You know from the first few pages of this chapter that ulcers aren’t caused by excessive stomach acid production but by bacteria. Most adults actually produce too little stomach acid. When ulcers are already established, it may help in the healing process to further reduce acid production, but in the long run, this strategy can be counterproductive and doesn’t deal with the root of the problem, which is probably H. pylori infection. Some of these drugs are used as part of an H. pylori eradication regime.
H2 blockers can cause mineral imbalances in the body. Calcium, phosphorus, and magnesium levels are affected. Vitamin B12 isn’t absorbed well by people using H2 blockers. If you have an allergy to one of the H2 blockers, you shouldn’t use any of them. If you are using H2 blockers over-the-counter, don’t use the maximum dose for more than two weeks at a time without consulting with your physician. If you have symptoms such as difficulty swallowing or persistent abdominal pain, you should think twice about using H2 blockers sold over the counter.
Any acid-blocking medication interacts with the food you eat. Inadequate acid production in the stomach means that your ability to digest what you eat is impaired, and your body may not be able to absorb nutrients properly. The valve that must open to allow food to pass from the stomach into the small intestine is triggered by the acidity of the stomach’s contents, and heart-burn can result if acid levels are low and food sits too long in the stomach.
If you are using an acid-reducing medication for more than a week, be sure to use an intranasal or sublingual vitamin B12 supplement in addition to your multivitamin.
All of the H2 blockers interact with a long list of other drugs, usually blocking or reducing their effects. If you are taking other drugs, please check their drug information sheets carefully for interactions with heartburn drugs.
Ranitidine (Zantac)
What Is It Used For? Treatment of duodenal or gastric ulcer, gastroesophageal reflux disease (heartburn), erosive esophagitis, heartburn, H. pylori eradication, treatment of Zollinger-Ellison syndrome (a condition that causes over-secretion of stomach acid), prevention of damage of the gastrointestinal lining that can result from long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), prevention of stress ulcers, and control of upper gastrointestinal bleeding.
What Are the Possible Side Effects? Zantac adversely affects the liver’s ability to detoxify other drugs you may be taking. That could mean that other drugs will have magnified effects on your body. Other possible side effects include severe headache, sleepiness or fatigue, diarrhea, stomach pain, and itching. Very rarely there may be a decrease in the number of blood cells, vertigo, blurred vision, and blood pressure and liver function changes.
CAUTION!
Think Twice About Taking This Drug If . . .
• You have any of a group of disorders known as porphyria.
• You have kidney or liver problems.
• You are under 16 years of age.
Famotidine (Pepcid, Pepcid AC)
What Is It Used For? Duodenal and stomach ulcer, heartburn, acid indigestion, sour stomach, and Zollinger-Ellison syndrome (a condition that causes oversecretion of stomach acid).
What Are the Possible Side Effects? Headache, sleepiness, fatigue, dizziness, confusion, diarrhea, growth of breasts in males (gynecomastia), kidney or liver impairment, impotence, loss of appetite, dry mouth, musculoskeletal pain, numbness, acne, dry or peeling skin, flushing, ringing in the ears, changes in sense of taste, fever, heart palpitations, and itching.
CAUTION!
Think Twice About Taking This Drug If . . .
You have kidney or liver problems.
What Are the Interactions with Food? Food increases the absorption of famotidine.
Nizatidine (Axid)
What Is It Used For? Duodenal and stomach ulcer, heartburn, acid indigestion, sour stomach, erosive esophagitis, gastroesophageal reflux disease, and prevention of upper gastrointestinal bleeding.
What Are the Possible Side Effects? Sleepiness, fatigue, dizziness, diarrhea, constipation, sweating, heart rhythm irregularities, a rise in uric acid levels in the bloodstream, changes in blood cell counts, and fever.
What Are the Interactions with Other Drugs? Nizatidine increases blood levels of salicylates (aspirin). It can make alcohol’s effects on you more pronounced. If you are using antacids, they can make nizatidine less effective.
