OTC remedies generally fall into two categories: products that neutralise excess acid (antacids), and those that reduce acid production (proton pump inhibitors and H2 antagonists).

Antacids and alginates

Antacid remedies often contain several different ingredients and are generally considered first line treatment, after or alongside lifestyle changes. Aluminium and magnesium salts frequently form the base of these products, sometimes in combination so the respective side effects of constipation and diarrhoea cancel each other out. Antacids can react with other medicines, so make sure to ask customers if they are taking anything else when recommending or selling such products.

Alginates, sometimes called rafting agents, are commonly recommended for their ability to form a layer that sits above the stomach contents and stops them leaking into the oesophagus. Liquids have a quicker effect than tablets (which should always be sucked or chewed rather than swallowed), and all products are best taken about an hour after eating, rather than immediately. 

OTC examples include Gaviscon Advance, Bisodol and Rennie. Some products contain both an alginate and an antacid (e.g. Gaviscon Double Action).

Proton pump inhibitors and H2 antagonists

If antacids haven’t resolved the symptoms, an acid-reducing agent may help. 

The proton pump inhibitors (PPIs) omeprazole, esomeprazole and pantoprazole block acid release in the stomach. They are effective and start to suppress acid production within one to two hours of taking the first dose, but two to three days’ treatment may be needed for the full benefit to be felt. OTC examples include Pantoloc Control and Nexium Control.

H2 antagonists such as ranitidine reduce stomach acid production and give up to 12 hours’ relief. They can be taken as soon as symptoms start and some can be used as a preventative measure – for example, if someone is going for dinner and knows that they will be eating rich food, which is likely to cause symptoms. OTC example: Zantac 75 Relief.

All OTC acid-reducing medicines should not be used long term, and there are various restrictions regarding their sale. Check packs carefully when recommending or selling these products to customers.