Probiotics and GERD medications: Antacids, PPIs, and other acid reducers?

Probiotics are one of the hottest topics in medicine and health nowadays. Recent research links the disturbance in your gut microbiota to various health problem.

Some recent studies suggest the use of probiotics in patients with Acid reflux. There is no large scale clinical trials investigating the role of probiotics in GERD. However, Small scale studies showed promising results.

Probiotics can potentially decrease gastric acidity and improve stomach motility (ref). This, in turn, will result in improvement in the symptoms of acid reflux.

Today, we will explain the interactions between Probiotics and GERD medications such as antacids, Proton Pump Inhibitors (as omeprazole or esomeprazole), and others.

What do we know about probiotic-drug interactions so far?

Probiotics are living micro-organisms (bacteria or fungi). They are not a conventional medication, because they are “living” organisms.

Unlike classical pharmaceutical medications, Probiotics are not considered drugs. The FDA categorizes probiotics as food supplements (ref).

Currently, the FDA doesn’t apply its strict regulations on probiotics. However, probiotics are generally considered safe to take. But no guarantee for their quality and efficacy except the manufacturer reputation.

A summary of our current knowledge about Probiotic interactions with other medications:

  • You can take probiotics together with most of the medications because they act locally inside your gut.
  • The most common group of medications that can affect probiotics is antibiotics.
  • Antibiotics can kill the living probiotic bacteria. So, Most manufacturers advise taking probiotics and antibiotics at least 2 hours apart.
  • Some probiotics contain fungi. Taking systemic antifungal medications can “de-activate“ your fungi-containing probiotics.
  • Don’t use probiotics if you are on medications that affect your immunity such as cancer chemotherapy and drugs used for autoimmune diseases.
  • We couldn’t find any studies discussing the direct interactions between probiotics and GERD medications such as PPI (as omeprazole or esomeprazole), antacids (such as tums and Pepto-Bismol, and H2 blockers (as Pepcid).
  • However, Probiotics are not-contraindicated to use with such medications.
  • But the question we are going to answer today is “when to take probiotics with antacids, PPIs, and other GERD medications.

Can you take probiotics and antacids (such as tums) together?

Probiotics are safe to take with antacids such as Tums, Milk of magnesia, Gaviscon, Maalox, and Pepto-Bismol. No evidence suggests interactions between antacids and probiotics, However, it’s better to take them 30-60 minutes apart to make sure that they don’t affect each other.

As a gastroenterologist, I advise many patients to take the probiotic one hour before meals. And to take the antacids just before meals.

Again, Probiotics are not considered a medication by the FDA and other health authorities. No Thorough studies about the possible interactions between Probiotics are present at the current time.

The response may vary from one person to another. Always consult your doctor or pharmacist. Ask him about the best options and the best time to take probiotics according your medications.

Can you take Probiotics and PPIs together (such as omeprazole and lansoprazole)?

Probiotics are safe to take with Proton Pump Inhibitors such as Omeprazole, Esomeprazole, Pantoprazole, and Dexalansoprazole. we couldn’t find any interactions between the two groups in the literature.

You can take probiotics at the same time with the same time of PPIs, or better take them 30-60 minutes apart (before meal). For example, you can take the probiotic 1 hour before the meal, and your PPI 30 minutes before the meal.

Can you take probiotics and H2 blockers (as Pepcid) at the same time?

The same rule goes for H2-blockers such as Famotidine. Probiotics are generally safe to take with H2-blockers. You can take Probiotics at the same time or 30 to 60 minutes apart.

Always consult your doctor about your medications.

Can you take Probiotics with H. Pylori Medications?

The only concern about Probiotics is antibiotics and antifungal medications. Antibiotics and antifungals can kill the living bacteria contained in your Probiotics.

Taking H. Pylori eradication regiments that contain antibiotics should be under medical supervision. Ask your doctor about the best time to take probiotics with H. pylori treatment.

You have to take H. pylori antibiotics and your probiotic at least 2-3 hours apart. This is to prevent the antibiotics from “Deactivating” the live bacteria inside your probiotic.

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