Heartburn Medications in Pregnancy: Safe Options Like Tums, Pepcid, and Prilosec
Heartburn during pregnancy isn’t just uncomfortable-it’s common. Up to 80% of pregnant people experience it, especially in the second and third trimesters. The growing baby presses up on the stomach, and pregnancy hormones relax the valve that keeps acid down. It feels like a burning wave behind your breastbone, often worse after eating or lying down. You want relief. But you also don’t want to risk your baby’s health. So what can you safely take?
First-Line Defense: Calcium Carbonate Antacids
The safest place to start is with antacids made from calcium carbonate. Brands like Tums, Rolaids, and some store generics work by neutralizing stomach acid right away. They don’t stop acid production-they just mop it up. Effects last about 1 to 2 hours, which is fine for occasional flare-ups.
Why calcium carbonate? Because your body needs calcium during pregnancy-to build your baby’s bones and teeth, and to keep your own strong. Tums gives you relief and a little extra calcium at the same time. That’s why doctors recommend it as the first option. The American College of Obstetricians and Gynecologists (ACOG) and major clinics like Cleveland Clinic both list calcium-based antacids as safe throughout pregnancy.
But not all antacids are equal. Avoid products with aluminum hydroxide or magnesium trisilicate. Aluminum can build up in your system and may affect your baby’s development. Magnesium trisilicate has been linked to rare but serious side effects. Also, skip Pepto-Bismol. It contains bismuth subsalicylate, which breaks down into something similar to aspirin-and aspirin is a hard no during pregnancy.
How much is too much? Stick to the label. For Tums, that’s usually 2 to 4 tablets every 4 to 6 hours, not more than 10 tablets in 24 hours. Long-term, daily use-even of Tums-can lead to too much calcium in your blood, which might cause kidney stones or interfere with iron absorption. If you’re taking them every day for more than a week, talk to your provider.
Second-Line: H2 Blockers Like Pepcid
If antacids aren’t doing enough, the next step is an H2 blocker. These work differently. Instead of neutralizing acid, they tell your stomach to make less of it. The most studied and recommended option is famotidine, sold as Pepcid.
Famotidine starts working in about an hour and lasts up to 12 hours. That makes it great for nighttime heartburn or if you know you’re going to eat something spicy. It’s been used safely in pregnancy for decades. Studies tracking thousands of pregnant women show no increase in birth defects or complications when famotidine is taken as directed.
What about Zantac? Don’t use it. Ranitidine, the active ingredient in Zantac, was pulled from the U.S. and Australian markets in 2020 because it was found to contain NDMA, a probable carcinogen. Even if you still have old bottles lying around, throw them out. Stick with famotidine.
Other H2 blockers like cimetidine (Tagamet) are also considered safe in pregnancy, but famotidine is preferred because it has fewer drug interactions and less risk of side effects like headaches or dizziness, which affect about 3-5% of users.
Still, don’t just start taking H2 blockers without checking in. Your provider might suggest using them only after trying antacids for a few days. And avoid long-term daily use unless necessary. The goal is to use the least amount for the shortest time possible.
Third-Line: Proton Pump Inhibitors (PPIs)
If you’re still struggling with heartburn after antacids and H2 blockers, your doctor might consider a proton pump inhibitor (PPI). These are the strongest acid reducers available over the counter. The most commonly prescribed in pregnancy is omeprazole (Prilosec). Lansoprazole (Prevacid) and pantoprazole (Protonix) are also options.
PPIs block acid production at the source-the proton pumps in your stomach lining. They take longer to kick in-1 to 4 hours-but last a full day or more. That’s why they’re used for persistent, daily heartburn, not just occasional flare-ups.
Is it safe? Most studies say yes. Omeprazole is the most researched PPI in pregnancy. Data from large population studies, including one published in JAMA Pediatrics in 2019, show no clear link to major birth defects. But that same study did find a small possible association between first-trimester PPI use and childhood asthma. It didn’t prove cause and effect, but it’s enough for doctors to be cautious.
