Is Your Medication a Pain in the Gut?

Medications can either be your best friend or a big nuisance when you suffer from heartburn. While antacids (Maalox, Mylanta, Rolaids and Tums) provide immediate relief for acid reflux, there are several common medications you might take for other health ailments that can aggravate heartburn issues in a major way. Each person responds to medications differently, but trial and error can help you find which medication works best for your medical needs while also limiting heartburn symptoms. Here is some information to determine if your medication could be causing you more pain.

Many medications contribute to heartburn discomfort by relaxing the lower esophageal sphincter (LES) and allowing stomach acids to re-enter and irritate the esophagus. Examples of these medications include:
  • Antianxiety medications and sleep aids (diazepam, lorazepam) 
  • Narcotic painkillers (merpidine, morphine)
  • Tricyclic antidepressants (imipramine, amitriptyline)
  • Anticholinergic muscle spasm medications (levodopa, dicyclomine, glycopyrrolate) 
  • Asthma medications (theophylline)
  • Heart and blood pressure medications (diltiazem hydrochloride, nifedipine, propranolol hydrochloride, atenolol, prazosin hydrochloride, isosorbide dinitrate, nitroglycerin)
  • Hormones (progesterone, birth control pills)
Other medications cause irritation because they increase stomach acid production, irritate the stomach/esophagus lining or decrease the rate of stomach emptying. Examples of these medications include:
  • Non-steroidal anti-inflammatory drugs (NSAIDS) (aspirin, ibuprofen, naproxen sodium, celecoxib)
  • Osteoporosis medications (alendronate sodium, risedronate sodium)
  • Iron supplements
  • Tetracycline antibiotics
  • Potassium supplements
  • Steroid medications (prednisone)
  • Vitamin C
If you experience frequent and persistent heartburn and feel that your medications may be to blame, talk with your doctor to see if there is an alternative medication that will better meet your needs. Some of the following substitutions may work for you.
Take This Instead of This
Acetaminophen Ibuprofen
Percocet Other narcotics
Baby aspirin or enteric-coated options Regular aspirin
Non-tricyclic antidepressants Tricyclic antidepressants
Iron supplements in the morning Iron supplements at night
Enteric-coated antibiotics Tetracycline antibiotics
Slow-releasing potassium Instantly-dissolving potassium
Inhaler asthma medications Oral asthma medications
Osteoporosis medications in the morning Osteoporosis medications at night
Osteoporosis infusion Daily and weekly osteoporosis options

Here are some other tips to help you deal with heartburn caused by medications:
  • Talk with your medical provider about other prescription medication options and timing advice that might still meet your medical needs while relieving heartburn symptoms.
  • Calcium-based antacids (Maalox, Rolaids, and Tums) are generally safe for most people, but are intended for short term use. Be sure not to take them within two hours of taking other oral medications.
  • If you are using calcium-based antacids regularly, talk with your medical provider to see if other OTC acid blockers (cimetidine, famotidine, ranitidine) might work better. Because OTC medications can interfere with prescription medications, be sure to seek advice so you get the most from all your medications.
  • Talk with your pharmacist about vitamin and mineral supplements that might be causing heartburn symptoms. The pharmacy is also a great free resource where you can ask about drug interactions that might be causing problems.
  • Be sure to stay in an upright position after taking prescription medications that are causing irritation, since lying down tends to magnify heartburn symptoms.
  • Be sure you are applying good standing and sitting posture to minimize intra-abdominal pressure. 
  • Evaluate your diet and follow a heartburn-friendly eating plan while working toward and maintaining a healthy weight.
  • Minimize heartburn-causing daily stress by applying stress busters whenever possible.
  • Try chewing gum to stimulate salivary production, which can neutralize acid.
  • Try sipping on soothing ginger herbal tea as part of your daily fluid intake. Dehydration is a leading cause of excess stomach acid, so having sufficient amounts of water is a natural way to regulate your heartburn symptoms.