Cimetidine (Tagamet, Tagamet HB)
What Does It Do in the Body? Cimetidine blocks acid production in the stomach.
What Is It Used For? Duodenal and stomach ulcer, heartburn, acid indigestion, sour stomach, erosive esophagitis, gastroesophageal reflux disease, Zollinger-Ellison syndrome, and prevention of upper gastrointestinal bleeding. It has also been used to treat hyperparathyroidism, chronic viral warts in children, stress ulcers, herpes virus infections, excessive body hair growth in women, and dyspepsia (general symptoms of stomach upset, heartburn, nausea, and lack of appetite).
What Are the Possible Side Effects? Headache, sleepiness, fatigue, dizziness, confusion, hallucinations, diarrhea, breast development in males (gynecomastia), and impotence. Rarely, side effects can include inflammation of the pancreas, effects on the liver, changes in blood cell counts or immune function, skin problems, cardiac arrhythmias or arrest, joint pain, and hypersensitivity reactions.
In people with arthritis, cimetidine may aggravate joint symptoms; stopping the drug reverses this effect. Severely ill people, especially those with compromised liver or kidney function, may experience mental confusion, agitation, psychosis, anxiety, or disorientation when given this drug (which is reversible when the drug is discontinued).
There is some evidence that cimetidine may impair male fertility.
CAUTION!
Think Twice About Taking This Drug If . . .
You have impaired kidney or liver function. People with liver or kidney disease can’t clear the drug from their systems as rapidly as others, and so blood concentrations may be too high. This is a common concern for elderly people.
What Are the Interactions with Food? Tyramine-rich foods such as aged cheese, processed meats, avocados, bananas, sauerkraut, most soy products, and some wines and beers can cause severe headache and temporarily raise your blood pressure when eaten while using cimetidine. Food delays the absorption of cimetidine.
Examples of Proton Pump Inhibitors
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)
Esomeprazole (Nexium)
They suppress stomach acid production by inhibiting the cellular mechanism that pumps acid into the stomach.
What Do They Do in the Body? Suppress stomach acid production. They are much more powerful than the H2 blockers in this respect.
What Are They Used For? Gastric or duodenal ulcer, gastroesophageal reflux disease (heartburn), to maintain healing of erosive esophagitis, with antibiotics for eradication of H. pylori, treatment of Zollinger-Ellison syndrome (a condition that causes oversecretion of stomach acid). Omeprazole is the only drug in this class that has been subjected to long-term trials; all of the other drugs should not be used for more than four to eight weeks at a time.
What Are the Possible Side Effects? Increased risk of hip fracture, headache, dizziness, fatigue, weakness, diarrhea, abdominal pain, nausea, vomiting, constipation, upper respiratory infection, rash, cough, back pain, and constipation.
Combination therapy with the antibiotic clarithromycin and omeprazole may cause your sense of taste to change or may result in tongue discoloration, runny nose, inflammation of the pharynx, or flulike symptoms.
Long-term treatment with omeprazole has been linked to a serious condition called atrophic gastritis, where the stomach becomes inflamed and parts of it die.
Dozens of other cardiovascular, nervous system, gastrointestinal, urinary, metabolic, musculoskeletal, and respiratory symptoms have been reported but are rare. Severe rash (Stevens-J
ohnson syndrome) and changes in blood cell counts, liver function, hearing, and taste are other rarely observed side effects.
Animal tests have found that omeprazole, rabeprazole, and pantoprazole cause cell changes that could lead to cancer. Human studies have shown similar results with regard to rabeprazole and pantoprazole.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You are elderly.
• You have osteoporosis or are at risk for osteoporosis.
Because of their profound, long-lasting inhibition of stomach acid secretion, proton pump inhibitors can interfere with drugs that require a specific pH for absorption. The effects of the antifungal drug ketoconazole, the antibiotic ampicillin, iron salts, and the heart drug digoxin can be decreased if given with these drugs.
What Are the Interactions with Food? If taken after meals, the drugs’ effects are minimized. Take proton pump inhibitors on an empty stomach.