Because of this, PPIs are reserved for when other treatments fail. They’re not for quick fixes. If you’re in your first trimester and your heartburn is new, your provider will likely tell you to hold off on PPIs unless your symptoms are severe. The first 14 weeks are when your baby’s organs are forming, and even small risks are weighed more heavily.
Long-term PPI use-even outside pregnancy-can affect calcium and magnesium absorption, increase risk of bone fractures, and alter gut bacteria. During pregnancy, these concerns are monitored closely. Your doctor will likely prescribe the lowest effective dose and re-evaluate every few weeks.
What to Avoid Completely
Not all heartburn remedies are created equal-and some are outright dangerous during pregnancy.
- Pepto-Bismol: Contains salicylates (like aspirin). Risk of bleeding complications and fetal harm.
- Ranitidine (Zantac): Withdrawn due to cancer-causing contaminants. Not safe at any stage.
- Aluminum-based antacids: May accumulate in the body and affect fetal development.
- Herbal remedies: Many are unregulated. Chamomile, ginger, and licorice root sound natural, but their safety in pregnancy isn’t proven.
- Over-the-counter combination products: Products that say “heartburn + gas + nausea” often include multiple active ingredients, some unsafe. Always read the label.
If you’re unsure about a product, check the ingredients. If you see “bismuth subsalicylate,” “aspirin,” “naproxen,” or “ibuprofen,” put it back. Even if it’s labeled “for upset stomach,” it’s not safe for pregnancy.
Lifestyle Changes Work-And They’re First
Medications help, but they’re not the only tool. In fact, most experts agree: start with lifestyle changes before reaching for pills.
- Eat smaller meals, 5-6 times a day instead of 3 big ones.
- Avoid trigger foods: spicy dishes, fried foods, chocolate, caffeine, citrus, tomatoes.
- Don’t lie down for at least 3 hours after eating.
- Wear loose clothing. Tight waistbands push on your stomach.
- Elevate your head while sleeping. Use pillows or a wedge under your mattress.
- Don’t smoke. Smoking weakens the lower esophageal sphincter and increases acid reflux.
These aren’t just “tips.” They’re evidence-backed strategies that reduce heartburn in over 70% of pregnant women, according to studies cited by the Cleveland Clinic. Many women find that combining lifestyle changes with occasional Tums gives them full control without needing stronger meds.
When to Call Your Doctor
Heartburn is normal. But if you’re experiencing any of these, call your provider right away:
- Difficulty swallowing or pain when swallowing
- Vomiting blood or black, tarry stools
- Unexplained weight loss
- Chest pain that radiates to your arm, neck, or jaw
- Heartburn that wakes you up at night or doesn’t improve with meds
These could signal something more serious-like GERD complications, esophagitis, or even heart issues. Don’t assume it’s just pregnancy. Get it checked.
What About Breastfeeding?
If you’re breastfeeding, most of these medications are still considered safe. Calcium carbonate passes into breast milk in tiny, harmless amounts. Famotidine is also low-risk-only a small fraction gets into milk. Omeprazole is excreted in breast milk, but at levels far below what would affect a baby.
Still, if you’re nursing, tell your provider. They might adjust your dose or suggest timing your meds right after a feeding to minimize exposure. The bottom line: you don’t have to suffer through heartburn while breastfeeding. Safe options exist.
Final Takeaway
Heartburn in pregnancy doesn’t mean you have to suffer. You have options-and they’re ranked by safety. Start with lifestyle changes. If you need more, reach for calcium carbonate antacids like Tums. If that’s not enough, ask about famotidine (Pepcid). Save PPIs like omeprazole for when nothing else works, and only under your doctor’s guidance.
Always check with your provider before taking anything-even if it’s “just an antacid.” What’s safe for one person might not be right for you. Your pregnancy is unique. So should your treatment plan be.
