Can you use propranolol with acid reflux meds? (+3 tips)

In this article, we will explore whether propranolol can be taken with acid reflux medications, and the possible interactions between propranolol and the commonly used acid reflux medications such as proton pump inhibitors, H2 receptor blockers or antacids.

In addition to this, we will also discuss the importance of consulting your healthcare provider before starting any of these medications together. 

Can you use propranolol with acid reflux meds?

Yes, you can take propranolol with acid reflux medication in most cases after consulting with your healthcare provider. The most commonly used acid reflux medications are:

Propranolol and acid reflux medications work on different systems and mechanisms of the body so there are low risks of interactions between them.

Propranolol is a beta-blocker that works by reducing the effect of adrenaline on the body. Propranolol is usually prescribed to treat high blood pressure, chest pain and heart rhythm disorders. In addition to these, propranolol is sometimes used for the treatment of anxiety. This is an off-label use of propranolol (1).

Whereas, acid reflux medications reduce the production of acid in the stomach to help reduce the discomfort. This is either done by blocking the action of proton pumps in the stomach or by blocking histamine actions. In the case, of antacids, it is simply brought about by managing the pH in the stomach and reducing acidity. 

If you have any queries or concerns regarding the use of propranolol concurrently with acid reflux medication then you should consult your healthcare provider. Several factors are involved in the drug-drug interaction. Your doctor can understand the condition better and then prescribe you medication accordingly.

What does the research suggest?

There are no significant interactions between propranolol and acid reflux medications whereas, these may contribute or influence each other’s effects if taken together at the same time.  

Propranolol with PPIs

Generally, it is safe to take proton pump inhibitors such as omeprazole, lansoprazole and esomeprazole with propranolol. Even though there are no significant interactions found (2), there can be an increased risk of side effects if the two medications are taken together.  

Proton pump inhibitors are the most effective medications for treating acid reflux. They work by blocking the production of stomach acid. They are available as over-the-counter as well as prescription medications. These may include (3):

• Omeprazole
• Lansoprazole
• Esomeprazole
• Pantoprazole
• Rabeprazole 

A study conducted in 2000 to determine the interaction between propranolol and lansoprazole (a PPI) concluded that there is no need for dosage adjustments if the patient is using these two medications concurrently as they both do not interact (4). 

Propranolol with H2 receptor blockers

H2 receptor blockers are generally considered safe to be taken with propranolol, a beta blocker. H2 receptor blockers work by blocking the histamine receptors and preventing the production of stomach acid to relieve acid reflux. They are not as effective as PPIs but can be taken for mild to moderate conditions (5). 

This class of acid reducers may include:

• Famotidine
• Ranitidine
• Cimetidine
• Nizatidine

Out of all these, cimetidine is a specific H2RAS. This means that cimetidine can affect the metabolism of propranolol in the body and cause cause increased steady-state plasma levels of propranolol leading to an increased risk of side effects (6). However, other drugs of H2 receptor blockers do not show the same interactions.

Propranolol and antacids

Although there are no significant life-threatening interactions observed between propranolol and antacids, taking Tums (calcium carbonate) or Milk of Magnesia (magnesium hydroxide) together with propranolol can affect the absorption of propranolol from the stomach.

The levels of propranolol are reduced in the blood and thereby the overall effect of propranolol is affected (7).

Antacids neutralize the stomach acid and provide immediate relief from stomach burn but they do not treat the cause of acid reflux (8). They interact more strongly with some of the medications such as antibiotics rather than propranolol. The most commonly used antacids are:

• Tums
• Rolaids
• Alka-Seltzer
• Maalox
• Gaviscon
• Pepto-Bismol

Side effect synergism

Sometimes, the acid reducers such as PPIs, and H2-receptor blockers except antacids can show synergism with propranolol regarding the side effects. All these medications cause headaches, dizziness and fatigue. If any of the two medications are taken together at the same time there can be an amplification of these effects in the body.

Why you should consult your healthcare provider?

It is important to consult your healthcare provider before using propranolol with acid reflux medications as several factors are involved such as genetics, metabolism, age, gender, pharmacological factors etc. Here is why:

• Your doctor can consider your past medical history or look for any underlying health condition that may cause a severe interaction with the use of any of the above medications.

• Your doctor can modify your treatment plan if needed. They can adjust your dosage of the propranolol and acid reflux medication if there are any chances of interaction between them.

• Some acid reflux medications such as cimetidine can affect the metabolism of propranolol. This can be avoided by discussion with your doctor. They can help you switch medications if needed.

• Some antacids also affect the absorption of propranolol. If you consult your doctor before starting the medication together, your doctor can inform you about the complications with drug absorption beforehand and save you from wasting your medication. 

• If you are susceptible to the side effects of acid reflux medications and propranolol, then your healthcare provider can modify the plan to adjust the doses and duration or even the interval between the two medications to avoid the side effect synergism. 

• Your doctor can provide you with suitable alternatives to both, acid reflux medication or propranolol if any significant interaction occurs.

In my opinion, taking propranolol with acid reflux medications can be safe but some interactions exist between a few of the drugs such as propranolol and cimetidine, propranolol and Tums or Milk of Magnesia. Therefore, it is essential to consult your doctor and have a detailed discussion with them before starting any new drug treatment plan. 

You need to have open communication with your doctor and tell them about your past medical history or any medication that you might be taking so that your doctor can analyze your condition and look for any possible interactions that may occur, whether drug-drug or drug-disease. 

References