms of GERD. One reason is that undertreating GERD could lead to other long-term problems. However, that being said, many people will treat their symptoms with a medication that is available over the counter before seeking help from a healthcare provider.
People who have other diagnosed conditions and may be taking other medications should be especially vigilant about talking to a healthcare provider concerning treatments for GERD. Even commonly used OTC remedies like antacids can affect other medications and supplements.
One other reason for seeking a prescription might be the cost. In some cases, a prescription medication may be less expensive than the OTC version, especially when using prescription coverage through a health plan. It’s always a good idea to check on the cost of a drug in the store compared to what it might cost by prescription.
Combining Medicines
More than one type of medication may be used at a time to treat GERD. It’s important to be under the care of a healthcare provider for GERD to determine which combinations will be helpful and at what dosages.
Combining over-the-counter remedies isn’t recommended. If a medication is necessary to treat your symptoms, getting a recommendation or a prescription from a medical professional will be more helpful.
In some cases, if a PPI is not managing GERD, a healthcare provider may consider adding a drug from another class of medications, such as an H2 blocker.
This might be done, for instance, on demand, such as if symptoms continue to be bothersome at night. Antacids might also be used to get quick relief from breakthrough symptoms, but they’re not a long-term solution for GERD.
A Word From Verywell
GERD has different causes and its management needs to be tailored. Treating it effectively is important to avoid progression to more serious problems. Management focuses largely on improving symptoms and might be needed on a long-term basis.
For these reasons, it is important to see a healthcare provider regarding symptoms of GERD, such as heartburn, that are frequent, severe, or don’t respond to antacids or OTC medications. Effective management can help avoid problems such as discomfort, loss of sleep, and trial and error of OTC remedies or dietary restrictions.
