Acid Reflux Treatment Phase 2 - Medications, Five Types Of Drug
Type Ⅰ : Antacids
Many antacids are available without prescription and are the first drugs recommended to relieve heartburn and mild symptoms. It neutralize the acid in the stomach so that there is no acid to reflux.
The problem with antacids is that their action is brief. They are emptied from the empty stomach quickly, in less than an hour, and the acid then re-accumulates. The best way to take antacids, therefore, is approximately one hour after meals or just before the symptoms of reflux begin after a meal. Since the food from meals slows the emptying from the stomach, an antacid taken after a meal stays in the stomach longer and is effective longer. For the same reason, a second dose of antacids approximately two hours after a meal takes advantage of the continuing post-meal slower emptying of the stomach and replenishes the acid-neutralizing capacity within the stomach.
Despite the many brands, they all rely on various combinations of three basic ingredients: Magnesium, Calcium, or Aluminum. Aluminum-containing antacids have a tendency to cause constipation, while magnesium-containing antacids tend to cause diarrhea. If diarrhea or constipation becomes a problem, it may be necessary to switch antacids or alternately use antacids containing aluminum and magnesium.
Magnesium salts are available in the form of magnesium carbonate, magnesium trisilicate, and most commonly, magnesium hydroxide (Milk of Magnesia). The major side effect of magnesium salts is diarrhea. Magnesium salts offered in combination products with aluminum (Mylanta and Maalox) balance the side effects of diarrhea and constipation.
Calcium carbonate (Tums, Titralac, and Alka-2) is a potent and rapid acting antacid that can cause constipation. These antacids are actually sources of calcium. There have been rare cases of hypercalcemia (elevated levels of calcium in the blood) in people taking calcium carbonate for long periods of time. This can lead to kidney failure and is very dangerous. None of the other antacids has this side effect.
Aluminum salts (Amphogel, Alternagel) are also available. The most common side effect of antacids containing aluminum salts is constipation. People who take large amounts of antacids that contain aluminum may also be at risk for calcium loss, which can lead to osteoporosis.
Type Ⅱ : H2 Blockers
Although antacids can neutralize acid, they do so for only a short period of time. For substantial neutralization of acid throughout the day, antacids would need to be given frequently, at least every hour. The first medication developed for more effective and convenient treatment of acid-related diseases, including GERD, was a Histamine Antagonist, specifically cimetidine (Tagamet).
Histamine is an important chemical because it stimulates acid production. Released within the wall of the stomach, histamine attaches to receptors (binders) on the stomach's acid-producing cells and stimulates the cells to produce acid. Histamine antagonists work by blocking the receptor for histamine and thereby preventing histamine from stimulating the acid-producing cells. (Histamine antagonists are referred to as H2 antagonists because the specific receptor they block is the histamine type 2 receptor.)
The drugs are usually taken at bedtime. Some people may need to take them twice a day. H2 blockers inhibit acid secretion for 6 to 24 hours and are very useful for people who need persistent acid suppression. They may also prevent heartburn episodes in people who are able to predict its occurrence. In some studies, H2 blockers improved asthmatic symptoms in people who suffer from both conditions. A 2001 study suggested, however, that they rarely provide complete symptoms relief for chronic heartburn and dyspepsia and they have done little to reduce office visits to physicians for GERD. Brands are currently available :
- Famotidine (Pepcid AC) - Most Potent
The most common side effect of famotidine is headache, which occurs in 4.7% of people who take it. Famotidine is virtually free of drug interactions but the FDA has issued a warning on its use in patients with kidney problems.
- Cimetidine (Tagamet, Tagamet HB) - The Oldest
It has few side effects; About 1% of people taking it will experience mild temporary diarrhea, dizziness, rash, or headache.
Cimetidine interacts with a number of commonly used medications, such as phenytoin, theophylline, and warfarin. Long-term use of excessive doses (more than 3 grams a day) may cause impotence or breast enlargement in men. These problems resolve after the drug is discontinued.
- Ranitidine (Zantac, Zantac 75, Zantac Efferdose, Zantac injection, Zantac Syrup)
Ranitidine (Zantac) interacts with very few drugs. In a recent study, ranitidine provided more pain relief and healed ulcers more quickly than cimetidine in people less than 60 years old, but there was no difference in older patients. A common side effect associated with ranitidine is headache, which occurs in about 3% of the people who take it.
- Nizatidine Capsules (Axid AR, Axid Capsules, Nizatidine Capsules)
It is nearly free of side effects and drug interactions. A controlled release form is proving to help alleviate nighttime GERD.
Type Ⅲ : Proton-Pump Inhibitors
Proton-pump inhibitors (PPIs) suppress the production of stomach acid and work by inhibiting the molecule in the stomach glands that is responsible for acid secretion, which is called the gastric acid pump.
Over-the-counter Without A Prescription :
Newer Prescription Oral :
Esomeprazole (Nexium), Lansoprazole (Prevacid), Rabeprazole (Aciphex), Pantoprazole (Protonix)
Studies report significant relief from PPIs in most patients with heartburn. PPIs are effective for healing erosive esophagitis and may also be helpful in patients with chronic laryngitis that is suspected to be caused by GERD. The newer agents provide quicker symptom relief compared to omeprazole. However, a 2002 comparison study suggested that to date esomeprazole (Nexium) is the only newer oral PPI to show any significant advantage over omeprazole (Prilosec). In any case all PPIs are more effective than the H2 blockers.
Type Ⅳ : Agents That Protect The Mucus Lining (Sucralfate)
Sucralfate (Carafate) protects the mucus lining in the gastrointestinal tract. It seems to work by sticking to an ulcer crater and protecting it from damage due to stomach acid and pepsin. It may be helpful for maintenance therapy in people with mild to moderate GERD. Other than constipation, which occurs in 2.2% of patients, the drug has few side effects. Sucralfate interacts with a wide variety of drugs, however, including warfarin, phenytoin, and tetracycline.
Type Ⅴ : Anti-Spasm Drugs To Prevent Acid And Non-Acid Reflux
Most drugs used for GERD have no effect on non-acid reflux, such as back-up of bile. Baclofen, known as a gamma-amino butyric acid agonist, is commonly used to reduce muscle spasms. Investigators are now showing that is can reduce both acid and non-acid reflux episodes (as much as 70%) and to increase LES pressure, an important factor for preventing back up.