Semaglutide heartburn: why it happens and how to treat it

If you’ve started taking semaglutide and noticed heartburn or acid reflux, you’re not alone. Semaglutide heartburn is a possible side effect of GLP-1 medications, including Ozempic and Wegovy. While not as commonly reported as other side effects like nausea, heartburn (and related issues like indigestion, belching, or acid reflux) can happen — especially as your dose increases.

So, does semaglutide cause heartburn? The short answer is yes, but the reasons why (and how long it lasts) aren’t always straightforward. 

Let’s look at what the research shows, why these symptoms may happen, and what you can do to manage them so that you can continue taking semaglutide for weight loss and/or blood sugar management.

Yes, semaglutide can cause heartburn. The side effect was reported in clinical trials comparing Ozempic and Wegovy (the brand-name versions of semaglutide) to placebo.

Before we get into some statistics, let’s back up and clarify a few things. When people complain of “heartburn,” they might be talking about a few different sensations. For some, they’re describing a burning feeling in the chest or throat that happens after eating. Others mean a sour taste in the mouth, a feeling of food coming back up, or discomfort that feels more like bloating or fullness.  

In medical terms, heartburn is often associated with acid reflux or gastroesophageal reflux disease (GERD) — i.e. when stomach acid flows back into the esophagus. But some people use “heartburn” to describe indigestion, which includes symptoms like bloating, belching, and upper abdominal discomfort. 

GERD and indigestion can overlap. But GERD typically involves acid reflux, while indigestion may or may not. That distinction matters when looking at semaglutide’s side effects. 

In Ozempic’s clinical trials, gastrointestinal (GI) symptoms were common. Up to 36.4% of people taking the medication reported them, compared to 15.3% of those on placebo. The most frequent issues were nausea, vomiting, diarrhea, abdominal pain, and constipation. Less common, but still notable, were heartburn-related side effects in people who took Ozempic:

• Dyspepsia (aka indigestion): up to 3.5%

• GERD: up to 1.9%

• Belching: up to 1.1%

The pattern was similar in Wegovy’s studies. The top GI side effects were nausea, diarrhea, vomiting, and constipation. Heartburn-related side effects also occurred:

• Dyspepsia: 9%

• GERD: 5% 

• Belching: 7%

So, why did heartburn-related side effects, such as dyspepsia and GERD, show up more often in patients taking Wegovy vs. Ozempic? One possible reason is that the dose of semaglutide is higher for weight loss, and higher doses may be more likely to cause side effects than lower doses. FYI, 

• Wegovy has a typical maintenance dosage of 1.7 mg or 2.4 mg weekly.

• Ozempic has a maximum maintenance dosage of 1 mg or 2 mg weekly.

Another reason may have less to do with semaglutide and more with who’s taking it. In Wegovy’s trials, all participants had excess body weight or obesity. And obesity is a known risk factor for GERD. That’s because it can cause changes to the function and structure of the area where the esophagus meets the stomach (in medical terms, the gastroesophageal junction). 

Carrying extra weight can put added pressure on your stomach and esophagus, making it easier for acid to creep back up. So, many people in the weight loss studies of Wegovy may have been more likely to get heartburn in the first place. 

The good news is that losing weight (with or without the help of a medication like semaglutide) can help reduce reflux over time. But it usually doesn’t happen overnight.

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There isn’t one clear answer as to why semaglutide can cause heartburn and acid reflux. But it mostly comes down to how the medication affects your digestive system.

Semaglutide slows how quickly food leaves your stomach and moves into your small intestines. This keeps you feeling fuller for longer, so you eat less and ultimately lose weight. But it can also mean food and stomach acid sit in your stomach longer, which may lead to gas and acid buildup and, in turn, heartburn. It may also worsen existing GERD or trigger reflux symptoms in people who are already prone to it.

Another potential cause of semaglutide heartburn? Irritation from the common side effects of nausea and vomiting. Both of these symptoms can lead to more acid in the esophagus and irritate it, which can be painful and cause a burning sensation. 

How long semaglutide heartburn lasts varies from patient to patient. But most people can expect GI side effects to last anywhere from one to two days to a couple of weeks. Generally, heartburn can last for up to two weeks or more. Some people adjust quickly, while others notice symptoms for longer.

Like other side effects, semaglutide heartburn tends to be dose-dependent. Meaning, it’s more likely to occur — and even worsen — at higher doses. That’s why treatment begins at a low dose. Your prescriber will likely increase your dose every four weeks or so until you reach a fitting maintenance dose. During these adjustment periods, it’s normal to notice flare-ups of heartburn or other side effects. 

There are several ways to ease or prevent heartburn while taking semaglutide, from lifestyle changes to over-the-counter (OTC) medications. Keep in mind that not every method works for everyone — it’s best to work with your healthcare provider to find the right approach for you.

