Zoloft and GERD (Is there any drug-disease interaction?)

In this blog, we are going to discuss the relationship between zoloft and GERD. Gastroesophageal reflux disease is a kind of condition which is associated with stomach acid reflux and heartburn. In this blog, we will also talk about effective ways to help relieve the symptoms of gerd. 

What is the relationship between zoloft and Gastroesophageal reflux disease (GERD)? 

It has been reported that zoloft can cause the side effects associated with GERD. Although the drug itself does not possess anticholinergic effects which cause malfunctioning of esophageal sphincter muscle, it can definitely exacerbate the symptoms of pre-existing GERD. 

GERD is an entire medical condition in itself. It is not just a case of increased acidity after you eat spicy food or have an upset stomach, it’s actually a disease. It is caused when prolonged acid reflux damages the sphincter of the oesophagus. 

This allows the acid to reach your throat and cause disturbing side effects which include:

• Damage to esophageal mucosa
• Swelling or pain in throat 
• Burning sensation in mouth, throat, chest and stomach. 
• Inability to digest food
• Difficulty in swallowing food
• Blisters in mouth
• Lump-in-throat feeling
• Stomach ulcer
• Cough
• Difficulty in breathing
• Highly acidic vomiting, which further damages the upper gastrointestinal tract. 

Risk factors of GERD and zoloft induced acid reflux 

Following people are at higher risk of GERD and GERD like symptoms associated with the use of zoloft:

• People who are obese are more likely to suffer from this condition. Several studies suggest excess belly fat can result in GERD like symptoms. 
• People living with underlying conditions like hiatal hernia. 
• Pregnant women 
• People who have prolonged gastric emptying time
• Smoking
• Heavily spiced and oily food
• Overeating, which leads to higher gastric acid production in order to digest the excess amount of food. 

What could be done to help relieve the symptoms of GERD while taking zoloft? 

Severe GERD symptoms in the presence of zoloft can cause disturbing complications. Zoloft is not tolerated well by some people just because of its acid reflux. There are a few things you can try to help relieve the symptoms of GERD. These include:

Talk to your healthcare provider 

First thing’s first, tell your doctor about your side effects. It is extremely important to discuss if it’s okay to continue using zoloft. If your side effects decrease the quality of your life, it simply means you need to change your antidepressant or reduce the dose. 

Zoloft is meant to be taken daily and for a couple of months, depending on your condition. If it’s not comfortable, it can’t be tolerated well. Yes, it will produce side effects, but these side effects begin to subside within a few weeks of your treatment. 

If your side effects persist, it means zoloft is not the right choice of antidepressant for you. 

Do not take zoloft on an empty stomach 

If you suffer from zoloft induced GERD like side effects, it is important to make sure you don’t take your med on an empty stomach. The drug itself increases the acid content of the stomach because of the nature of its formulation. 

Without food, it directly affects gastric mucosa, which is the protective membrane lining your stomach. Make sure you eat something before taking your zoloft or try taking it with meals. 

Don’t eat too much carbs

Some researchers suspected that undigested carbs may cause bacterial overgrowth and increased pressure inside the abdomen, which could contribute to acid reflux. Having high amounts of undigested carbs in your stomach can cause flatulence and bloating. 

Avoid bad eating habits 

Do not eat heavy meals 3 hours before bedtime. When you lie down on bed, the process of digestion gets slower. So you need to digest your food before you go to sleep. 

Avoid eating large portions of food. You can try having smaller, more frequent meals. Large meals can put a burden on your stomach and it releases more and more acid to help digest the food. 

Avoid drinking carbonated beverages 

Studies have observed that regular consumption of carbonated or fizzy beverages, including soft drinks, club soda, and seltzer, could be linked to a higher risk of gastric esophageal reflux. 

One study found that carbonated soft drinks can worsen certain acid reflux symptoms, like heartburn, fullness, and burning sensation in your throat. 

This is because carbonated beverages make your burp more, that can increase the amount of acid escaping your stomach and irritating your oesophagus, throat and mouth. 

Walk a mile after dinner

Studies suggest that going for a short walk after dinner can help your body to produce more digestive enzymes and makes your stomach absorb the nutrients from your food. 

It improves your digestion and reduces bloating, acid reflux, constipation and provides relaxation from several other gastrointestinal problems. 

Add natural probiotics to your diet

Milk and yoghurt are considered natural probiotics. They are well known to provide relief from gastric acidity. Yoghurt contains lactobacillus, also known as ‘good bacteria’. This good bacteria can improve your digestion and can manage excessive acid secretion in your stomach. 

Cut back on spicy foods

Heavily spiced food is your biggest enemy when it comes to coping with gastric acid reflux. Spicy food can mess up your stomach and is the most common cause of acid reflux in people who add high amounts of spices in their foods. Make sure you cut back on spicy food, at least for a while. 

Try Over-the-counter acid reducers 

You can also try OTC medications to help relieve the symptoms of GERD. Make sure you ask for your doctor’s approval first to rule out any drug interaction. OTC meds include:

• Antacids are widely used to relieve heartburn. They are alkaline in nature and once inside your stomach, they neutralise gastric acid. Examples include Aluminium hydroxide gel (Alternagel), calcium carbonate (Alka-Seltzer), gaviscon, pepto-Bismol etc. 

• Histamine-2-blockers are also used to relieve heartburn. These OTC meds inhibit the production of gastric acid. Examples include cimetidine, famotidine, rimantadine, zantac 360 and nizatidine etc. 

