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What Causes Constant Nausea And Heartburn After Taking Z-Pak?

Posted on Sat, 28 Nov 2015

Question: I had an awful ear infection almost 4 weeks ago. The Z pack antibiotic was not kind as to my stomach. However, even though it's almost 4 weeks ago I am still experiencing constant nausea and heartburn. I'm barely eating anymore and antacids are not helping at all. I'm not pregnant as I am having very severe ovulation pain at the moment. I have actually never had ovulation pain the severe before, and it times it feels like it's happening on both sides instead of just one.
Nexium wasn't working. What can be causing this?

Answered by Dr. Tushar Kanti Biswas (8 hours later)

Brief Answer:
Peptic dyspepsia

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

Z-Pak antibiotic contains azithromycin which can cause gastro-intestinal side effects like -nausea , abdominal pain; dyspepsia etc. However it subsides once the drug is discontinued. It seems you have pre-existing peptic dyspepsia which only got aggravated with Z-Pak antibiotic.

Since Nexium (esomeprazole) , a proton pump inhibitor is not giving enough relief ,you can add sucralfate liquid (mucosal protective agents),as additional antacid.
You can also go for ultrasonography (USG) abdomen to exclude any co-existing gall bladder disease ,which can image also ovaries at the same sitting ,as you are having severe ovulation pain on both sides.

Discontinue Tums as it contains calcium carbonate (CaCO3) and may cause rebound acidity.
For Ovulation pain take only paracetamol for relief of pain rather than NSAID(non-steroidal anti-inflammatory drug),as it will aggravate dyspeptic symptoms.
H-pylori infection can also cause persistent dyspepsia .
Several noninvasive methods for detecting this organism are routinely used like serologic testing, urea breath test, and the fecal H. pylori (Hp) antigen test.
You may go for one of these tests to rule out any H-pylori infection causing persistent dyspeptic symptoms.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Tushar Kanti Biswas (48 minutes later)

Would dyspepsia also cause constant nausea even in the absence of heartburn? The heartburn comes and goes, but the nausea is constant .

Answered by Dr. Tushar Kanti Biswas (29 minutes later)

Brief Answer:
Peptic dyspepsia

Detailed Answer:
Epigastric pain described as a burning or heart burn can
be present with associated symptoms such as nausea in dyspepsia.Heart burn goes more in favor of gastro-esophageal reflux disease (GERD)-not uncommon association.
Dyspepsia can cause myriad of symptoms like indigestion, bloating, nausea, epigastric discomfort ,heart burn,fullness etc.
PPI (proton pump inhibitor) needs to be continued, at least for short term (8 weeks).
Is there any history of alcoholic drink or smoking?

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Tushar Kanti Biswas (18 minutes later)

No. I don't drink or smoke.

Answered by Dr. Tushar Kanti Biswas (15 minutes later)

Brief Answer:
Peptic dyspepsia

Detailed Answer:
You don't have any pathogenetic factor related to smoking. You also don't drink.
Even former alcohol use also is most likely not there.
Diet has also been thought to play a role in peptic diseases but no convincing studies indicate an association with a specific diet. However avoid excessive tea or coffee (>4 cups).

Regards

Dr. T.K. Biswas M.D. XXXXXXX

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Above answer was peer-reviewed by : Dr. Sonia Raina