Got heartburn? The best treatment for you.

Remember “Plop, plop, fizz, fizz, oh what a relief it is”? Well, heartburn drugs have changed a lot since that TV jingle became popular. Americans spent $6 billion on the acid-reflux drug Nexium in 2012, making it the top-selling branded prescription medication. But other drugs work just as well and cost less, according to a Consumer Reports Best Buy Drugs analysis. Here’s how to treat heartburn right.

“Proton pump inhibitors are often the first thing doctors give patients for heartburn,” Lauren B. Gerson, M.D., a gastroenterologist at California Pacific Medical Center in San Francisco, said. But up to 70 percent of people taking the drugs, such as esomeprazole (Nexium) and omeprazole (Prilosec and generic), might not need such strong medication, research has found.

Some people say they think that these drugs provide immediate relief, but they can take one to four days to work and should be taken for at least two weeks, or longer if your doctor recommends. PPIs aren’t meant to treat run-of-the-mill heartburn, but rather gastroesophageal reflux disease, when heartburn occurs twice a week or more for weeks or months. If your symptoms strike less often, use a fast-acting over-the-counter antacid such as Maalox, Mylanta, Rolaids, or Tums. Or try an over-the-counter H2 blocker, such as famotidine (Pepcid AC) or ranitidine (Zantac 75). They tend to cause fewer side effects and are typically cheaper than PPIs.

PPIs are linked to pneumonia and C. difficile (an infection that can cause disabling diarrhea), and to bone fractures and vitamin B12 deficiency, which can lead to anemia and even dementia.

Quitting heartburn drugs can be difficult because you might get rebound symptoms. They cause your stomach to produce less acid, and stopping suddenly can cause it to overproduce acid. If you’re taking a PPI or H2 blocker once a day, ask your doctor about cutting back, perhaps to every other day, and then every few days.

For more detailed information on drugs to treat heartburn, GERD and acid reflux, see our free Consumer Reports Best Buy Drugs Report on these medications.

Self-medicating with over-the-counter heartburn drugs can mask underlying health problems. Frequent burning or pain in the upper abdomen or chest can signal an ulcer or even esophageal cancer. Some people mistake pain from gallstones or heart disease for heartburn. So before starting any heartburn drug, see a doctor to rule out other health issues.

A number of steps can help:

• Raise the head of your bed 6 to 8 inches to prevent acid from traveling back into your esophagus.
• Lose weight. Extra pounds put pressure on the abdomen, pushing stomach contents into the esophagus.
• Don’t eat for 2 to 3 hours before bedtime, and avoid having large, fatty meals in general.
• Track which foods cause symptoms, and cut back on them.

Save money on heartburn drugs

All proton pump inhibitors are equally effective and safe. So if you need a PPI, choose by price. As the chart below shows, you could save $200 a month or more by taking nonprescription generic versions of lansoprazole or omeprazole. Where you shop matters, too. Our secret shoppers found that Target and Walmart have the lowest prices for both drugs, while CVS and Rite Aid have the highest. For more information, go to CRBestBuyDrugs.org.

1. Consumer Reports Best Buy Drugs report, July 2013.

This article also appeared in the April 2014 issue of Consumer Reports on Health.

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