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Drugs to treat heartburn, GERD
Proton pump inhibitors (PPIs) are a class of very effective and generally safe medicines used to treat heartburn, gastroesophageal reflux disease (GERD), and gastric ulcers.But not everyone who experiences heartburn needs one.

Several of the PPIs have been widely advertised to consumers and heavily promoted to physicians, and this has led to an overuse of the drugs in the treatment of garden-variety heartburn. PPIs are among the highest-selling classes of drugs in the U.S., with $9.5 billion in sales last year, and one of them, Nexium, was the top-selling of all drugs, earning nearly $6 billion in 2012, according to IMS Health, which tracks drug sales and marketing.

If you suffer from occasional heartburn and have not been diagnosed with GERD, nonprescription antacids such as Maalox, Mylanta, Rolaids, and Tums, or acid-reducing drugs known as H2 blockers, such as cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac) will very likely provide relief. All of those products are available without a prescription as low-cost generics.

Talk with your doctor about the role that dietary and lifestyle changes can play in alleviating heartburn, too, such as eating smaller meals and not lying down for at least three hours after eating, losing weight if you need to, and avoiding alcohol. If, however, you experience heartburn twice a week or more for weeks or months on end, have frequent regurgitation of food into your throat or mouth (with or without heartburn), or if your heartburn is not relieved by the drugs mentioned above, you may have GERD and may need a PPI. GERD is a condition that makes you prone to acid reflux and, over time, can cause damage to your esophagus.

The seven available PPI medicines are roughly equal in effectiveness and safety but differ in cost. Three—omeprazole (Prilosec, Prilosec OTC), lansoprazole (Prevacid, Prevacid 24HR), and omeprazole/sodium bicarbonate (Zegerid, Zegerid OTC)—are available as both prescription and nonprescription drugs. Four—lansoprazole, omeprazole, omeprazole/sodium bicarbonate, and pantoprazole (Protonix)—are available as both brand-name drugs and generics that contain the same active ingredient but cost significantly less.

Taking the evidence for effectiveness, safety, cost, and other factors into account, if you need a PPI, we have chosen the following as Consumer Reports Best Buy Drugs:
  • Generic omeprazole OTC
  • Generic lansoprazole OTC
This report was last updated in July 2013.

PPI Cost Comparison
Generic Name and Dose Brand NameA Frequency of UseB Average Monthly CostC Compare Prices
  Dexlansoprazole 30 mg sustained-release tablets Dexilant One per day $188
  Dexlansoprazole 60 mg sustained-release tablets Dexilant One per day $183
  Esomeprazole 20 mg capsules Nexium One per day $240
  Esomeprazole 40 mg capsules Nexium One per day $234
  Lansoprazole 20 mg delayed-release tablets (nonprescription) Prevacid 24HR One per day $24D
Lansoprazole 20 mg delayed-release tablets (nonprescription) Generic One per day $17D
  Lansoprazole 15 mg delayed-release capsules Prevacid One per day $265
  Lansoprazole 15 mg delayed-release capsules Generic One per day $119
  Lansoprazole 15 mg delayed-release dissolvable tablets Prevacid One per day $285
  Lansoprazole 15 mg delayed-release dissolvable tablets Generic One per day $161
  Lansoprazole 30 mg delayed-release capsules Prevacid One per day $275
  Lansoprazole 30 mg delayed-release capsules Generic One per day $107
  Lansoprazole 30 mg delayed-release dissolvable tablets Prevacid One per day $265
  Lansoprazole 30 mg delayed-release dissolvable tablets Generic One per day $163
  Omeprazole 20 mg tablets (nonprescription) Prilosec OTC One per day $22D
Omeprazole 20 mg tablets (nonprescription) Generic One per day $17D
  Omeprazole 10 mg delayed-release capsules Prilosec One per day $211
  Omeprazole 10 mg delayed-release capsules Generic One per day $64
  Omeprazole 20 mg delayed-release capsules Prilosec One per day $236
  Omeprazole 20 mg delayed-release capsules Generic One per day $58
  Omeprazole 40 mg delayed-release capsules Prilosec One per day $374
  Omeprazole 40 mg delayed-release capsules Generic One per day $134
  Pantoprazole 20 mg delayed-release tablets Protonix One per day $254
  Pantoprazole 20 mg delayed-release tablets Generic One per day $70
  Pantoprazole 40 mg delayed-release tablets Protonix One per day $232
  Pantoprazole 40 mg delayed-release tablets Generic One per day $66
  Rabeprazole 20 mg tablets AcipHex One per day $355
A. "Generic" indicates drug sold by generic name. Among PPIs, omeprazole, omeprazole/sodium bicarbonate, lansoprazole, and pantoprazole are available as generic drugs.

B. As typically prescribed.

C. Monthly cost reflects nationwide retail average prices for April 2013, rounded to the nearest dollar. Information was derived by Consumer Reports Best Buy Drugs from data provided by Source Healthcare Analytics, Inc., which is not involved in our analysis or recommendations. Average monthly cost is based on recommended dosage of one pill daily.

D. Prices for these medications were obtained by Consumer Reports secret shoppers at five major chain pharmacies (CVS, Rite Aid, Target, Walgreens, and Walmart) and local supermarkets across the U.S. in January 2013. The prices from the various stores were averaged to yield per-pill prices, which were then converted into a monthly price.