Tirzepitide and Omeprazole-bad acid reflux

Needsalife

Needsalife

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I’m suffering acid reflux pretty badly, even 12 hours after eating. I’m taking digestive enzymes and they seem to help, but it’s still bad. I have a lifelong history of acid reflux (GERD?) and have been on Omeprazole for years. I just read that Tirzepitide decreases stomach acid, just like Omeprazole does. I’m just wondering if perhaps I’m producing too low acid. I would go off it slowly, halving my dose for a week or more before going off it completely (I have done this before and cold turkey off Omeprazole was misery. The step-down method made it doable).

Conversely, I have a prescription for double dose Omeprazole that I could try. I was given it by an ear nose and throat doctor earlier this year but I felt like it made my acid reflux worse and went back to single dose. I guess I’m answering my own question. If too much acid reducing med made my problem worse the first time (using double Omeprazole) it’s a decent bet it’s doing it again.

Anyway, has anyone tried adjusting their Omeprazole dosage to help acid reflux?

Any other hints for acid reflux are welcome. I’m using a wedge pillow, taking Pepsid Complete, Tums and Apple Cider Vinegar, in addition to the digestive enzymes with all meals.
 
I just double up on the omeprazole when the heartburn flares. Tirz does make it worse, which is a little alarming with my Barrett's Esophagus... I think it makes it worse by slowing the speed of food moving through, so food/acid mix is stinking around longer
 
Needsalife said:
I’m suffering acid reflux pretty badly, even 12 hours after eating. I’m taking digestive enzymes and they seem to help, but it’s still bad. I have a lifelong history of acid reflux (GERD?) and have been on Omeprazole for years. I just read that Tirzepitide decreases stomach acid, just like Omeprazole does. I’m just wondering if perhaps I’m producing too low acid. I would go off it slowly, halving my dose for a week or more before going off it completely (I have done this before and cold turkey off Omeprazole was misery. The step-down method made it doable).
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How long have you been on these GLP1 medications?

GLP1 agonists slow stomach emptying and thus also slows stomach acid production.

How big are your meals you're eating? And how close to bed time are you consuming food? One thing I had a terrible time with my midnight snacking. No matter how much my dose of GLP1s, I'd get up and have a snack....

Then when I went back to sleep, I'd burp up stomach acid into my mouth and aspirate some of it.... I'd wake up coughing and trying to clear my throat. Kept me up for hours.

I'd stop eating so close to bed time and that helped. Try try try to stop midnight snacks.

Sorry, I don't have any experience with the meds. But I had some questions I think might be helpful to those who do. How long on the GLP1 meds? And how close to lying flat do you eat?
 
brentm said:
How long have you been on these GLP1 medications?

GLP1 agonists slow stomach emptying and thus also slows stomach acid production.

How big are your meals you're eating? And how close to bed time are you consuming food? One thing I had a terrible time with my midnight snacking. No matter how much my dose of GLP1s, I'd get up and have a snack....

Then when I went back to sleep, I'd burp up stomach acid into my mouth and aspirate some of it.... I'd wake up coughing and trying to clear my throat. Kept me up for hours.

I'd stop eating so close to bed time and that helped. Try try try to stop midnight snacks.

Sorry, I don't have any experience with the meds. But I had some questions I think might be helpful to those who do. How long on the GLP1 meds? And how close to lying flat do you eat?
Click to expand...
I’ve been on Tirzepitide 6 weeks. I’m taking 5 mg, weekly and this is the 2nd dose on 5 mg. I have nothing after 7 pm and typically go to bed at 1 am. I’ve even learned to take my meds at 7 pm so I literally have nothing but water between 7 pm and bedtime. So I’m trying for no food 6 hours before bed. And no laying flat until then.
 
cta7978 said:
Just in case you haven't explored.. look up eosinophilic esophagitis, commonly mistaken for GERD. I cut out dairy and symtoms resolved in a week. https://www.nih.gov/news-events/new...s-eosinophilic-esophagitis-well-excluding-six
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I’m not a big dairy eater/drinker. I actually love milk but I learned many years ago it does not love me. I have been eating yogurt since being on this medicine because the probiotic benefits. I will stop eating it and be mindful not to eat other dairy and see if that helps. Thank you.
 
