Heartburn, treatment

Cimetidine (Tagamet, 8.26), a histamine H2-receptor antagonist for ulcer and heartburn treatment, inhibits several isoforms of CYP CYP1A2, CYP2D6, and, most importantly, CYP3 A4 (Figure 8.5). If a patient takes cimetidine as well as a drug that is metabolized... 

The proton pump inhibitors are used for treatment or symptomatic relief of various gastric disorders, including gastric and duodenal ulcers, GERD, or pathological hypersecretory conditions. Painful, persistent heartburn 2 or more days a week may indicate acid reflux disease which can erode the delicate lining of the esophagus,... 

Nonpharmacologic recommendations for the treatment of heartburn in a pregnant patient do not differ from those given... 

During lactation, sucralfate maybe the best choice for treatment of heartburn because it is not absorbed systemically.25 If symptoms are not controlled, the H2 blockers are acceptable alternatives.14,25 Avoid aluminum-containing antacids during lactation owing to reports of aluminum toxicity in otherwise healthy infants.22... 

Histamine H2 antagonists these relieve persistent heartburn and are generally safe and effective in acid reflux without mucosal damage. There is little reason to prefer one clinically over another. Treatment has to be continued indefinitely. They are relatively ineffective in established inflammation. 

II.b.2.1. Prokinetic agents. Cisapride cisapride treatment can be demonstrated to improve sphincter and motor function and to improve modestly the symptoms of heartburn. However, it is relatively ineffective in severe disease, and adverse effects of impaired intracardiac electrical conduction causing ventricular tachyarrhythmias have resulted in its withdrawal from general use. 

A 57-year-old man with extensive onychomycosis (fungal toenail infection) asks you for an evaluation. He requests a prescription for itraconazole for treatment of this problem after seeing a television advertisement for this drug. He has chronic heartburn attributed to gastroesophageal reflux disease and is treated with the proton pump inhibitor omeprazole. He is taking lovastatin for treatment of... 

Antacids have been used for centuries in the treatment of patients with dyspepsia and acid-peptic disorders. They were the mainstay of treatment for acid-peptic disorders until the advent of H2-receptor antagonists and proton pump inhibitors. They continue to be used commonly by patients as nonprescription remedies for the treatment of intermittent heartburn and dyspepsia. 

Metoclopramide is available for clinical use in the USA domperidone is available in many other countries. These agents are sometimes used in the treatment of symptomatic GERD but are not effective in patients with erosive esophagitis. Because of the superior efficacy and safety of antisecretory agents in the treatment of heartburn, prokinetic agents are used mainly in combination with antisecretory agents in patients with regurgitation or refractory heartburn. 

Acid reducers (Proton pump inhibitors) Omeprazole magnesium, 20.6 mg once daily for 14 days Prilosec OTC, various generic Omeprazole is the first proton pump inhibitor approved for the treatment of frequent heartburn in adults (> 18 years of age) with symptoms of heartburn 2 or more days per week. The product should not be taken for more than 14 days or more often than every 4 months unless directed by a physician. Omeprazole magnesium 20.6 mg is equivalent to 20 mg of omeprazole (prescription strength). 

E-mail web form Phone + 44 20 7304 5000 15 Stanhope Gate London W1K 1LN United Kingdom A company resulting from the merger of Swedish AB and the British Zeneca Group in 1999, it is the maker of Arimidex for treatment of certain types of breast cancer, Crestor for high cholesterol, and Nexium (the purple pill) for heartburn relief. 

Represents typical dose for treatment of gastric or duodenal ulcers. Doses for preventing ulcer recurrence or treating gastroesophageal reflux disease [heartburn] may be somewhat lower. 

Meadowsweet is reputed to have stomachic, mild urinary antiseptic, antirheumatic, astringent, and antacid properties. Traditionally, it has been used for atonic dyspepsia with heartburn and hyperacidity, acute catarrhal cystitis, rheumatic muscle and joint pains, diarrhea in children, and specifically for the prophylaxis and treatment of peptic ulcers. 

Ranitidine (Zantac /GlaxoSmithKline) is a histamine H2-receptor antagonist that inhibits the release of gastric acid and is useful in the treatment of a variety of hypersecretory conditions [dyspepsia, heartburn, duodenal and gastric ulcers, and gastroesophageal reflux (GERD)]. Lansoprazole (Prevacid /TAP), omeprazole (Prilosec /AstraZeneca), and esomeprazole (Nexium /AstraZeneca) are benzimidazole... 

The Pepcid AC case illustrates many of the factors at work in the OTC-switch process. Pepcid AC is by almost every account one of the most successful examples of a prescription drug switched to a nonprescription OTC. The launch of Pepcid AC in the OTC market resulted from a 5-year strategy developed by Merck and Johnson Johnson to market OTC versions of Merck s leading prescription drugs. Prescription Pepcid AC was to be the first case. Originally marketed as a prescription medicine for the treatment of ulcers, Pepcid AC was a reduced-strength version marketed to consumers for the relief of acid indigestion and heartburn. 

There has been a systematic review of published randomized studies of the use of iV-acetylcysteine in chronic bronchitis (2). A total of 39 trials were considered, of which only nine were included in the meta-analysis. In all cases, oral A -acetylcysteine had been used in a dosage of 200-300 mg bd for 4-32 weeks. There were gastrointestinal adverse effects (dyspepsia, diarrhea, and heartburn) in 10% of 2011 patients, and 6.5% withdrew because of their symptoms. However, the rate of gastrointestinal adverse effects was higher in the placebo group (11% with a withdrawal rate of 7.1%). There was no exacerbation of chronic bronchitis in 49% of patients treated with acetylcysteine compared with 31% of placebo-treated patients, a relative benefit of 1.56 (95% Cl = 1.37, 1.77). There was also symptom improvement with treatment 61 % reported improvement in symptoms with acetylcysteine compared with 35% with placebo. 

Talley NJ, Moore MG, Sprogis A, Katelaris P. Randomised controlled trial of pantoprazole versus ranitidine for the treatment of uninvestigated heartburn in primary care. Med J Aust 2002 177(8) 423-7. 

Lansoprazole 15 mg/day and omeprazole 10 mg/day for 4 weeks have been compared in the relief of heartburn and epigastric pain in a randomized, double-blind, parallel-group study in 609 patients with acid-related dyspepsia (4). Low-dose lansoprazole was more effective in control-hng symptoms. There were no significant differences in adverse events between the two groups, although there was a trend toward a higher incidence of more severe adverse events with omeprazole. Most of the reported adverse events were difficult to relate to the treatments. 

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