Is Your Reflux Medication Causing Acid Rebound? Here’s How to Know
Key takeaways:
Acid rebound happens when your stomach makes extra acid after you stop reflux medications — like proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2 blockers).
Acid rebound often feels like a return of heartburn or other symptoms of gastroesophageal reflux disease (GERD).
Don’t ignore symptoms of acid rebound, especially if they are bothersome to you. Your healthcare team can help make changes to your medications that will help.
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Table of contents
If you’ve ever been diagnosed with gastroesophageal reflux disease (GERD), there’s a good chance you take medication for it.
Treatment for GERD includes medications that lower stomach acid levels. These include proton pump inhibitors (PPIs) and histamine-2 antagonists (H2 blockers).
Side effects of PPIs and H2 blockers are usually mild. But one side effect, called acid rebound, may be particularly bothersome. It’s when your body creates excess acid after you’ve stopped taking an acid-suppressing medication. We’ll explain the causes and symptoms of acid rebound — and how you can avoid it.
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What is acid rebound?
Acid rebound happens when your body makes too much acid after you stop taking an acid-suppressing medication. The full medical term for this is rebound acid hypersecretion. And it can cause GERD symptoms that may be similar to, or even worse than, your original symptoms.
The symptoms of acid rebound vary from person to person. But even short-term use of acid-suppressing medications can cause acid rebound. It’s been seen in people who took PPIs for as little as 2 months.
What medications cause acid rebound?
Two medications in particular — H2 blockers and PPIs — are most likely to cause acid rebound.
H2 blockers
H2 blockers are a common medication to prevent and treat heartburn symptoms. Some also treat GERD and certain types of stomach and intestinal ulcers. They work by binding to and blocking histamine-2 receptors in the stomach. This lowers the amount of acid your stomach produces.
H2 blockers include famotidine (Zantac 360, Pepcid AC), nizatidine (Axid), and cimetidine (Tagamet HB).
PPIs
PPIs are used to treat heartburn, GERD, and different types of ulcers. They’re the first-choice medication option for GERD. But even people without GERD sometimes take them for heartburn prevention — especially if an H2 blocker hasn’t worked.
How to stop your PPI: Proton pump inhibitors (PPIs) have some unwanted side effects. Here are some tips for how to safely stop taking PPIs.
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They work by blocking an enzyme in the stomach that’s responsible for acid production.
Common PPIs include:
Omeprazole (Prilosec)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
What causes acid rebound?
PPIs and H2 blockers lower the amount of acid that’s made in your stomach. But, PPIs and H2 blockers also raise the levels of a hormone in your stomach called gastrin. One of the main functions of gastrin is to produce acid.
When you stop either of these medications, the gastrin in your stomach remains elevated. Since you’re no longer taking a PPI or H2 blocker to limit the downstream effects of gastrin (acid production), the stomach can become too acidic. This can cause acid rebound.
What are the symptoms of acid rebound?
When acid rebound occurs, it may just feel like GERD symptoms are reappearing. Symptoms of both acid rebound and GERD include:
A burning sensation in the chest or throat (heartburn)
Nausea
Pain with swallowing
Burping
An acid taste in the mouth
Food rising back up into your throat
Chronic cough
Hoarse voice
Acid rebound can happen soon — within the first 2 weeks — after stopping an acid-suppressing medication.
How long does acid rebound last?
There’s no definite answer on how long acid rebound symptoms will last. But research suggests it lasts for several weeks.
One study looked at 120 people without any problems with acid who took a PPI for 8 weeks. The participants developed acid rebound symptoms after stopping the medication, and the symptoms lasted for at least 3 weeks.
Another study looked at a small group of people taking PPIs for over a year. Acid rebound symptoms lasted over 8 weeks after stopping the PPI.
How can I prevent acid rebound?
If you’re planning to stop your acid medication, a few strategies might help prevent acid rebound:
Slowly lower the dose of your medication before stopping it. Your healthcare team can help you come up with a plan to do this.
Switch to another medication. For example, if you’re taking a PPI, you may be able to lower the dose of your PPI then switch to an H2 blocker.
Adjust your lifestyle. Some lifestyle modifications can help prevent you from experiencing GERD symptoms. This includes changes to your diet, alcohol intake, and sleep routine.
When should I contact a healthcare professional about acid rebound symptoms?
If your acid rebound symptoms feel frequent or interfere with your quality of life, contact your healthcare team. They can help make sure nothing else is going on that may be contributing to your symptoms.
And remember that when acid rebound occurs, it may feel like your GERD symptoms have returned. This could make you think that you need an acid-suppressing medication for the long term, but this might not be the case. A healthcare professional can offer solutions to help with your symptoms.
The bottom line
When you stop taking an acid-suppressing medication like a PPI or H2 blocker, your stomach can produce extra acid for a period of time. This can lead to worsening heartburn and other GERD symptoms in the weeks or months after stopping the medication. If this happens to you, talk with your healthcare team. They can help you taper or change your medications for a smoother process.
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References
Farrell, B., et al. (2017). Deprescribing proton pump inhibitors. Canadian Family Physician.
Fossmark, R., et al. (2004). Rebound acid hypersecretion after long-term inhibition of gastric acid secretion. Alimentary Pharmacology and Therapeutics.
Katz, P. O., et al. (2022). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. The American Journal of Gastroenterology.
Kim, J., et al. (2018). Strategies for effective discontinuation of proton pump inhibitors. Current Gastoenterology Reports.
Lerotić, I., et al. (2011). Acid inhibition and the acid rebound effect. Digestive Diseases.
Lødrup, A. B., et al. (2013). Systematic review: Symptoms of rebound acid hypersecretion following proton pump inhibitor treatment. Scandinavian Journal of Gastoenterology.
Prosapio, J. G., et al. (2023). Physiology, gastrin. StatPearls.
Reimer, C., et al. (2009). Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology.
Rochoy, M., et al. (2018). Gastric acid rebound after a proton pump inhibitor: Narrative review of literature. Thérapie.