Needsalife said:
I’ve been on Tirzepitide 6 weeks. I’m taking 5 mg, weekly and this is the 2nd dose on 5 mg. I have nothing after 7 pm and typically go to bed at 1 am. I’ve even learned to take my meds at 7 pm so I literally have nothing but water between 7 pm and bedtime. So I’m trying for no food 6 hours before bed. And no laying flat until then.
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It seems like, for me, that my stomach issues and bile burps have gotten better with time. I haven't had one in quite a while now that I think of it.

I'd listen to your instincts with the acid reflux meds.
 
I have GERD and EoE. I take 20mg omeprazole in am daily - been on it for years.

I had no indigestion on tirz until I jumped from 5mg to 6mg. Had it the 2nd and 3rd night after dosing. I probably had 3-4 reflux incidents both nights. Did this a second week but didn’t eat dinner those nights and no reflux but had indigestion and burping.

I decided to split my dose and pin 2x weekly and the indigestion has not returned. I started taking the pip at night as well as aspirating on stomach acid is no fun.

Hope you are able to get past this.
 
cta7978 said:
Just in case you haven't explored.. look up eosinophilic esophagitis, commonly mistaken for GERD. I cut out dairy and symtoms resolved in a week. https://www.nih.gov/news-events/new...s-eosinophilic-esophagitis-well-excluding-six
Click to expand...
I’ve had EoE for 30 years - well before docs knew what it was. Dairy seemed to be a trigger for me as well. Since being on tirz, I’ve had zero incidents of food impaction in my esophagus - was almost daily before starting on tirz. I’m getting scoped in January for a checkup and biopsy and am very interested if tirz has provided a benefit. The indigestion and reflux certainly didn’t help.
 
I have a similar issue. I stopped taking it for a while because it was spiking my liver enzymes significantly. I was taking it daily for a few months though. Doesn't matter what I eat, when I eat, or how much I eat. I started taking heartburn meds again but a lot less frequently. I did have to stop taking my Metamucil because the citric acid was DESTROYING me. Now I avoid anything citrus flavored or containing citric acid whenever possible. I still get heartburn, but it seems to have helped.
 
you can also add pepcid (famotidine) H2 blocker in addition to your PPI of choice.
 
PopTart said:
I decided to split my dose and pin 2x weekly and the indigestion has not returned. I started taking the pip at night as well as aspirating on stomach acid is no fun.

Hope you are able to get past this.
Click to expand...

When I switched over to Tirz, I also started at 2x weekly. The fairly extreme sawtooth of weekly injections was irritating. I hadn't considered the it would help with the indigestion but it's a good point to bring up.

Here's what that looks like on a graph

First image is weekly, second is 2x weekly.


1728131167059.png

Weekly dose sawtooth pattern


1728131272360.png

2x weekly sawtooth pattern

source: https://glp1plotter.com/
 
geoguy78 said:
I just double up on the omeprazole when the heartburn flares. Tirz does make it worse, which is a little alarming with my Barrett's Esophagus... I think it makes it worse by slowing the speed of food moving through, so food/acid mix is stinking around longer
Click to expand...
I'm on tirz 10. Omeprazole 40mg QD for GERD and Barrett's. Worst. Reflux. Of. My. Entire. Life. since starting tirz. No more spicy food, no overeating ever especially near bedtime. And yep, double up on Omeprazole.
 
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I think all the other threads have done a good job of addressing the "sawtooth" wave we ride on these meds. Also all the diet/timing thoughts so I won't restate them.
I had gastric sleeve back in 2018 and started having acid reflux EVERY NIGHT no matter what I ate or how late. Litterally choking on the acid in my throat. Couldn't take enough tums or seemingly anything else.

