Medications for Heartburn and Interaction with HIV Drugs

Medicines to Alleviate Heartburn and How They Interact with HIV Drugs

Woman with hand on chest
Woman with hand on chest. Getty Images/Nicholas Everleigh/The Image Bank

Heartburn is common among people infected with HIV, just as it's common in the general population. But while there are a number of effective over-the-counter and prescription medications for heartburn, some of them interact with HIV medications — in most cases decreasing the effect of the HIV medication.

Let's address medication to treat heartburn in people with HIV, and how they interact with a person's HIV medications.


What is Heartburn?

Heartburn — a symptom of the medical condition known as GERD — refers to the reflux or movements of contents from the stomach into the esophagus. Typical symptoms of GERD include heartburn, regurgitation, and less commonly, cough. 

Heartburn can mimic other medical conditions, like heart disease or serious opportunistic infections in people with HIV. Therefore it's important a person seeks a diagnosis and care from their doctor before taking any heartburn medications.

How is Heartburn Treated?

If a person is diagnosed with heartburn due to GERD, a trial of medication — usually a proton pump inhibitor — is recommended. 

Many of the medications used to treat GERD interact with HIV medications. For instance, many heartburn medications lower the levels of certain antiretroviral medications — this means they decrease the amount of HIV medicine in the body, so it's theoretically not as effective.

So it's critical a person with HIV reviews all their medications and their potential interactions carefully with their doctor to ensure optimal therapy. 

Here are heartburn medications, some available over-the-counter, and others available by prescription only:

Proton Pump Inhibitors

Proton pump inhibitors are the mainstay medical therapy for heartburn.


Examples include:

  • Rabeprazole (Aciphex)
  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)
  • Pantoprazole (Protonix)
  • Omeprazole (Prilosec)

All proton pump inhibitors decrease levels of atazanavir (Reyataz), rilpivirine (Edurant), and likely levels of indinavir (Crixivan). They increase levels of raltegravir (Isentress).

In addition, omeprazole decreases levels of nelfinavir (Viracept), etravirine (Intelence), and saquinavir (Invirase).

H2 Blockers

H2 blockers are usually not as effective as proton pump inhibitors for heartburn, but may be sufficient for certain people. Examples of H2 Blockers include:

  • Nizatidine (Axid)
  • Famotidine (Pepcid)
  • Cimetidine (Tagamet)
  • Ranitidine (Zantac)

All of the H2 blockers lower levels of atazanavir (Reyataz) and rilpivirine (Edurant). H2 blockers may also increase levels of raltegravir (Isentress) in the body. 

Cimetidine interacts with a number of medications, including HIV medications. It decreases levels of nevirapine (Viramune) and may decrease darunavir (Prezista) levels.

Cimetidine may increase fosamprenavir (Lexiva) levels. 

Ranitidine may also decrease fosamprenavir (Prezista) levels, as well as lopinavir/ritonavir (Kaletra) levels.


Antacids are sometimes used in addition to proton pump inhibitors to give extra heartburn relief.

Examples of antacids include:

  • Maalox
  • Mylanta
  • Tums
  • Rolaids

All antacids may decrease levels of rilpivirine (Edurant). Some antacids, like maalox, mylanta, tums, or milk of magnesia, may decrease levels of atazanavir (Reyataz), fosamprenavir (Lexiva), and Tipranavir (Aptivus).

Calcium tablets – like tums – may bind integrase inhibitors and interfere with how they work in the body.

Final Thought

Heartburn is common in the general population, as well as in people with HIV. It's important to see your doctor if you are suffering from heartburn, as it may mimic other serious medical conditions, like heart disease or infection.

In addition, be sure to review all medications with your doctor, as many heartburn medications interact with HIV medications. 


Thompson T et al. Prevalence of gastrointestinal symptoms among ambulatory HIV patients and control population. Ann Gastroenterol. 2012;25(3):243-248.

US Department of Veteran Affairs. (2011). Gastroesophageal Reflux Disease (GERD): Primary Care of Veterans with HIV. Retrieved September 28th, 2015. 

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