GERD: Can certain medications increase severity?

Q: I've heard that some medications can aggravate the symptoms of gastroesophageal reflux disease (GERD). Can you tell me more?

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Certain medications can increase the severity of gastroesophageal reflux disease (GERD). GERD is a chronic condition in which stomach acid flows back (refluxes) into your esophagus. This backwash of acid causes irritation and inflammation of the lining of your esophagus.

Normally, when you swallow, your lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again. If you have GERD, this band of muscle doesn't work properly. Certain medications can further impair its function, including:

• Anticholinergics such as oxybutynin (Ditropan), hyoscyamine (Levsinex) and certain antidepressants.
• Sedatives or tranquilizers, including benzodiazepines such as diazepam (Valium) and temazepam (Restoril)
• Theophylline (Elixophyllin, Uniphyl)
• Calcium channel blockers and nitrates
• Progesterone
• Narcotics (opioids) such as codeine and hydrocodone

Also, some medications and dietary supplements — especially when used on a regular basis — can increase inflammation that GERD causes in the esophagus. These include:

• Potassium supplements
• Iron supplements
• Vitamin C supplements
• Nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen (Advil, Motrin, others)
• Antibiotics such as tetracycline
• Bisphosphonates, such as alendronate (Fosamax), ibandronate (Boniva) and risedronate (Actonel)
• Quinidine

If you have GERD, ask your doctor if medications you take may affect your symptoms.