Does Ozempic cause heartburn?

Ozempic (semaglutide) often receives praise for its impressive ability to manage blood sugar and promote weight loss—and rightfully so. After all, the drug is approved by the US Food and Drug Administration (FDA) to treat type 2 diabetes and often prescribed off-label for weight loss. But, like any other prescription medication, it can also cause side effects. And while nausea, vomitting, and diarrhea are considered the most common side effects on Ozempic, heartburn is also possible. But why? And how does Ozempic cause heartburn, exactly? 

Ahead, we answer those questions and dig deeper into Ozempic-caused heartburn to explain how long the side effect can last and how to treat it. (Spoiler alert: In most cases, relief can be achieved with some simple lifestyle changes, among other options.) 

Ozempic can cause heartburn.

In clinical trials, about 2% of people reported experiencing gastroesophageal reflux disease (GERD)—a condition where stomach acid or bile flows back up into the esophagus. This backflow, i.e. acid reflux, can irritate the throat, causing heartburn, which describes a burning sensation or discomfort felt in your chest and sometimes in your neck, typically after eating or when lying down. Patients were more likely to experience heartburn when taking 0.5 mg of Ozempic weekly. This is particularly interesting as common side effects of Ozempic—most of which are gastrointestinal (like heartburn)—have been found to be dose-dependent, meaning they tend to be worse at higher doses. 

“Many of my patients taking Ozempic experience heartburn,” says David Nazarian, MD, a Los Angeles-based physician board-certified in Internal Medicine. “One or more symptoms may be experienced like acid reflux, excessive belching, feeling full or bloated, or even nausea and vomiting. It's important to remember that these symptoms can vary in severity and frequency from person to person.” Some people experience heartburn as chest pain, tachycardia (racing heart), or a chronic dry cough. 

Also important to keep in mind? The fact that heartburn (listed as GERD) is not the most common side effect of Ozempic, but sometimes different issues in the gastrointestinal system can present with similar symptoms. The most common side effects of Ozempic include nausea, vomiting, and diarrhea, which, respectively, affected 15.8%, 5%, and 8.5% of patients taking 0.5 mg of Ozempic in the above studies.

The duration of heartburn from Ozempic varies amongst patients. 

“Some individuals may experience heartburn for a few days or weeks as their body adjusts to the medication, while others may have more persistent symptoms,” Dr. Nazarian says. “Additionally, if you already have stomach problems, you might experience heartburn more often, or it might be worse.” 

And while the aforementioned clinical trials suggest heartburn may be most likely to occur with 0.5 mg of Ozempic, side effects of the drug typically worsen as you increase the dose. So, it’s also possible that “people taking higher doses of Ozempic might be more likely to have heartburn,” Dr. Nazarian adds, even though that’s not what was exactly observed on the drug label. 

In general, Ozempic side effects tend to become less severe and even go away on their own as you get used to the medication. What’s more, for some people, heartburn can be relieved with some lifestyle changes, including how and what you eat—but more on this latter. 

While the exact answer is still somewhat TBD (mainly because there hasn’t been research focused on Ozempic-induced heartburn in particular), there are a few potential explanations. 

As a glucagon-like peptide 1 (GLP-1) receptor agonist, Ozempic slows down how quickly food moves through your digestive system. This can help keep blood sugar levels in check over time and make you feel full sooner, reducing your appetite and, you guessed it, potentially causing heartburn. 

Here’s the thinking: By slowing down gastric emptying, Ozempic makes it so food stays in your stomach longer. This can “increase the pressure in the stomach, which can then, in turn, push food and acid up in the esophagus, causing reflux and heartburn,” Dr. Nazarian explains. 

“Other things that can affect your risk of heartburn on Ozempic include how your body naturally digests food, any stomach problems you already have, and other medicines you might be taking,” he adds.

Heartburn is also more likely when you skip meals on Ozempic, says Dina Peralta-Reich, MD, a physician holding dual board certifications in Pediatrics and Obesity Medicine and the founder and director of New York Weight Wellness Medicine. “Because Ozempic lowers appetite, some people don’t feel as hungry. So, they [may] skip meals, but then you get the side effects like heartburn.” In particular, forgoing breakfast has been linked to an increased risk of heartburn. What’s more, both vomiting and indigestion—two side effects of Ozempic—can bring acid back up your throat, causing heartburn. 

Ozempic-induced heartburn can be common, especially if patients are not given the right instructions before starting the medication, Dr. Peralta-Reich says. 

What does that look like exactly? “Generally, patients are advised to avoid foods that already caused them to have reflux symptoms or heartburn because this will be exacerbated when they start GLP-1s,” says Holly F. Lofton, MD, an internist board-certified in Obesity Medicine and director of the Weight Management Program at NYU Langone Health. “Patients are also recommended to avoid laying down 2–4 hours after eating, and avoid fried foods or very oily foods as these can worsen reflux as well as nausea symptoms.” 

This guidance can help not only prevent heartburn on Ozempic but also stop the symptoms if they do occur during treatment. And on that note, here are a few simple solutions to feel better and beat that burning sensation. 

Avoid heartburn-triggering foods and drinks 

“First, pay attention to what foods seem to trigger your heartburn and try to avoid them. Limiting acidic drinks can also help,” Dr. Nazarian says. 

