(This article first appeared 22 January2019)
Do you remember those Pepcid commercials from the 1990s, the ones that showed a relatively young couple being unable to enjoy Mexican food until the miracle of Pepcid entered their lives? My husband and I laughed at them--only older people had stomach issues. Then he became one of those people, and at a pretty young age. It wasn't so funny anymore.
If you're a younger reader, you may think this post won't be of use to you. Hopefully you're right. However, you're reading this blog because you feel a need to prepare for the unexpected, or what most people don't expect, anyway. Knowledge is power, and besides, quite a few of these over-the-counter drugs are relatively inexpensive, and they have alternative uses.
ANTACIDS
Calcium carbonate (Tums) has been used to treat heartburn since the 1930s. It provides immediate relief from heartburn and is completely safe to use during pregnancy. And it comes in lots of flavors. For best shelf life, get the regular chewables. Calcium carbonate may decrease the absorption of some drugs, including tetracycline antibiotics like minocycline and doxycycline and quinolone antibiotics such as ciprofloxacin and levofloxacin.
Effervescent antacids (Alka-Seltzer) contain aspirin, sodium bicarbonate, and anhydrous (dry) citric acid to treat inflammation, fever, headache, minor aches and pains, in addition to heartburn, indigestion, and acid reflux.
Contraindications: Not for use in individuals with heart failure or kidney failure.
H2 BLOCKERS
Famotidine (Pepcid) is an anti-histamine that inhibits acid production in the stomach and is thus used in treating gastric and duodenal ulcers and gastroesophageal reflux disease (GERD). This H2 blocker may also be used to treat Helicobacter pylori infections, though omeprazole seems to be more effective. And it is even used to prevent the development of NSAID-induced ulcers. It was discovered in 1979 and has a great advantage over other similar medications in that it does not seem to interact with other drugs. It is available over-the-counter in 10 mg and 20 mg tablets. Prescription strengths are sold in 20 mg and 40 mg tablets.
Doctors routinely prescribe the following dosages for common conditions:
- Duodenal ulcers
- 40 mg taken once per day at bedtime OR
- 20 mg taken twice per day for 6-8 weeks, and then followed by a maintenance dose of 20 mg taken at bedtime. (In treating ulcers, the night-time dosing is important for healing, when the stomach and duodenum are empty.)
- Gastric ulcers, 40 mg once per day at bedtime.
- GERD, 20 mg twice per day for 6 weeks. (In treating GERD, smaller, frequent doses are important for controlling acid production.)
Ranitidine (Zantac) was withdrawn from the market by the US FDA in 2020 pending further testing following the implication that it contains a carcinogen. It is/was an antihistamine that was developed for treating heartburn, gastric and duodenal and H. pylori ulcers,
and GERD. I am including the following information for those who still have some ranitidine on hand and may wish to consider using it in a crisis.
At about five cents per dose, this H2 blocker is on WHO's
List of Essential Medicines. It may be administered to help prevent
NSAID-induced ulcers, but proton-pump inhibitors are generally more
effective in this role. It is used for preventing stress-induced ulcers
in critically ill patients. According to Dr. Cynthia Koelker, author
of Armageddon Medicine, ranitidine may be taken one hour before
taking over-the-counter pain medications if those pain relievers cause
stomach discomfort. Ranitidine was initially used to treat long-term acid
reflux, but proton pump inhibitors have also taken over this role.
Ranitidine is available OTC in the US in 75 and 150 mg tablets.
Prescription strength is 300 mg.
Ranitidine may be used
by physicians in conjunction with diphenhydramine (Benadryl) as a
secondary treatment for anaphylaxis, after epinephrine.
Use
of ranitidine may increase the risk of developing infectious diarrhea,
may lead to an elevated risk of developing food allergies, and may lead
to a risk of developing pneumonia.
Omeprazole (Prilosec)
may be used to treat frequent heartburn (2x+days/week). However, it
takes 1-4 days to start working, so heartburn is not relieved right
away. As a proton pump inhibitor, it decreases the amount of acid
produced by the stomach to let the stomach and esophagus heal from
damage done by acids. Omeprazole is used to treat GERD and gastric and
duodenal ulcers, especially those caused by aspirin and NSAIDs, and H. pylori.
Dosages physicians commonly prescribe for individuals 16+ years of age:
- Active duodenal ulcer--20 mg per day for up to 4 weeks
- Duodenal ulcer with H. pylori infection
- 20 mg twice per day for 10 days, plus amoxicillin and clarithromycin, OR
- 40 mg once per day for 14 days, plus clarithromycin
- Gastric ulcer--40 mg once per day for 4-8 weeks
- GERD--20 mg once per day up to 4 weeks
Contraindications: Omeprazole may cause new or worsening symptoms of lupus.
Contraindications for all PPIs and to a lesser extent, the H2 blockers: These drugs may interfere with the bioavailability of vitamin B12, so a supplement should be taken to prevent negative effects on the nervous system. In addition, these drugs also increase the risk of osteoporosis.
Do not use any of these drugs for more than 14 days unless directed by a doctor. Also, consult with a doctor before using more than once every four months.
For more information:
https://www.webmd.com/drugs/2/drug-3766-2250/omeprazole-oral/omeprazole-delayed-release-tablet-oral/details/list-conditions
https://www.healthline.com/health/omeprazole-oral-capsule-sprinkles#dosage
https://reference.medscape.com/drug/pepcid-act-famotidine-341989
https://www.kevinmd.com/blog/2013/12/proton-pump-inhibitors-b12-deficiency.html
https://www.fda.gov/news-events/press-announcements/statement-alerting-patients-and-health-care-professionals-ndma-found-samples-ranitidine
22 january 2019
20 october 2019
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