Why Is My Heartburn Medication Not Working?

Heartburn medication may not work for a few reasons. You may not have acid reflux if your heartburn medication is not working. Other causes may include your diet or incorrectly taking the medication. 

Acid reflux occurs when your stomach acid leaks back into your esophagus, which causes heartburn and irritation. Proton pump inhibitors (PPIs) keep your body from making stomach acid. A little stomach acid is good for your health, but too much can be painful.

You can manage acid reflux by using PPIs. Common brand names include Nexium (esomeprazole), Prilosec (omeprazole), and Protonix (pantoprazole).

Of note: PPIs do not work for everyone. You may have "breakthrough" symptoms from time to time. More than 54% of people in the United States who take PPIs daily still have acid reflux. Read on to learn why your heartburn medication may not work and what to do instead.

What Are Proton Pump Inhibitors?

PPIs can heal damage to the esophagus, help relieve acid reflux, and treat stomach ulcers in some people.

One of the most common PPIs that treat gastroesophageal reflux disease (GERD) is Prilosec (omeprazole). Prescription-strength Prilosec heals the esophagus and prevents damage from stomach acid. Prilosec over-the-counter (OTC) treats acid reflux that occurs at least two days per week.

Other PPIs that commonly treat acid reflux include:

• AcipHex (rabeprazole)
• Dexilant (dexlansoprazole)
• Nexium (esomeprazole)
• Prevacid (lansoprazole)
• Protonix (pantoprazole)
• Zegerid (omeprazole with sodium bicarbonate)

Like Prilosec, there are OTC versions of Nexium, Prevacid, and Zegerid. Consult a healthcare provider about what PPI might best treat your symptoms. They can give specific instructions if you do not know how and when to take PPIs.

Still, PPIs might not work for everyone. You may not have acid reflux if the medicine does not resolve your symptoms. Other causes may include your diet or incorrectly taking PPIs. 

1. You Do Not Have Acid Reflux

PPIs may not alleviate your heartburn if you were misdiagnosed, Joel Richter, MD, director of the division of digestive diseases and nutrition at the University of South Florida School of Medicine, told Health. Typically, PPIs treat gastroesophageal reflux disease (GERD), which causes persistent acid reflux.

Other health conditions that may cause acid reflux-like symptoms include:

• Achalasia, which happens if your esophagus cannot push food to your stomach
• Eosinophilic esophagitis, or white blood cells that build up in your esophagus
• Non-acidic reflux in the esophagus
• Other types of inflammation of the esophagus

Heart disease can feel similar to heartburn. The esophagus and the heart are near each other in your chest area. It may be hard to tell the difference between angina (chest pain) and heartburn.

"There is a big group of people who get put on these medications and don't get better, and most of the time, it's because they don't have an acid-related problem," said Dr. Richter.

Follow up with a healthcare provider if you want to test whether your symptoms are due to another health condition. They may recommend a 24-hour pH impedance test. 

A pH impedance test measures stomach acid levels in your esophagus. This test also monitors the movement of fluid and gas along your esophagus. That combination can help figure out whether you actually have acid reflux.

2. You Take PPIs Incorrectly

People often have breakthrough acid reflux symptoms if they do not take their PPIs correctly. 

Generally, PPIs are most effective if you take them about 30 minutes before your first meal. Food signals your body to secrete stomach acid.

Talk to a healthcare provider if taking PPIs 30 minutes before your first meal does not help. You may need a second dose, taken 30 minutes before dinner. Do not up your dose without consulting a healthcare provider. 

3. Your Diet Causes Heartburn

PPIs might not work well for you, even if you have GERD, if you eat foods that trigger acid reflux.

Certain foods can cause GERD flares like:

• Acidic foods (e.g., citrus fruits and tomatoes)
• Alcoholic drinks
• Caffeine
• Chocolate
• High-fat foods
• Mint
• Spicy foods

Eating meals less than three hours before lying down or sleeping may worsen acid reflux.

Tips for Managing GERD

Talk to a healthcare provider if Prilosec or other PPIs are not working. Of note: PPIs will not alleviate symptoms right away since it's slow-acting. Your symptoms may not subside until one to four days later.

At the same time, you can make some lifestyle changes to minimize and prevent breakthrough acid reflux.

Do Not Sleep With a Full Stomach

Avoid sleeping with a full stomach. Lying down within three to four hours of consuming a meal may trigger acid reflux.

"My big push is to keep the patients away from late eating, large meals, and [laying down]," David Johnson, MD, the chief of gastroenterology at the Eastern Virginia Medical School, told Health.

A combination of those factors may cause too much of a burden on your body, one that even PPIs cannot treat. Instead, try eating at least three hours before bedtime, and limit late-night snacking.

Elevate Your Head

Consider elevating your head while you sleep to keep stomach acid from leaking back into your esophagus.

Some evidence suggests that people with GERD have reduced pH levels in their esophagus after elevating their heads while lying down. pH measures acidity. Low pH levels in the esophagus indicate less stomach acid.

Try lifting your head off your bed with foam blocks or placing extra pillows under your head and upper back. Elevating your head six to eight inches may help.

Manage Your Weight

Research has found that overweight or obesity increases GERD risk. The American College of Gastroenterology (ACG) advises losing weight to help alleviate acid reflux.

Eating a balanced diet may help you lose weight while alleviating acid reflux. For example, increasing fiber intake may help you manage your weight. Some evidence suggests that fiber might also alleviate acid reflux.

A study published in 2016 noted that high-cholesterol and high-fat diets link to acid reflux. Limiting your saturated fat intake helps lower your cholesterol and manage your weight.

Recognize the Foods That Trigger Acid Reflux

Consider skipping those certain foods that trigger acid reflux, like caffeine or spicy foods. Pay attention to the foods you eat before you notice acid reflux. It may be helpful to keep a food diary or document the foods you eat daily.

Try taking an H2 blocker an hour before eating if you plan to eat foods that cause acid reflux. An H2 blocker may help prevent symptoms by reducing how much acid your stomach produces.

Take Your Medicine as Prescribed

A healthcare provider may prescribe PPIs, while some are available over the counter and do not require a prescription.

A healthcare provider will likely instruct you to take a PPI in the morning before eating. You may need to take a second dose about 30 minutes before dinner if advised. Some people who take PPIs once daily may take them before dinnertime if their symptoms flare at night.

Make sure to do the following if a healthcare provider prescribes you PPIs:

• Do not stop taking medicine unless a healthcare provider instructs you to do so.
• Ensure that you have enough medicine so that you do not run out.
• Take medicine as directed by a healthcare provider.
• Take medicine at the same time each day.

Try an Over-the-Counter Medicine

Some over-the-counter (OTC) medicine help manage heartburn. For example, H2 blockers reduce the amount of acid your stomach makes. Antacids help relieve mild heartburn.

Of note: You are not meant to use those medicines daily. Antacids may cause side effects like constipation or diarrhea.

"What I suggest to my patients is that they take an OTC H2 blocker when they have their breakthrough symptoms," said Dr. Richter. "That seems to give them better control."

A Quick Review

You can treat GERD symptoms like acid reflux with lifestyle changes and medicines. PPIs, which reduce the acid in your stomach, often treat GERD.

Still, PPIs are not effective for everyone. Some people are misdiagnosed with GERD. Others may take PPIs incorrectly or eat a diet that causes acid reflux. Working with a healthcare provider can pinpoint why PPIs do not work and what alternative treatments you can try.