Jackie Petersen
December 4, 2025 AT 19:29Tums? Yeah right. That’s just Big Pharma’s way of keeping you hooked while they sell you calcium like it’s candy. I’ve been pregnant three times and never took anything but ginger tea and a cold compress. Your baby doesn’t need extra calcium-it needs less corporate manipulation.
Annie Gardiner
December 5, 2025 AT 03:51Isn’t it funny how we’ve turned a natural biological process into a medical crisis? Heartburn is just your body saying ‘hey, I’m making a human’-not a defect to be fixed with pills. We used to just eat bland food, sleep upright, and accept it. Now we’re told to pop antacids like M&Ms. What happened to resilience?
Rashmi Gupta
December 5, 2025 AT 05:17In India, we use ajwain water and fennel seeds. No pills. No Tums. Just ancient wisdom passed down for centuries. Why do we trust American drug labels more than our grandmothers?
Andrew Frazier
December 5, 2025 AT 17:06lmao pepcid? bro did u even read the label? famotidine is fine but dont be a sheep. if u r on ppi's u r already losing. and why are we letting big pharma dictate what pregnant women can eat? this is why america is falling apart.
Kumar Shubhranshu
December 7, 2025 AT 11:45Mayur Panchamia
December 8, 2025 AT 12:48Ohhh so now we’re recommending PPIs like they’re vitamins?? Omeprazole?? You know what else causes ‘possible’ asthma links? VACCINES. And yet nobody’s screaming about those! This is pure fearmongering wrapped in a white coat! And don’t get me started on ‘lifestyle changes’-like I don’t have 17 kids and a full-time job already!!
Karen Mitchell
December 10, 2025 AT 08:28It is imperative to note that the utilization of calcium carbonate antacids, while ostensibly benign, may induce a false sense of security, thereby encouraging prolonged and potentially deleterious usage patterns. Furthermore, the normalization of pharmaceutical intervention during a physiologically natural state constitutes a troubling cultural regression toward medicalization of the feminine experience.
Geraldine Trainer-Cooper
December 11, 2025 AT 05:23Nava Jothy
December 11, 2025 AT 17:11OMG I had heartburn so bad I cried in the shower 😭 and I tried everything - Tums, Pepcid, even a wedge pillow from Amazon (it looked like a UFO) - and NOTHING worked until my doula whispered: ‘Breathe into your belly.’ I did. I cried harder. And then… silence. The burning… GONE. 🌸 Maybe the real medicine isn’t in the bottle… it’s in the breath. 💖
Kenny Pakade
December 13, 2025 AT 06:44They say ‘start with lifestyle changes’ - yeah, right. Like I have time to eat 6 tiny meals when I’m working two jobs and my husband’s out drinking with his bros. Tums? Fine. Pepcid? Sure. But don’t tell me to ‘sleep upright’ when I’m passed out on the couch with a burrito in one hand and a Netflix remote in the other. This isn’t a yoga retreat, it’s real life.
brenda olvera
December 13, 2025 AT 08:16Heartburn is just love squeezing out from the inside 💕 I remember when my daughter kicked so hard I thought I was having a heart attack - turns out it was just her saying hi. I ate spicy tacos, slept on my side, and took Tums like candy. My baby is now a dancer. No pills needed, just joy.
Myles White
December 13, 2025 AT 19:36I appreciate the thorough breakdown here, and I think it’s important to acknowledge that while the data on omeprazole and childhood asthma is correlational and not causal, the precautionary principle still holds weight in obstetric practice - particularly because the placental transfer of PPIs is well-documented, even if the clinical significance remains unclear. That said, the real issue isn’t the medication hierarchy, it’s the systemic lack of prenatal support that forces women to self-manage symptoms with over-the-counter drugs because they can’t get timely appointments with OB-GYNs or dietitians who specialize in gestational nutrition. We’re treating symptoms, not root causes - and that’s a public health failure, not a pharmacological one.