A man with heartburn clutching his chest.

For many, the holidays can mean overindulgence in rich foods and alcohol at parties and events—followed by an upset stomach and a bout of heartburn.

But before you turn to popular treatments lined up on pharmacy shelves—such as Nexium 24HR, Prevacid 24HR, and Prilosec OTC—consider whether the fire in your belly is a onetime flare-up or an ongoing flame that happens several times a week. 

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If You Have Heartburn From Overeating

The best first option for most people is an inexpensive, fast-acting, over-the-counter antacid, such as Maalox, Mylanta, Rolaids, or Tums, or their generic equivalents, according to an earlier analysis by CR.

You might need something stronger if you know in advance that you’ll be consuming something that triggers heartburn, according to the report. In that case, try an acid-reducing H2 blocker, such as famotidine (Pepcid AC), nizatidine (Axid AR), or ranitidine (Zantac 75, Zantac 150). These drugs help about half of people who suffer from predictable heartburn and are available without a prescription as low-cost generics.

If You Have Heartburn a Few Times a Week

It’s time to see a doctor because you may have gastroesophageal reflux disease, or GERD. This serious condition can cause damage to your esophagus if left untreated. The good news is that drugs called proton pump inhibitors, or PPIs (Nexium 24HR, Prevacid 24HR, and Prilosec OTC), can help keep GERD under control. They effectively reduce the amount of stomach acid produced, making the contents of your stomach less erosive to the lining of the esophagus.

If you are diagnosed with GERD, your doctor may recommend that you take a PPI to reduce the acid in your stomach and allow any irritation or ulcers in your throat to heal. For this problem, discuss two of the over-the-counter generic PPIs with your doctor as your best first option: generic omeprazole OTC and generic lansoprazole OTC.

You should know that, although effective, the drugs might not provide immediate relief; they can take up to four days to start working.

But when taken over months or years, PPIs can have serious side effects that, although uncommon, can be serious. They include chronic diarrhea due to a bacterial infection that can lead to severe intestinal problems and, in rare cases, death. Long-term use can deplete magnesium levels, which can trigger muscle spasms, an irregular heartbeat, and convulsions.

A 2016 study found a roughly 20 percent higher risk of kidney disease in people taking PPIs compared with those treated with a different class of heartburn drugs called H2 blockers, such as Pepcid AC and Zantac. And some research suggests that they also can deplete vitamin B12 levels. 

Other potential side effects with long-term use include an increased risk of dementia, heart attack, pneumonia and certain bone fractures, including breaks in the wrist, forearm, and spine. You don’t want to take one of these drugs unless a doctor has diagnosed you with GERD.

Prevent Heartburn in the First Place

Instead of relying on medication to put out the flames, first try these simple steps to help keep your belly happy this holiday season:

  • Cut back on caffeine and alcoholic beverages.
  • Eat smaller meals.
  • Eat fewer fatty and fried foods.
  • Go easy on spicy foods, garlic, onions, and citrus fruit.
  • Avoid lying down for at least 3 hours after eating.
  • If you smoke, quit.

There’s not much evidence to support most of those options, but they are good for you in general and may be helpful.

If your heartburn is still bothering you, try raising the head of your bed 6 to 8 inches. This may help reduce heartburn flare-ups while you’re asleep. Place wooden blocks under the bed legs so that your head is higher than your feet. One small study found that this eased heartburn symptoms.

A long-range strategy is losing weight if you need to, which may give you another reason to hold back on second helpings during holiday feasts.

If these changes don’t bring relief, it may be time to try one of the medications discussed above. But for a onetime holiday heartburn flare-up, don’t reflexively reach for a PPI. In most cases an antacid or an acid-reducing H2 blocker is all you need.

Editor’s Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).