Hi, I Am A 26 Year Old Female. I've Had

Posted on Sat, 13 Apr 2019

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 12 Apr 2019 Answered on

Last reviewed on

Question : Hi, I am a 26 year old female. I've had a problem that's been happening more and more frequently (perhaps once a month now). It happened last night, about an hour after I fell asleep. I woke up with a strong urge to cough that eventually I had to give in to (it's a spasm I can't control if I hold it long enough). When I cough, i cough up a foul-tasting acidic substance that makes me nauseous it's so gross. It lasts for about half an hour before finally going away. This last time I took a dissolvable anti-nausea medication (Ondansetron ODT) and it helped almost immediately, I'm not sure why or if that's relevant. The time before last, I coughed until I vomited an empty stomach's worth of acid.

It seems like the severity of my symptoms when this DOES happen depends on how long I sleep before waking up coughing. For instance, the first time this happened I had a full night's sleep and woke up with "crackly breathing" along with the coughing as if the acid was in my lungs. Despite that, though, it seemed to take about the same amount of time to go away. I have chronic acid reflux/heartburn and have been diagnosed with NERD. I also sleep at an incline which I thought was supposed to relieve these symptoms. I think it's helping, but it's certainly not getting rid of them entirely.

My question is this-- currently I take Zantac and my anti-anxiety medication together about 10-20 minutes before bed. My last episode happened an hour after I fell asleep. Is it possible that my medication is aggravating my reflux and causing these coughing fits that wake me from my sleep?

Here's my daily medication list:
In the morning:
1x 75mg Zantac (For Heartburn)
1x Probiotic (For Constipation)
1/3x 8.6-2.1mg Zubsolv (suboxone) sublingual tablet (for chronic pain)

In the afternoon:
Occasionally 1/2 75mg Zantac (For persistent heartburn)
1x 200mg Spironolactone (For Hormone Therapy)
1x 2mg Estrogen (Hormone Therapy)
1/3x 8.6-2.1mg Zubsolv sublingual tablet (for chronic pain)

In the evening:
1/3x 8.6-2.1mg Zubsolv sublingual tablet (for chronic pain)
1/2x 25mg Metroprolol ER Succinate Tab (for arrhythmia and minor tachycardia)

Just before bed:
1x 75mg Zantac (For Heartburn)
1x 10mg Valium (For Anxiety)

Thank you for your help, XXXXXXX XXXXXXX

Follow up: Dr. Ramesh Kumar (-5 hours later)

Hi,

To be more clear, I'm curious if the medication I'm taking is causing/aggravating this issue, but I'm also just wondering what the heck is causing it in the first place. Thank you.

Answered by Dr. Ramesh Kumar (59 minutes later)

Brief Answer:
They can be duodenal ulcers.

Detailed Answer:
Hello and thanks for being on 'Ask A Doctor' forum,

This problem has nothing to do with medications my dear but chances are gastritis and acid peptic disorder now has changed into ulcers that too in the duodenum.

A peptic ulcer is usually characteristic the patient starts to have symptoms right after having food. As soon as the patient has food stomach secretes an acid which irritates the mucosa. While in your case is more of a classic case of duodenal ulcer. An hour or two after a person sleeps the food moves into the duodenum. This stimulates and irritates the ulcer, waking you up at night and giving you a coughing and nauseating sensation.

Recommendation--

Immediately go for a planned endoscopy. The doctor is going to look into your stomach and duodenum via a tube with a camera and would find out the exact location of ulcers.

Medications--
Ranitidine is an H2 blocker which is far inferior to Proton pump inhibitors in controlling symptoms of gastritis acid peptic disorder.

And lastly, if there are ulcers(which surely would be there) the sucralfate 1gm thrice daily would be given for few months. Some times these ulcers are caused by bacteria H.pylori (specific medicines are given to cure it).

Yes, it's not because of medicines you are on.

Do update with the reports of endoscopy.
Hope I was clear and easy to understand.
Follow-ups are welcome.
Regards!

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ramesh Kumar (8 hours later)

Hi,

Thank you so much for that information! If proton pump inhibitors are more effective than H2 agonists, is there a certain brand/type you recommend? (12hr vs 24hr, etc.) Or are they all very similar?

Thank you, XXXXXXX

Answered by Dr. Ramesh Kumar (15 minutes later)

Brief Answer:
Follow up.

Detailed Answer:
Hello my dear
Yes
Tab Nexium(esomeprazole) 40 mg twice daily can be raised to 80 mg twice daily.

Note-Don't eat anything for 30 minutes after having the pill.
Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng