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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18757
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have the worst heartburn. I was on nexium for years but

Customer Question

I have the worst heartburn. I was on nexium for years but haven't taken for a year or so. I take a super good probiotic. Lots of Greek yogurt. Been making ginger tea every day. My stomach gets a bit squeamish some. I have for 2 weeks. I've had several very light stools and then some very dark. I called my doc today. Gonna go Monday.
Submitted: 1 year ago.
Category: Medical
Customer: replied 1 year ago.
I am 5'8" and 225 pounds
Expert:  Dr. D. Love replied 1 year ago.

Hello from JustAnswer.

Is there a reason that you have not resumed the Nexium?

Did you stop it because of side effects?

Customer: replied 1 year ago.
It is sooooo bad for your gut! I am really trying to heal my gut. I have been taking the probiotics and it worked great until a couple weeks ago. I was in the hospital for 3 days and it started when I got home. I had taken an OD of nexium, clonazapam, and sertraline.
Customer: replied 1 year ago.
I have quit nexium completely. And down to 1 mg of clonazapam per night now. Gonna go off that all the way too
Customer: replied 1 year ago.
Still on 200 mg of sertraline per day
Expert:  Dr. D. Love replied 1 year ago.

There are several issues to discuss in this situation.

If the probiotics, ginger tea, and tums were working, that would be fine. But if the heartburn is not well controlled, then it may be necessary to use a stronger medicine to suppress stomach acid. It certainly is true that any medicine can have adverse effects, but it is also true that sometimes certain medicines will work better than others.

There are also a couple of lifestyle changes that may be able to help. It may ease some of the reflux if you were to eat smaller, more frequent meals, and to avoid any food intake for several hours before sleeping. Placing 4-6 inch blocks under the feet at the head of the bed can also help limit the amount of reflux at night, which also may help with daytime symptoms.

The Aleve that is being used for the sciatica also can irritate any of the acid irritation syndromes, including acid reflux. There may not be much choice when a musculoskeletal problem is bad, but reducing the intake as much as possible and relying on medicines that do not irritate the stomach, such as acetaminophen/Tylenol, can help the heartburn.

From the standpoint of medicines to help counteract acid to help ease heartburn, it is also true that the Nexium and similar medicines are the strongest medicines that are available, and it may be that you can get control of the condition with a medicine that is less potent. The Tums is one of the least potent medicines to counteract acid. A liquid antacid may work better, partly because it neutralizes a greater amount of acid and partly because the liquid formulation coats the lower esophagus. The next type of medicines that are stronger than the antacids are the H2 blockers, such as ranitidine/Zantac or famotidine/Pepcid. These medicines were the primary medicines used for heartburn before the proton pump inhibitors were discovered, such as Prilosec and Nexium, and some doctors would still argue that the primary reason to use a proton pump inhibitor would be if an H2 blocker is not adequate. The recommended dose of ranitidine for acid reflux is 150 mg twice daily and for famotidine is 20 mg twice daily.

Is there any further information that would be helpful.

Customer: replied 1 year ago.
The Aleve is what I take for my arthritis in my knees when they r super bad. It is not touching the pain of my siatica. What do u recommend?
Expert:  Dr. D. Love replied 1 year ago.

Unfortunately, there are not many options that are available over the counter. There are two good anti-inflammatory medicines available over the counter - Aleve/naproxen and Advil/ibuprofen. From the perspective of effectiveness, there is not much difference between the two drugs, although some people may notice that one or the other works better for them. Both can also cause an exacerbation of acid reflux. Aspirin also has an anti-inflammatory action, but at doses to relieve inflammation, it is actually much harder on the stomach. Acetaminophen is less irritating to the stomach and may help, but many people find that it is not as strong for relief of musculoskeletal pain. After these medicines, though, anything stronger would require a prescription, with the usual next step of either a mild opiate, such as codeine or hydrocodone, which are usually in combination with acetaminophen, or a medicine called tramadol that has a unique blend of mechanisms of action with a partial opiate effect and a partial effect on how the nerves transmit the pain message. Any of these prescription options will usually not exacerbate acid reflux, although any of these medicines may cause nausea or vomiting as a side effect. For these prescription medicines, though, you would need to see your doctor.

Expert:  Dr. D. Love replied 1 year ago.

Please let me know if I can provide any further assistance.

Customer: replied 1 year ago.
Expert:  Dr. D. Love replied 1 year ago.

You are most welcome.

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