Can Lexapro Cause Heartburn? Understanding the Link

In clinical trials for Major Depressive Disorder, 15% of Lexapro users reported nausea [1.6.1]. A related, though less discussed, side effect is heartburn. So, can Lexapro cause heartburn? Yes, it is a documented side effect linked to its impact on the digestive system [1.2.1, 1.2.4, 1.2.5].

Quick Summary

Lexapro (escitalopram) may induce heartburn or acid reflux in some users. This occurs because the medication influences serotonin receptors in the gut, potentially affecting digestive motility and stomach function [1.4.2, 1.5.7].

Key Points

• Direct Side Effect: Heartburn, indigestion, and gastroesophageal reflux are all officially listed as potential side effects of Lexapro (escitalopram) [1.2.1, 1.2.5].

• Gut-Brain Connection: Lexapro affects serotonin receptors not just in the brain, but also extensively in the gut, which can alter digestive function and lead to acid reflux [1.4.2, 1.5.7].

• Dose-Dependent: Higher doses of Lexapro (e.g., 20 mg) are associated with a greater incidence of gastrointestinal side effects, including indigestion, compared to lower doses [1.6.1].

• Management is Possible: Strategies like taking Lexapro with food, avoiding trigger foods, and not lying down after meals can help manage heartburn [1.3.8, 1.4.7].

• Consult a Professional: Do not stop or alter your medication dosage without first consulting your doctor. They can provide safe management options or consider alternatives if needed [1.4.4].

• Relative Tolerability: While all SSRIs can cause GI issues, some studies suggest escitalopram may be better tolerated in the gut compared to sertraline (Zoloft) [1.7.3, 1.7.4].

What is Lexapro (Escitalopram)?

Lexapro, with the generic name escitalopram, is a widely prescribed medication belonging to a class of drugs called selective serotonin reuptake inhibitors (SSRIs) [1.5.3]. It works by increasing the levels of serotonin, a neurotransmitter in the brain, which helps to improve mood and reduce anxiety [1.5.5]. It is primarily approved by the FDA for the treatment of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) in adults [1.6.2]. While effective for many, it comes with a range of potential side effects, many of which are gastrointestinal in nature [1.3.3, 1.6.4].

The Connection: How Lexapro Can Cause Heartburn

Yes, Lexapro can cause heartburn and related symptoms like acid reflux and indigestion [1.2.1, 1.2.4, 1.2.5]. In fact, 'heartburn' and 'gastroesophageal reflux' are listed as potential gastrointestinal side effects in the drug's documentation [1.2.1, 1.6.7]. The reason for this connection lies in the medication's primary mechanism of action.

While we often think of serotonin as a 'brain chemical,' approximately 95% of the body's serotonin receptors are located in the gastrointestinal (GI) tract [1.4.2]. SSRIs like Lexapro work by blocking the reabsorption of serotonin, increasing its available levels [1.5.5]. This increase doesn't just happen in the brain; it also occurs in the gut [1.5.2, 1.5.7].

This elevated serotonin activity in the digestive system can lead to several changes:

• Altered Gut Motility: Serotonin plays a crucial role in regulating the muscle movements of the intestines [1.5.7]. Altering its levels can speed up or slow down this process, potentially leading to symptoms like diarrhea or constipation [1.3.4, 1.3.8].
• Increased Gastric Acid: Some evidence suggests SSRIs might increase gastric acid secretion [1.2.6].
• Lower Esophageal Sphincter (LES) Function: Other types of antidepressants have been shown to affect the function of the LES, the muscle that prevents stomach acid from flowing back into the esophagus. While less studied with SSRIs specifically, altered GI function can contribute to reflux [1.2.8].

In clinical trials, indigestion was reported in 3% of patients with depression taking Lexapro, compared to 1% on placebo. Higher doses (20 mg) were more likely to cause indigestion (6%) than lower doses (2%) [1.6.1].

Managing Heartburn While Taking Lexapro

Experiencing heartburn doesn't necessarily mean you need to stop your medication. Many management strategies can help alleviate this side effect. Always consult your doctor before making any changes to your medication regimen or adding new over-the-counter treatments.

Lifestyle and Dietary Adjustments

• Take with Food: Taking Lexapro with a meal can help minimize stomach upset and reduce the risk of heartburn [1.3.8, 1.4.5].
• Stay Hydrated: Drink plenty of water when you take your pill to ensure it doesn't get stuck and to help with digestion [1.4.4].
• Identify and Avoid Triggers: Common heartburn triggers include spicy foods, fatty or fried foods, citrus, tomatoes, caffeine, and alcohol [1.4.7]. Limiting these may provide relief.
• Eat Smaller Meals: Instead of a few large meals, try eating smaller, more frequent meals throughout the day to reduce pressure on your stomach [1.4.3, 1.4.7].
• Don't Lie Down After Eating: Wait at least 2-3 hours after a meal before lying down or going to bed [1.4.4, 1.4.7].
• Elevate Your Head: If heartburn is worse at night, try elevating the head of your bed by 6-8 inches [1.4.7].