What Else to Take If You Take These Drugs. A sublingual vitamin B12 supplement. These drugs can interfere with B12 absorption.
Miscellaneous Drugs for Heartburn and Other Stomach Disorders
Sucralfate (Carafate)
What Does It Do in the Body? It creates a sticky gel in your stomach or small intestine that binds to ulcers, protecting them from further burning and ulceration by stomach acid.
What Is It Used For? Treatment of stomach and duodenal ulcers.
What Are the Possible Side Effects? Constipation, dry mouth, diarrhea, nausea, stomachache, gas, indigestion, headache, insomnia, sleepiness, dizziness, and back pain.
CAUTION!
• If you develop a rash or swelling, or have trouble breathing, you may be allergic to sucralfate.
• Those with kidney problems should not take this drug with aluminum-containing antacids. Sucralfate contains aluminum, and the two combined could bring too much of the mineral into the body at once for weakened kidneys to handle.
• This drug should be used with caution if you have kidney failure or need dialysis.
• Because of its high aluminum content, there doesn’t seem to be any good reason to use this drug.
What Are the Interactions with Food? Take this drug on an empty stomach, at least one hour before meals.
Examples of Antacids
Aluminum carbonate gel (Basaljel)
Aluminum hydroxide gel (Amphojel, Alu-Tab, Alu-Cap, Dialume)
Calcium carbonate (Amitone, Mallamint, Dicarbosil, Equilet, Tums, Chooz, Maalox Antacid caplets, Mylanta)
Magaldrate (Riopan, Iosopan)
Magnesium hydroxide (Milk of Magnesia)
Magnesium oxide (Mag-Ox 400, Maox 420, Uro-Mag)
Sodium bicarbonate (Bell/ans)
Sodium citrate (Citra pH)
Antacids are some of the biggest-selling over-the-counter drugs in pharmacies. But not only do these drugs not treat the underlying problem, they may actually make the symptoms worse. Although antacids such as Mylanta, Rolaids, and Tums can temporarily suppress the symptoms of heartburn, in the long run they’ll likely do you more harm than good. You may even become dependent upon them. These over-the-counter medications help neutralize the acid in your stomach for up to an hour. That’s fine for the moment, but your stomach may respond an hour later by producing even more acid to make up for what was neutralized, causing you to reach for more antacids. They also contain aluminum, silicone, sugar, and a long list of dyes and preservatives. Your stomach acid is one of your frontline defenses against harmful bacteria. Suppress it, and the rest of your systems have to work overtime to protect you.
What Do They Do in the Body? Antacids neutralize stomach acid. By increasing the pH of the stomach and duodenum (the first part of the small intestine), they also inhibit the action of the enzyme pepsin, which breaks down proteins. Antacids also increase the tone of the sphincter between the esophagus and the stomach, which decreases the likelihood of gastroesophageal reflux (heartburn).
What Are They Used For? Relief of upset stomach, heartburn, acid indigestion, and sour stomach. Aluminum- and magnesium-based antacids are also used to prevent stress ulcer bleeding, and antacids are often used in the treatment of ulcers.
What Are the Possible Side Effects? Magnesium-containing antacids can cause diarrhea.
Aluminum-containing antacids can cause constipation, intestinal blockage, or dangerously high body levels of aluminum. There is no conceivable reason to use aluminum-containing antacids.
Antacids may cause rebound acid production, where acid levels rise above normal once the antacid wears off.
Use of high doses of calcium carbonate and sodium bicarbonate at the same time can lead to milk-alkali syndrome. Symptoms are headache, nausea, irritability, weakness, electrolyte imbalances, and kidney damage.
Long-term use of aluminum-containing antacids can lead to phosphate depletion (hypophosphatemia) if intake of this mineral isn’t adequate. Hypophosphatemia can lead to loss of appetite, exhaustion, weakness, and bone problems.
