Heartburn always gets blamed on food and stress. We put it down to that fatty meal we just ate or the upcoming job interview. But if you’ve suddenly developed heartburn out of nowhere (or your symptoms have worsened), it might be the medication you just started.

Read the side effects list of many common medications, and you’ll see heartburn listed. These drugs can irritate the oesophagus or increase stomach acid production, making acid reflux more likely. It might feel like you’re swapping one set of symptoms for another.

But don’t panic, you don’t have to stop your meds. Diagnosing reflux just lets your doctor know that they may need to add an acid-suppressing medication to your usual prescription.

Quick Refresher: What Are Heartburn and Reflux?

Heartburn is a symptom of acid reflux. When acid from the stomach moves upward into the oesophagus, it irritates the oesophageal lining. This can cause the burning sensation in your chest which is characteristic of heartburn. You might also notice a sour taste, throat irritation, or hoarse voice.

Often, acid reflux is caused by your diet. Fatty foods, caffeine, acidic foods, or alcohol can all trigger an episode. But medications are another cause.

How Medications Can Cause Heartburn

Many medications can cause heartburn. The question is how. There are a few underlying mechanisms (often more than one at the same time). These include:

• Relaxing the lower oesophageal sphincter (LOS): This valve normally keeps stomach acid where it belongs. If it loosens, acid can creep upward, causing burning.

• Irritating the oesophagus lining: Some tablets can inflame the throat as they go down, especially if taken without enough water or just before lying flat.

• Slowing stomach emptying: Causing food and acid to sit in the stomach longer, increasing the likelihood of reflux.

• Increasing stomach acid production: Certain drugs stimulate acid release, making symptoms stronger and more frequent.

Common Types of Medications That Can Trigger Heartburn

Painkillers and Anti-Inflammatories

NSAIDs and aspirin are the most common causes of heartburn when it comes to these types of medications. They irritate and weaken the stomach lining, making it more vulnerable to acid.

In fact, at high doses, NSAIDs (like ibuprofen or naproxen) can lead to stomach ulcers. Look out for vomiting blood or dark, tarry stools.

Antibiotics

Do antibiotics cause heartburn? The answer is it depends.

Antibiotics are a broad class of drugs that fight bacterial infections. But not every antibiotic causes heartburn.

Doxycycline and tetracycline are the classic examples. They can irritate the oesophagus if taken without water or before lying down. Other potential culprits include clindamycin, erythromycin, clarithromycin, co-amoxiclav, and ciprofloxacin.

Blood Pressure and Heart Medicines

Many people start blood pressure medication in their 50s or 60s only to find a sudden bout of acid reflux. The most common triggers are calcium channel blockers or nitrates.

Unlike many other triggers, they don’t increase acid production. Instead, they relax the lower oesophageal sphincter, allowing the existing acid to backflow from the stomach into the food pipe more easily.

Osteoporosis Medications

Bisphosphonates are known to cause acid reflux. These side effects are most likely to occur in the first month of treatment. It’s recommended to remain upright for at least 30 minutes after taking the medication to avoid an acid attack.

Antidepressants and Anxiety Medications

Most forms of antidepressants can cause acid reflux in some people. That includes SSRIs, SNRIs, and other formulations.

However, it’s tricyclics and sedatives that have the most potent effect. Why? Well, they affect both digestion and sphincter contraction, creating a double effect that increases the likelihood of acid attacks.

Hormone-Based Medications

Hormone replacement therapy or oral contraceptives increase muscle relaxation. Your LOS remains relaxed, allowing backflow of acid.

What To Do If You Think Your Medicine Is Causing Heartburn

Just started a new medication? If you suddenly develop heartburn, it’s often quite clear what’s going on. But it can be more difficult to discern whether your heartburn symptoms have been ongoing for some time.

Here’s what you should do:

• Don’t stop medications suddenly. Some treatments need to be finished or tapered safely.

• Speak to your GP or pharmacist. They can confirm whether your medicine is a likely trigger and if it is safe for you to come off them.

• Adjust the timing. Taking doses earlier in the day or away from bedtime can reduce reflux.

• Take with food or plenty of water but only if the label says it’s safe to do so.

• Stay upright for at least 30 minutes after swallowing tablets.

• Ask about alternatives if symptoms persist, another option may suit your stomach better.

The Functional Gut Clinic can perform diagnostic testing to confirm the presence of acid reflux and whether it’s causing your symptoms. This may be a step in the right direction towards ending your symptoms.

You can read the following interesting article: Is Acid Reflux Genetic?