Working with my doctor I believe we tried famotidine (Pepcid AC),omeprazole (Prilosec), and esomeprazole (Nexium). Maybe we just didn't find the right dose but none seemed to help.

We then started 40mg Pantoprazole Sodium Delayed-Release Tablets.

I pretty much never have the acid reflux/choking issues since. I can survive missing a single dose but if I miss the 2nd day in a row it is horrible that night! I know the doctor checks bloodwork to supposedly check to make sure it is not causing issues with organs over time but I can't remember what they are looking at specifically.
Since starting Tirz (Dec 2024) I can have issues with burping back up food if I eat to late in the day. Also I am still working on finding a dose of Tirz that is high enough to work without causing the nausea/indigestion/fatique/cold.🤷‍♂️ The nausea/indigestion is nothing compared to the ACID I have without the Pantoprazole.
Might be worth talking to your doctor about trying it if nothing else is working...Of course meds work different for different folks so who knows. 🤷‍♂️
 
PepOhio said:
I know the doctor checks bloodwork to supposedly check to make sure it is not causing issues with organs over time but I can't remember what they are looking at specifically.
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Kidney and liver mostly I think. I've had bad heartburn since way before the Tirz. It just made it worse. My liver enzymes came back super elevated after talking Omeprazole daily for like 2 months. I stopped taking it and my enzymes dropped like 30 points in 30 days.
 
PepOhio said:
I think all the other threads have done a good job of addressing the "sawtooth" wave we ride on these meds. Also all the diet/timing thoughts so I won't restate them.
I had gastric sleeve back in 2018 and started having acid reflux EVERY NIGHT no matter what I ate or how late. Litterally choking on the acid in my throat. Couldn't take enough tums or seemingly anything else.

Working with my doctor I believe we tried famotidine (Pepcid AC),omeprazole (Prilosec), and esomeprazole (Nexium). Maybe we just didn't find the right dose but none seemed to help.

We then started 40mg Pantoprazole Sodium Delayed-Release Tablets.

I pretty much never have the acid reflux/choking issues since. I can survive missing a single dose but if I miss the 2nd day in a row it is horrible that night! I know the doctor checks bloodwork to supposedly check to make sure it is not causing issues with organs over time but I can't remember what they are looking at specifically.
Since starting Tirz (Dec 2024) I can have issues with burping back up food if I eat to late in the day. Also I am still working on finding a dose of Tirz that is high enough to work without causing the nausea/indigestion/fatique/cold.🤷‍♂️ The nausea/indigestion is nothing compared to the ACID I have without the Pantoprazole.
Might be worth talking to your doctor about trying it if nothing else is working...Of course meds work different for different folks so who knows. 🤷‍♂️
Click to expand...
I started taking 40mg Pantoprazole twice a day earlier this year because I was getting heartburn after dinner. I took my first dose of Tirz. This past Friday and Saturday night I had the worse reflux that I ever had.

Now I am going to take the Pantoprazole at least 1 hour before eating. I hope that this helps after this Friday’s dose of Tirz.
 
John316 said:
I started taking 40mg Pantoprazole twice a day earlier this year because I was getting heartburn after dinner. I took my first dose of Tirz. This past Friday and Saturday night I had the worse reflux that I ever had.

Now I am going to take the Pantoprazole at least 1 hour before eating. I hope that this helps after this Friday’s dose of Tirz.
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Do you drink alcohol? I was actually able to completely stop pantoprazole when I gave up the drink (eheh), and now when I have it occasionally, it gets me really bad because I think it sits in my stomach for too long!
 
MiniatureSnail said:
Do you drink alcohol? I was actually able to completely stop pantoprazole when I gave up the drink (eheh), and now when I have it occasionally, it gets me really bad because I think it sits in my stomach for too long!
Click to expand...
I used to drink. Now just occasionally( every other month maybe ).
 
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