Antacids can deplete calcium levels. Using antacids such as Tums as a source of calcium is not useful, since at best it will replace what the antacid is blocking.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have hypertension, congestive heart failure, or kidney failure, or you are on a low-sodium diet. Most antacids are very high in sodium, so look for a low-sodium version.
• You are undergoing dialysis. Avoid aluminum-containing antacids. (We recommend avoiding aluminum-containing antacids, period.)
• You have had recent gastrointestinal hemorrhage. Use aluminum hydroxide with care.
How Do Antacids Interact with Nutrients? Aluminum- and magnesium-containing antacids can bind with phosphate and deplete the body of calcium, resulting in weakening of bones. Phosphate depletion can cause muscle weakness.
Vitamins A, B1 (thiamine), and D are not well absorbed or are destroyed if antacids are in your system. In general, antacids block the action of stomach acid, reducing the absorption of nutrients.
Examples of Antidiarrhea Drugs
Difenoxin with atropine sulfate
Diphenoxylate with atropine sulfate
Loperamide
Bismuth subsalicylate
Diarrhea is your body’s way of getting rid of harmful substances. When you have diarrhea, food containing bacteria or viruses can be flushed out of the body quickly. You may also have diarrhea when you eat certain foods that don’t agree with you. If diarrhea goes on for more than five days, you may have a medical problem that needs attention. Severe diarrhea in infants, children, or the elderly should get medical attention within three days, since they can rapidly become dangerously dehydrated.
Difenoxin with atropine sulfate (Motofen)
What Does It Do in the Body? Slows the contractions of the intestines so that their contents move through more slowly.
What Is It Used For? Treatment of diarrhea.
What Are the Possible Side Effects? Nausea, vomiting, dry mouth, upset stomach, constipation, dizziness, light-headedness, drowsiness, headache, burning eyes, and blurred vision.
In some people, especially children, atropine (an ingredient of this drug) may cause skin and mucous membrane dryness, flushing, low body temperature, fast heartbeat, and difficulty urinating.
CAUTION!
Think Twice About Taking This Drug If . . .
• Your diarrhea could be caused by bacteria such as E. coli, salmonella, or shigella.
• You have been taking broad-spectrum antibiotics.
• You have colitis.
• You have jaundice.
• You have narrow-angle glaucoma or adhesions between the iris and lens of the eye.
• You have a heart condition such as rapid heartbeat or angina, gastrointestinal obstructive disease, urinary problems, or myasthenia gravis.
• You have liver or kidney disease. Use difenoxin with caution.
Diphenoxylate with atropine sulfat
e (Logen, Lomotil, Lonox, Lomanate)
What Does It Do in the Body? It has a constipating effect, making feces more solid.
What Is It Used For? Treatment of diarrhea.
What Are the Possible Side Effects? If you are hypersensitive to diphenoxylate, you may experience rash, swelling in the gums and elsewhere, or a life-threatening allergic reaction called anaphylaxis.
Other potential side effects include dizziness, drowsiness, sedation, headache, general feeling of not being well, lethargy, euphoria, depression, confusion, numbness of the extremities, loss of appetite, vomiting, abdominal discomfort, problems with the natural movements of the intestines, and inflammation of the pancreas.
CAUTION!
Think Twice About Taking This Drug If . . .
• Your diarrhea could be caused by bacteria such as E. coli, salmonella, or shigella.
• You have been taking broad-spectrum antibiotics.
• You have colitis.
• You have liver or kidney disease. Use diphenoxylate with caution.
Loperamide (Diar-Aid, Imodium A-D, Kaopectate, Maalox, Neo-Diaral, Pepto Diarrhea Control)
What Does It Do in the Body? Decreases the movement of the intestines and slows water and electrolyte transfer into the bowel.
What Is It Used For? Treatment of diarrhea.
What Are the Possible Side Effects? Usually minor, they include abdominal pain, distention, or discomfort; constipation; dry mouth; nausea; vomiting; tiredness; dizziness; and skin rash.
CAUTION!
Think Twice About Taking This Drug If . . .
Prescription Alternatives Page 21