• Proton pump inhibitors or PPIs are also used to inhibit stomach acid secretion. These meds are used worldwide to treat heartburn and indigestion. Examples include lansoprazole (Prevacid), esomeprazole (Nexium), and omeprazole (Risek)

Other drugs which can exacerbate the symptoms of GERD

There are several other medications that can make your GERD even more unbearable. These include:

• Antibiotics are well known for upsetting your stomach. They can kill natural gut microflora and make your GERD much worse. 
• Supplements to replenish iron reserves 
• Antimalarial agents
• Non-steroidal anti-inflammatory drugs (NSAIDS)*
• Anticholinergic drugs
• Antihypertensives, like calcium channel blockers, beta blockers and ACE inhibitors. 
• Controlled substances including narcotic analgesics, amphetamines, ecstasy etc. 
• Certain hormones like progesterone. 
• Sedatives and hypnotics

*Note: NSAIDS are not safe to use with zoloft. The concomitant use can increase the risk of bleeding. 

Make sure you tell your healthcare provider about your side effects and ask if there’s any other prescription medication that might exacerbate the symptoms of GERD, all on its own or in combination with zoloft. It is important to be safe from disturbing drug interactions.

Conclusion 

In this blog, we talked about the relationship between zoloft and GERD. Zoloft is known to increase stomach acidity and cause disturbing gastrointestinal side effects. Prolonged use of zoloft can damage your stomach lining and cause gastroesophageal reflux. 

The main cause of GERD is known to be the malfunctioning of the esophageal sphincter, which is made up of muscles. These muscles are badly damaged as a result of prolonged acid reflux. 

Most people suffer from a lump-in-throat feeling which is caused by the inflammation of these muscles. Make sure you take your medication properly. It is advised not to take it on an empty stomach if you get disturbed by increased acidity. 

Try taking it with meals. Adopt a healthy lifestyle, add loads of probiotics in your diet and avoid stomach irritants, as long as you suffer from this problem. It is best to discuss with your healthcare provider the types of OTC acid reducers which are safe to use and if there is any dose adjustment required.

FAQs: Zoloft and gerd

Can sertraline give you acid reflux?

Yes, sertraline can cause acid reflux. This side effect can be responsible for further zoloft induced side effects, including vomiting, abdominal pain and lump-in-throat feeling, which occurs when excess acid reflux causes the inflammation of esophageal muscles. 

Can SSRIs cause GERD?

Zoloft can cause GERD-like symptoms because of its ability to increase stomach acid secretion and acidic reflux. Although the drug itself does not possess anticholinergic effects which cause malfunctioning of esophageal sphincter muscle, it can definitely increase stomach acidity and exacerbate the symptoms of pre-existing GERD. 

Can Zoloft cause gastric problems?

Yes , zoloft can cause gastric problems including nausea, vomiting, diarrhoea, acid reflux, indigestion, loss of appetite and abdominal pain. These side effects stay as long as your body tries to adapt to the drug. Once it is well adjusted with your current dose, you start to feel much better. 

Can I take antacids with sertraline?

Yes, it is safe to take antacids with sertraline. They are alkaline in nature and help neutralise your stomach acid. it’s still preferred to ask for your doctor’s advice before taking any meds, even over-the-counter antacids.

What medications trigger acid reflux?

Following medications can trigger acid reflux:

• Antibiotics are well known for upsetting your stomach.
• Supplements to replenish iron reserves 
• Antimalarial agents
• Non-steroidal anti-inflammatory drugs (NSAIDS)*
• Anticholinergic drugs
• Antihypertensives, like calcium channel blockers, beta blockers and ACE inhibitors. 
• Controlled substances including narcotic analgesics, amphetamines, ecstasy etc. 
• Certain hormones like progesterone. 
• Sedatives and hypnotics

Can I take an acid reducer with Zoloft?

Yes, you can use over-the-counter acid reducers with zoloft. These include:

• Antacids are widely used to relieve heartburn. They are alkaline in nature and once inside your stomach, they neutralise gastric acid. Examples include Aluminium hydroxide gel (Alternagel), calcium carbonate (Alka-Seltzer), gaviscon, pepto-Bismol etc. 
• Histamine-2-blockers are also used to relieve heartburn. These OTC meds inhibit the production of gastric acid. Examples include cimetidine, famotidine, rimantadine, zantac 360 and nizatidine etc. 
• Proton pump inhibitors or PPIs are also used to inhibit stomach acid secretion. These meds are used worldwide to treat heartburn and indigestion. Examples include lansoprazole (Prevacid), esomeprazole (Nexium), and omeprazole (Risek)

References 

• Nancy C Brahm et al. Consult Pharm. (2011) – Antidepressant-mediated gastroesophageal reflux disease https://pubmed.ncbi.nlm.nih.gov/21486738/
• Gastroesophageal reflux disease (GERD) https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940#:~:text=Gastroesophageal%20reflux%20disease%20(GERD)%20occurs,reflux%20from%20time%20to%20time.
• GERD: Can certain medications make it worse? https://www.mayoclinic.org/diseases-conditions/gerd/expert-answers/heartburn-gerd/faq-20058535#:~:text=Answer%20From%20Michael%20F.,gastroesophageal%20reflux%20disease%20(GERD). 
• Which OTC Meds Treat Heartburn? https://www.webmd.com/heartburn-gerd/guide/treating-heartburn-over-counter-medicine
• Food and Drug Administration US – Over-The-Counter (OTC) Heartburn Treatment https://www.fda.gov/drugs/information-consumers-and-patients-drugs/over-counter-otc-heartburn-treatment
• Jen Uscher – 10 Tips for When Your Meds Trigger Heartburn https://www.webmd.com/heartburn-gerd/features/10-tips-ease-heartburn-triggered-medications