Recommended Antacids for Immediate Relief of Heartburn and Acid Reflux
For immediate symptom relief, use calcium carbonate (Tums), magnesium hydroxide (Milk of Magnesia), or aluminum hydroxide/magnesium hydroxide combinations (Maalox, Mylanta) as first-line antacids for sporadic, infrequent heartburn episodes. 1
Specific Antacid Formulations
Simple antacids provide the most rapid onset of action for immediate relief:
- Calcium carbonate (Tums) - neutralizes acid quickly 1
- Magnesium hydroxide (Milk of Magnesia) - rapid neutralization 1
- Aluminum hydroxide/magnesium hydroxide combinations (Maalox, Mylanta) - balanced formulation that minimizes side effects 1, 2
Enhanced Antacid Formulations
Alginate-containing antacids are superior to simple antacids alone and should be used for persistent post-prandial and nighttime breakthrough symptoms, particularly when symptoms occur despite other therapy. 1 These formulations create a physical barrier that floats on gastric contents and provides mechanical protection of the esophageal mucosa.
Critical Limitations of Antacids
Antacids should not be relied upon if symptoms occur ≥2 times per week, as this frequency requires stronger acid suppression with H2-receptor antagonists or proton pump inhibitors rather than antacids alone. 1
Antacids can only transiently neutralize acid in the esophagus but do not significantly affect gastric pH or prevent subsequent heartburn episodes. 3 They provide effective symptom relief to only about one quarter of patients suffering from GERD. 4
When Antacids Are Appropriate
Antacids are most appropriate for:
- Sporadic, infrequent heartburn (less than twice weekly) 1
- Rapid relief while awaiting onset of H2-receptor antagonists or PPIs 5
- Adjunctive therapy for breakthrough symptoms in patients already on acid suppression 2
When to Escalate Beyond Antacids
If lifestyle modifications plus antacids fail to control symptoms, empirical therapy with a proton pump inhibitor (omeprazole 20 mg once daily) should be initiated rather than continuing antacid monotherapy. 6, 1 PPIs provide significantly faster and more complete symptomatic relief compared to antacids and are the most effective initial therapy for persistent heartburn. 6