Heartburn “trigger foods” include spicy, oily, fried, acidic, and high-fat items such as:

• Fast food

• Citrus fruits

• Tomatoes

• Onions

• Garlic

• Chocolate

• Mint

Heartburn “trigger drinks” can include alcohol, carbonated beverages, and anything with caffeine, such as tea or coffee. Many of the same foods that cause heartburn, such as fatty foods or alcohol, are also recommended to be avoided when using Ozempic, as they can worsen other side effects like nausea.

To relieve heartburn on Ozempic, Dr. Peralta-Reich recommends increasing your water intake and eating non-irritating foods, such as lean proteins, whole grains, and fiber-rich items like oatmeal. 

Adjust meal portions

In addition to staying hydrated between meals, Dr. Peralta-Reich also recommends eating smaller, more frequent meals, as this can help reduce the pressure on your stomach. Larger portions, on the other hand, can cause the stomach to expand, which can make it more difficult for the muscles at the top of your gut to close completely and, in turn, allow acid to go back up your esophagus to ultimately cause heartburn. By keeping portions smaller, you’re minimizing the chances of this happening.

Change sleep positions

“It's always a good idea to elevate your head while sleeping to prevent acid reflux,” Dr. Nazarian says. Generally, the recommendation is to lift your head off of the bed by 6–8 inches while sleeping. You can do this by propping yourself up with pillows or inclining the bed if your mattress and bed frame allow. 

When you lie flat, stomach acid can more easily flow up into the esophagus because gravity isn’t helping to keep it down. So, elevating your head while sleeping allows gravity to keep up the work and prevent heartburn. You can also try sleeping on your left, which has been found to help keep stomach acid at bay more than sleeping on your right. One more tip: Avoid lying down after eating, as this can also aggravate heartburn.

Give ginger a go

According to a small non-controlled study, ginger supplements might help prevent heartburn. Participants with functional dyspepsia (a digestive disorder) took a 540 mg capsule of ginger before lunch and dinner for four weeks; by the end of the research, individuals experienced a decrease in heartburn, among other symptoms. However, this study was not “placebo-controlled,” so we do not know if the effect was from the ginger supplement itself or a “placebo effect.” While there haven’t been larger studies on the potential benefits of ginger, it’s commonly used in cooking anyway and might have the double benefit of more flavor in your food and less digestive discomfort.

Beyond heartburn relief, ginger has also historically been known to ease nausea, indigestion, and vomiting—all common side effects of Ozempic.

Wear loose-fitting clothing 

Tight clothing—especially belts and other items that are snug around the waist—can squeeze the stomach. This can increase pressure in the area and force food to reflux, triggering heartburn. Donning loose-fitting garments, such as elastic pants, skirts, and dresses, can help reduce this pressure and minimize the risk of heartburn. By allowing more room for the stomach to expand comfortably after meals, loose-fitting clothing can prevent the compression that often leads to acid reflux, making it a simple yet effective way to manage symptoms.

Consider over-the-counter medication

There are a variety of over-the-counter (OTC) medications to take for heartburn, including antacids and Histamine-2-antagonists (H2 blockers)—both of which can either neutralize or “reduce the amount of stomach acid produced,” Dr. Nazarian explains. 

Antacids, such as Tums, can start working within minutes, though their effects only last about an hour or two, depending on whether they’re taken with or without food. H2 blockers, on the other hand, take about an hour to kick in but can provide relief for up to 10–12 hours. Examples of these medications include Pepcid (famotidine) and Tagamet (cimetidine). 

Then there are proton-pump inhibitors (PPIs), such as Prilosec (omeprazole), which Dr. Lofton generally recommends (in addition to Tums) for patients with heartburn. PPIs take longer to start working—usually 1-4 days for full effect—but they provide much longer-lasting relief by reducing stomach acid production for up to 24 hours or more. PPIs need to be taken on a regular basis, not “as needed” for them to work.

“There’s also prescription medications if you have underlying reflux before starting Ozempic,” Dr. Peralta-Reich says. “Preventively, those medications can help.” When taking Ozempic (or any other medication), it’s a good idea to talk to your healthcare provider before adding another drug into the mix, OTC or otherwise. They can recommend a good option for you based on your medical history and current medication regimen, among other factors.

Contact a healthcare provider

Be sure to reach out to your provider if you continue to experience heartburn despite dietary changes and OTC medications. They may recommend you see a gastroenterologist who would perform additional examinations and tests to ensure your heartburn is not related to a more serious condition. 

Although it’s not necessarily a common side effect of Ozempic, heartburn is possible while taking the medication. The good news? You can try a lot of tactics to address your symptoms and might even find relief with simple solutions, such as adjusting your diet and making other lifestyle changes, such as elevating your head while sleeping. OTC and prescription medications can also help alleviate Ozempic-induced heartburn—just be sure to talk to a healthcare professional about your options and follow their expert advice.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

October 26, 2024

Written by

Amelia Willson

Fact checked by

Beverly Tchang, MD and Raagini Yedidi, MD

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About the medical reviewers

Beverly Tchang, MD

Beverly Tchang, MD, is an Obesity Medicine Advisor for Ro. She is also an assistant professor of Clinical Medicine at Weill Cornell Medicine in New York and triple board-certified in Internal Medicine, Endocrinology, and Obesity Medicine.

Raagini Yedidi, MD

Raagini Yedidi, MD, is an internal medicine resident and medical reviewer for Ro.