Guest Author - Caramy Spencer

As soon as the word “heartburn” is mentioned, the red flag associated with this painful condition generally points to an anatomical structure known as the lower esophageal sphincter (LES). The LES is a band of muscle that acts as a valve, and is located at the very bottom of the esophagus. This specialized muscle takes on an extremely important function – keeping the contents of the stomach from entering the esophagus and trachea. In cases of a normally functioning LES, when eating and the associated swallowing action has stopped, the LES maintains a pressure that is higher than that of the stomach thereby preventing its contents from refluxing. On the other hand, an abnormally functioning LES maintains a lower pressure barrier, allowing regurgitation of the stomach contents.

Did you know that this weakening of the LES can be caused by some common medications? The following is a list of medications that have the potential for this problem. If you are suffering from heartburn and you believe your medication may be the culprit, check with your doctor.

Antidepressants

Some antidepressants known as tricyclic antidepressants or TCAs, may have the ability to loosen the LES. Another unpleasant side effect related to “stomach issues” includes that TCAs may also decrease gastro-intestinal motility and secretion. This can lead to constipation. Tricyclic antidepressants include:

amitriptyline (Elavil®, Endep®, Tryptanol®, Trepiline®)
desipramine (Norpramin®, Pertofrane®)
dothiepin hydrochloride (Prothiaden®, Thaden®)
doxepin (Adapin®, Sinequan®)
clomipramine (Anafranil®)
imipramine (Tofranil®)
lofepramine (Gamanil®, Lomont®)
nortriptyline (Pamelor®)
protriptyline (Vivactil®)
trimipramine maleate (Surmontil®)

Antiasthmatics

These medications work to keep air passages in the lungs from becoming constricted. Theophylline is a commonly used drug which may decrease the pressure barrier of the LES. Other “stomach issues” side effects of this stimulant include stomach pain and diarrhea. Theophylline is also an ingredient naturally found in tea and coffee. Although it is found in significantly lesser amounts than in therapeutic doses, it is important to point out that these beverages can also cause loosening of the LES. Common brand names for theophylline include:

Bronkodyl®
Elixophyllin®
Slo-bid®
Slo-Phyllin®
Theo-24®
Theo-Dur®
Theolair®
Uniphyl®

Anticholinergics

This is a class of medications that disrupts the autonomic nervous system, or the part of functioning of the body that is primarily unconsciously controlled such as cardiovascular, digestive, and respiratory functions to name a few. These medications may also disrupt the functioning of the nerves that control the opening and closing of the LES. Common anticholinergics include:

Darifenacin (Enablex®)
Diphenhydramine (Benadryl®)
Dimenhydrinate (Dramamine®)
Dicyclomine
Flavoxate
Ipratropium
Oxybutynin
Tiotropium (Spiriva®)
Solifenacin (Vesicare®)

Antihypertensives

Two types of antihypertensives may cause weakening of the LES. These include calcium channel blockers and beta blockers. Common beta blockers include:

Acebutolol (Sectral ®)
Atenolol (Tenormin ®)
Betaxolol (Kerlone ®)
Bisoprolol (Zebeta®)
Carteolol (Cartrol®)
Metoprolol (Lopressor®)
Nadolol (Corgard®)
Penbutolol (Levatol®)
Pindolol (Visken®)
Propranolol (Inderal®)
Timolol (Blocadren®)

Common calcium channel blockers include:

Amlodipine (brand name Norvasc®)
Diltiazem (Cardizem®)
Felodipine (Plendil®)
Isradipine (DynaCirc®)
Nicardipine (Cardene®)
Nifedipine (Procardia®)
Verapamil (Calan, Covera-HS®, Verelan®)

Anti-anxieties and Sedatives

Commonly prescribed and a vast array available, these drugs may also be linked to the loosening of the LES.


Do you really need the medications you are currently taking? Of course you should always consult your doctor. In addition, read my article on FDA Pulls Zelnorm.


Note: Any information that I have provided regarding gastric issues, their diagnosis, and their treatments are intended for informational purposes only and are not meant as a substitution for the advice provided by your healthcare professional. You should immediately contact your healthcare provider if you believe you or your child may have a health condition. In addition, always talk to your doctor, pharmacist, or other healthcare provider before taking any prescription, over-the-counter medicines, or herbal supplements