Acid-reducing drugs

Several types of medication lower exposure to ulcer-causing stomach acids:

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Antacids neutralize gastric acid and are more effective than a placebo in healing gastric and duodenal ulcers. However, antacids must be taken in relatively large doses one and three hours after meals and at bedtime, and they may cause side effects. The major side effect of magnesium-containing antacids (Maalox, Mylanta) is diarrhea.

H2 receptor blockers: Histamine-receptor blockers reduce gastric acid production by blocking the H2 receptor on the parietal cells, or acid-secreting cells, located in the lining of the stomach. The histamine molecule fits into the H2 receptor like a key in a lock. These drugs block the keyhole, shutting off a significant amount of acid production. H2 blockers used to treat gastric and duodenal ulcers include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid). H2 receptor blockers are relatively safe. The choice of drug should be dictated by cost, dosing schedule, convenience, and possible drug interactions.

Proton-pump inhibitors (PPIs): These drugs block the action of cells in the stomach lining that pump hydrogen needed to produce stomach acid, thus completely shutting off acid production and allowing ulcers to heal. PPIs are also used in combination with antibiotics to eradicate H. pylori bacteria and to prevent gastroduodenal ulcers associated with nonsteroidal anti-inflammatory drugs. PPIs generally are well tolerated by most patients, but some people may develop side effects: headache, diarrhea, constipation, abdominal pain, nausea, and rash.

All PPIs are very similar in action, and there is no convincing evidence that one is significantly more effective than another. PPIs available by prescription include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). They differ in how they are broken down by the liver and their drug interactions. The absorption into the body of some drugs is affected by the presence of acid in the stomach, and because PPIs so effectively reduce acid in the stomach, they may affect how well these other medications work.