Medical and Over-the-Counter Options

If lifestyle changes aren't enough, discuss other options with your healthcare provider:

• Antacids: Medications like Tums can provide quick, short-term relief by neutralizing stomach acid [1.4.7]. It's important to check with a doctor or pharmacist about potential interactions.
• H2 Blockers or PPIs: For more persistent reflux, a doctor might suggest an H2 blocker (like famotidine/Pepcid) or a proton pump inhibitor (like omeprazole/Prilosec) [1.4.4, 1.4.7]. In some cases, these have been prescribed alongside SSRIs to manage GERD symptoms [1.4.6].
• Dosage or Timing Adjustment: Your doctor might adjust your dose, as higher doses are linked to more GI side effects [1.6.1]. They may also suggest changing the time of day you take it.

Comparison of GI Side Effects: Lexapro vs. Other SSRIs

All SSRIs can cause gastrointestinal side effects, but some studies suggest the incidence rates vary between medications.

Feature	Lexapro (Escitalopram)	Zoloft (Sertraline)	Prozac (Fluoxetine)
Heartburn/Indigestion	A listed side effect [1.2.5].	A listed side effect, often with a higher incidence of general GI issues [1.7.1, 1.7.7].	A listed side effect [1.4.2].
Diarrhea	Reported in 8-14% of users [1.6.1, 1.6.7].	Known for having a higher probability of causing diarrhea compared to other SSRIs [1.7.2, 1.7.6].	Can cause diarrhea [1.7.6].
Nausea	Reported in 15-18% of users [1.6.1].	A common side effect [1.7.7].	Nausea is also a common side effect [1.4.2].
General GI Tolerability	Generally considered to have better gastrointestinal tolerability than sertraline [1.7.3, 1.7.4].	May have the highest probability of digestive system side effects among common SSRIs [1.7.3].	Studies suggest it may have the lowest probability of digestive side effects [1.7.3].

Conclusion

So, can Lexapro cause heartburn? The answer is a clear yes. It is a recognized side effect resulting from the drug's influence on serotonin levels within the gastrointestinal tract [1.2.1, 1.4.2]. This can alter gut function and potentially lead to acid reflux, indigestion, and heartburn [1.2.6]. The side effect is often dose-dependent and may resolve as your body adjusts to the medication [1.3.8, 1.6.7]. If you are experiencing persistent or severe heartburn, it is crucial to speak with your healthcare provider. They can help you implement management strategies, from simple lifestyle changes to potentially adjusting your medication, ensuring your treatment is both effective and comfortable.

---

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before making any decisions about your health or treatment.

Authoritative Link: Lexapro Medication Guide - FDA [1.6.2]

Frequently Asked Questions

How common is heartburn as a side effect of Lexapro?

In clinical trials, indigestion was reported in about 3-6% of users, depending on the dosage. Heartburn and gastroesophageal reflux are also listed as known, but less frequent, side effects compared to nausea [1.6.1, 1.6.7].

Does the dosage of Lexapro affect the likelihood of heartburn?

Yes, higher doses of Lexapro are more likely to cause gastrointestinal side effects. In one study, indigestion was reported in 6% of patients on a 20mg dose, compared to 2% on a 10mg dose [1.6.1].

Will heartburn from Lexapro go away on its own?

For many people, gastrointestinal side effects like nausea and indigestion are most common during the first couple of weeks of treatment and may decrease or resolve as the body adjusts to the medication [1.3.8, 1.6.7].

Can I take antacids like Tums or PPIs with Lexapro?

Generally, occasional use of antacids is considered safe, but it is essential to consult your doctor or pharmacist. For persistent symptoms, they might recommend a proton pump inhibitor (PPI) or H2 blocker, which have been used alongside SSRIs to manage reflux [1.4.4, 1.4.6, 1.4.7].

Should I take Lexapro with food to prevent heartburn?

Yes, taking Lexapro with food is a recommended strategy to help minimize general stomach upset, which can include heartburn or nausea [1.3.8, 1.4.5].

Is it better to take Lexapro in the morning or at night to avoid heartburn?

Taking the medication at least 30 minutes to an hour before lying down can help prevent nighttime reflux [1.4.4]. However, the best time depends on your overall side effect profile (e.g., if it causes drowsiness or insomnia) and should be discussed with your doctor.

Are there antidepressants less likely to cause heartburn?

Different antidepressants have different side effect profiles. Some research suggests that fluoxetine (Prozac) may have a lower probability of digestive side effects, while sertraline (Zoloft) may have a higher probability. If heartburn is severe, your doctor may discuss alternative options [1.7.3, 1.7.4].