Histamine antagonists
Histamine2 (H2) receptor antagonists are moderately effective for treating GERD. These drugs are safe, with rare side effects. However, cimetidine may cause mental status changes, antiandrogenic activity (gynecomastia), and inhibition of the cytochrome P-450 system, which may alter levels of drugs metabolized by this pathway (eg, theophylline, warfarin, phenytoin).
The indicated oral doses for the treatment of reflux esophagitis are cimetidine (Tagamet), 800 mg twice daily; ranitidine (Zantac), 150 mg two to four times daily; famotidine (Pepcid), 20 mg to 40 mg twice daily; and nizatidine (Axid), 150 mg twice daily. The efficacy of all the H2 receptor antagonists is equivalent.
Proton pump inhibitors
The proton pump inhibitors (PPIs), omeprazole (Prilosec) and lansoprazole (Prevacid), are the most effective acid-suppressing medications available. These drugs inhibit the proton pump.
The usual dosage for treatment of reflux esophagitis is 20 to 40 mg of omeprazole (Prilosec) daily or 30 mg of lansoprazole (Prevacid) daily. At these doses, reflux symptoms are abolished in most patients. PPIs are safe and well tolerated. Side effects of headache, abdominal pain and diarrhea are rare.
Patients with classic symptoms who are less than 40 years old and who have had symptoms for less than 10 years do not require diagnostic studies. Indications for upper gastrointestinal endoscopy include onset of new symptoms in older patients with long-standing GERD, the presence of alarm symptoms, atypical or equivocal symptoms, and failure of full-dose H2 receptor antagonist therapy.
Alarm symptoms in patients with suspected GERD: Hematemesis Melena Dysphagia Unexplained weight loss Frequent vomiting.
PROTONIX helps to control NIGHTTIME heartburn and other symptoms associated with erosive Gastroesophageal Reflux Disease (GERD).
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