Change eating habits

When and how you eat can make a big difference in managing side effects like semaglutide heartburn. A few helpful changes include:

• Eating smaller, more frequent meals instead of large portions

• Eating slowly and stopping before you feel overly full

• Avoiding meals right before bedtime or lying down

• Leaving time between meals and physical activity

Avoid heartburn-triggering foods 

What you eat and drink matters too when dealing with semaglutide heartburn. For starters, you want to steer clear of common triggers of GERD and heartburn, such as:

• Spicy foods

• Citrus fruits

• Tomatoes

• Onions

• Garlic

• Chocolate 

• Mint

• Canned or highly processed foods 

• Carbonated drinks 

Because triggers can vary, keeping a food log can help you spot patterns between what you eat and when heartburn strikes.

Prioritize home-cooked meals with foods that are easily digestible, such as lean proteins, whole grains, and oatmeal, and stay hydrated. Drinking water can lower the acidity of your stomach and help clear acids from the esophagus to relieve pain, coughing, and burning. 

Exercise and consider weight loss 

Excess body weight is a known risk factor for GERD. Losing even 10–15 pounds (with or without the help of a medication like semaglutide) can resolve acid reflux symptoms. 

Physical activity can also have a positive impact on obesity-related symptoms like heartburn. Exercise may also help by strengthening abdominal and diaphragm muscles, which can support better control of reflux.

Since semaglutide is most effective when paired with diet and exercise anyway, this is a good opportunity to build healthy habits. A balanced plan usually includes:

• Fruits and vegetables

• Whole grains

• Lean proteins

• Healthy fats

If you’re unsure where to start, ask your healthcare provider or a registered dietitian about creating a semaglutide diet plan that works for you.

Quit smoking and limit alcohol 

Smoking and consuming alcohol are both risk factors for GERD. Research shows smokers are more likely to experience heartburn at least once a week, and the risk rises with the number of cigarettes per day. If you smoke, consider quitting or cutting back. 

Alcohol can trigger symptoms by boosting stomach acid production and irritating the esophagus. So, it’s a good idea to limit or avoid booze while taking semaglutide, especially if it makes your heartburn worse.

Practice other lifestyle tactics 

Outside of diet and exercise, try these strategies to reduce heartburn and other GERD symptoms: 

• Wear loose clothing: Restrictive belts and tight clothing can be uncomfortable and increase pressure on the stomach.

• Change your sleeping position: Elevate the head of your bed by around 6 inches using wedge pillows or by raising the bed frame. Stacking regular pillows isn’t an effective method. 

• Manage stress: Stress can make heartburn symptoms worse. Relaxation strategies like mindfulness, deep breathing, or prioritizing enjoyable hobbies can help.

Consider over-the-counter remedies 

If lifestyle changes aren’t enough, OTC medications may help relieve heartburn. 

• Antacids, such as Tums (calcium carbonate) and Mylanta (aluminum/magnesium hydroxide), work quickly to neutralize stomach acid.  They’re taken as needed for occasional heartburn symptoms. 

• H2 blockers, such as Pepcid AC (famotidine) and Tagamet HB (cimetidine), reduce the production of stomach acid. They can be taken once or twice daily before meals to help prevent and relieve heartburn symptoms, but check with your healthcare provider before exceeding two weeks of use. 

• Proton pump inhibitors (PPIs), such as Prilosec OTC (omeprazole) and Nexium 24HR (esomeprazole), work to block the final step of stomach acid release. They’re typically taken once daily in the morning and may work better than H2 blockers for some people. But they usually take a few days to reach full effect. OTC PPIs can be taken daily for up to two weeks; check with a healthcare provider before using PPIs long term. 

Always review the label warnings carefully and follow the directions on the package. If you’re not sure which product is right for you, your healthcare provider or pharmacist can help you choose. These OTC heartburn medications are meant for short-term use and shouldn’t be taken long-term without medical guidance.

Most OTC options for relieving heartburn are only recommended for short-term use — usually up to two weeks. If your heartburn symptoms continue despite lifestyle changes and OTC treatments, it’s time to check in with your healthcare provider. But don’t wait that long if your symptoms feel severe or interfere with your daily life. 

You and your provider can try to determine whether semaglutide is the cause of your heartburn and discuss possible solutions. They may suggest adjusting your dose, adding a prescription medication for heartburn, or switching to a semaglutide alternative.

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Semaglutide can cause heartburn or acid reflux, but for most people, it’s a temporary side effect that improves over time. Understanding why it happens and how to manage it can make it easier to stay on track with your treatment. Here are the key points to remember:

• Clinical trials show that some people taking semaglutide experience indigestion, GERD, or burping. However, rates of these side effects are lower compared with other more common ones, like nausea, vomiting, and diarrhea.

• Semaglutide slows digestion, which can leave more food and acid in the stomach for longer. This delay, combined with other side effects like nausea or reflux, may lead to heartburn symptoms.

• Semaglutide heartburn may happen or worsen after dose increases and usually improves within a few weeks. For many, side effects ease as your body adjusts to your maintenance dosage, which may take several months to reach.

Lifestyle changes like eating smaller meals, avoiding trigger foods, losing weight, and limiting smoking and alcohol can help. OTC options like antacids, H2 blockers, or PPIs may also provide short-term relief.