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What You Should Know About H2 Blockers for Acid Reflux

Image of What You Should Know About H2 Blockers for Acid Reflux
Image of What You Should Know About H2 Blockers for Acid Reflux

Picture this. You’re vacationing in Italy. You’ve washed down the best mozzarella caprese salad of your life. You’re traipsing around a charming, cobblestone village when it hits you. That familiar burning sensation in your chest. Ugh, not now. There’s no faster way to ruin a vacation — and all the meals you’ve been looking forward to for months — than acid reflux.

Acid reflux is a common, chronic condition that affects 20% of Americans. You feel that burning sensation when stomach acid moves back up into the esophagus. Unlike your stomach, your esophagus isn’t designed to handle that acid, hence the burning. (Nope, heartburn has nothing to do with your heart.)

Many cases of acid reflux go undiagnosed, because people believe their heartburn is the condition itself, when it’s actually a symptom of acid reflux. And to make this even more complicated, if you experience acid reflux more than two times a week, you may have the long-term, persistent gastroesophageal reflux disease, a.k.a. GERD.

While you can’t cure acid reflux or GERD, there are a few ways to find relief. In googling, you'll come across words like “PPIs” and “H2 blockers,” and it can all feel a little overwhelming. Luckily, Evens is here to help make sense of this crazy world of acid reflux, in easy-to-understand language. Let’s dive into one of the most common treatments for reflux: H2 blockers. You’ll be a pro in no time.

What is an H2 blocker?

There are several ways to treat symptoms and mitigate the effects of acid reflux and frequent heartburn, including over-the-counter medications (OTC) and prescription medications.

H2 blockers, which block histamine so your stomach produces less acid, are a common treatment. You’re probably familiar with H2 blockers without realizing it — Zantac and Pepcid AC are H2 blockers. H2 blockers can be bought over the counter in low doses, but they also come in prescription strength.

How do H2 blockers work to help acid reflux?

H2 blockers are a unique class of acid reflux treatments that reduce stomach acid by blocking histamine — that’s why they’re also known as "histamine H2 receptor antagonists," but that’s a real mouthful, so we’ll stick with H2 blockers.

Histamine is a chemical produced by your body, especially in cells in the lining of your stomach. When histamine is released, it triggers acid-making cells ("parietal cells") in the stomach to release acid, which helps to break down and digest food. H2 blockers stop those acid-making cells from responding to histamine, thereby reducing acid secretion in your stomach. Less acid means less burning and discomfort in the event of reflux.

There are several types of H2 blockers, and they all work similarly:

How do you take H2 blockers?

H2 blockers are typically taken orally as tablets, liquids, or capsules, often with the first meal of the day. Some people also take them before dinner or at bedtime, especially since reflux is more common at night.

They’re known for being fast and effective, kicking in within 30-90 minutes, and they last for several hours. Some patients even report symptom relief for up to 24 hours.

They can be purchased in lower doses without a prescription. But if you’re reaching for H2 blockers more than two days a week, you may have GERD and in that case, we recommend seeing a healthcare provider to talk through next steps, which may include a prescription dose or even combining H2 blockers with other medicines.

What’s going on with ranitidine?

You may remember seeing ranitidine (a.k.a. Zantac®) in the news due to an ongoing issue with a potentially dangerous ingredient. That ingredient is N-Nitrosodimethylamine NDMA, or NDMA for short, and the World Health Organization thinks it can cause cancer at high enough levels. Of course, pharmacies can’t sell medication that might give you cancer, so Zantac® has been pulled from shelves until further notice.

Nizatidine (generic Axid®), another H2 blocker, has also been recalled for similar reasons. That means that if you have old bottles of either of these medications gathering dust in your bathroom cabinet, now’s a great time to clean them out.

What are common side effects of H2 blockers?

As with pretty much all medications, there are side effects that come with using H2 blockers. The most common ones are:

While the use of H2 blockers is widespread, the National Institutes of Health reports that clinical studies have demonstrated a link between H2 blockers and liver injury — though, you should note that’s very rare. And if you have allergies, you may also be prone to allergic reactions and other side effects.

Who should take H2 blockers?

Those who suffer from frequent heartburn and aren’t finding relief from antacids can benefit tremendously from H2 blockers.

Who shouldn't take H2 blockers?

If you have kidney problems, H2 blockers may not be right for you. Make sure to talk to your healthcare professional about your personal medical history.

Can you take H2 blockers if you're pregnant or breastfeeding?

If you’re breastfeeding or pregnant, talk to your physician about the best treatment option. There have been limited studies of how H2 blockers (typically focused on famotidine and ranitidine) affect pregnant women, and studies show H2 blockers are effective in treating symptoms of heartburn and GERD in pregnant women.

However, it’s important to note that the chemicals cross the placenta, and that few studies have evaluated the effects of H2 blockers in the first trimester. And one type of H2 blocker — Axid, the nizatidine — has been linked to fetal risk, so that should be avoided throughout pregnancy.

Overall, if a pregnant woman’s reflux can’t be managed with lifestyle changes and antacids, H2 blockers are a good course of action, but should be administered under a physician’s supervision.

When should you talk to a doctor?

You should speak to a doctor if you’re experiencing routine acid reflux and over-the-counter medications aren’t working for you — you may require a mix of medications to keep your reflux at bay and manage your symptoms, or you might be misdiagnosing yourself.

What are other treatment options?

In addition to H2 blockers, there are other options for acid reflux relief:

  • Over-the-counter antacids, which neutralize stomach acid (you've probably heard of their brand names, like Gaviscon®, Tums®, etc.)
  • Proton pump inhibitors
  • (PPIs), which reduce how much acid your stomach produces and typically last longer than an H2 blocker. (You might know them by their brand names: Prilosec®, Prevacid®, Nexium®, and Protonix®).

There are also some lifestyle changes you can make to reduce acid reflux. Because reflux is often triggered by foods, it’s best to avoid spicy and fatty foods, citrus fruits, and even less "happy hour" foods, such as sashimi, wine, ice cream and fancy cheeses.

It’s also important to stop eating 2-3 hours before bedtime, so your body can digest with the benefit of gravity — lying down increases one’s risk for acid reflux, and many people who experience it often find relief by sleeping upright on a wedge or by sleeping on their left side.

Some people also manage their discomfort with home remedies and hacks, like drinking ginger tea, consuming fermented drinks and foods and even mustard, whose alkaline properties can offset acid.

The bottom line is, while acid reflux can be uncomfortable, there are many ways to reduce your risk for it, as well as manage symptoms. Talk to your healthcare provider about the best path for you.

The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.