Antiulcer Drugs

Antiulcer Drugs

 

Definition

'Antiulcer drugs are a class of drugs, exclusive of the antibacterial agents, used to treat ulcers in the stomach and the upper part of the small intestine.
Antiulcer Drugs
Brand Name
(Generic Name)
Possible Common Side Effects Include:
Axid (nitzatidine) Diarrhea, headache, nausea and vomiting, sore
throat
Carafate (sucralfate) Constipation, insomnia, hives, upset stomach,
vomiting
Cytotec (misoprostol) Cramps, diarrhea, nausea, gas, headache,
menstrual disorders (including heavy bleeding
and severe cramping)
Pepcid (famotidine) Constipation or diarrhea, dizziness, fatigue,
fever
Prilosec (omeprazole) Nausea and vomiting, headache, diarrhea,
abdominal pain
Tagamet (cimetidine) Headache, breast development in men, depres-
sion and disorientation
Zantac (ranitidine
hydrochloride)
Headache, constipation or diarrhea, joint pain

Purpose

Recurrent gastric and duodenal ulcers are caused by Helicobacter pylori infections, and are treated with combination treatments that incorporate antibiotic therapy with gastric acid suppression. Additionally, bismuth compounds have been used. The primary class of drugs used for gastric acid suppression are the proton pump inhibitors, omeprazole, lansoprazole, pantoprazole and rabeprazole. The H-2 receptor blocking agents, cimetidine, famotidine, nizatidine, and ranitidine have been used for this purpose, but are now more widely used for maintenance therapy after treatment with the proton pump inhibitors. Sucralfate, which acts by forming a protective coating over the ulcerate lesion, is also used in ulcer treatment and may be appropriate for patients in whom other classes of drugs are not indicated, or those whose gastric ulcers are caused by non-steroidal anti-inflammatory drugs (NSAIDs) rather than H. pylori infections.

Description

The proton pump inhibitors block the secretion of gastric acid by the gastric parietal cells. The extent of inhibition of acid secretion is dose related. In some cases, gastric acid secretion is completely blocked for over 24 hours on a single dose. In addition to their role in treatment of gastric ulcers, the proton pump inhibitors are used to treat syndromes of excessive acid secretion (Zollinger-Ellison Syndrome) and gastroesophageal reflux disease (GERD).
Histamine H-2 receptor blockers stop the action of histamine on the gastric parietal cells, inhibiting the secretion of gastric acid. These drugs are less effective than the proton pump inhibitors, but may achieve a 75-79% reduction in acid secretion. Higher rates of acid inhibition may be achieved when the drug is administered by the intravenous route. The H-2 receptor blockers may also be used to treat heartburn and hypersecretory syndromes. When given before surgery, the H-2 receptor blockers are useful in prevention of aspiration pneumonia.
Sucralfate (Carafate), a substituted sugar molecule with no nutritional value, does not inhibit gastric acid, but rather, reacts with existing stomach acid to form a thick coating that covers the surface of an ulcer, protecting the open area from further damage. A secondary effect is to act as an inhibitor of the digestive enzyme pepsin. Sucralfate does not bind to the normal stomach lining. The drug has been used for prevention of stress ulcers, the type seen in patients exposed to physical stress such as burns and surgery. It has no systemic effects.

Recommended dosage

The doses of the proton pump inhibitors and H-2 receptor blockers vary depending on the drug and condition being treated. Consult individual references.
The dose of sucralfate for acute ulcer therapy is 1 gram four times a day. After the ulcer has healed, maintenance treatment may continue at 1 gram two times daily.

Precautions

The proton pump inhibitors are generally well tolerated, and the most common adverse effects are diarrhea, itching, skin rash, dizziness and headache. Muscle aches and a higher than normal rate of respiratory infections are among the other adverse reactions reported. Omeprazole has an increased rate of fetal deaths in animal studies. It is not known if these drugs are excreted in human milk, but because of reported adverse effects to infants in animal studies, it is recommended that proton pump inhibitors not be used by nursing mothers.
The H-2 receptor blockers vary widely in their adverse effects. Although they are generally well tolerated, cimetidine may cause confusion in elderly patients, and has an antiandrogenic effect that may cause sexual dysfunction in males. Famotidine has been reported to cause headache in 4.7% of patients. It is advisable that mothers not take H-2 receptor blockers while nursing.
Sucralfate is well tolerated. It is poorly absorbed, and its most common side effect is constipation in 2% of patients. Diarrhea, nausea, vomiting, gastric discomfort, indigestion, flatulence, dry mouth, rash, pruritus (itching), back pain, headache, dizziness, sleepiness, and vertigo have been reported, as well as rare allergic responses. Because sucralfate releases small amounts of aluminum into the system, it should be used with caution in patients with renal insufficiency. There is no information available about sucralfate's safety in breastfeeding.

Interactions

Proton pump inhibitors may increase the pH of the stomach. This will inactivate some antifungal drugs that require an acid medium for effectiveness, notable itraconazole and ketoconazole.
H-2 receptor blocking agents have a large number of drug interactions. Consult individualized references.

Key terms

Antibiotic — Medicine used to treat infections.
Enzyme — A type of protein, produced in the body, that brings about or speeds up chemical reactions.
Gastrointestinal tract — The stomach, small intestine and large intestine.
Hypersecretory — Excessive production of a bodily secretion. The most common hypersecretory syndrome of the stomach is Zollinger-Ellison Syndrome, a syndrome consisting of fulminating intractable peptic ulcers, gastric hypersecretion and hyperacidity, and the occurrence of gastrinomas of the pancreatic cells of the islets of Langerhans.
Inflammation — Pain, redness, swelling, and heat that usually develop in response to injury or illness.
Mucous — Thick fluid produced by the moist membranes that line many body cavities and structures.
Nonsteroidal anti-inflammatory drug (NSAID) — A type of medicine used to relieve pain, swelling, and other symptoms of inflammation, such as ibuprofen or ketoprofen.
Sucralfate should not be used with aluminum containing antacids, because of the risk of increased aluminum absorption. Sucralfate may inhibit absorption and reduce blood levels of anticoagulants, digoxin, quinidine, ketoconazole, quinolones and phenytoin.

Resources

Organizations

Digestive Disease National Coalition. 507 Capitol Court NE, Suite 200, Washington, DC 20003. (202) 544-7497.
National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. nddic@aerie.com. http://www.niddk.nih.gov/Brochures/NDDIC.htm.

Other

Duodenal UlcerFact sheet. Johns Hopkins Health Information Adult Health Advisor. 〈http://csi.intelihealth.com〉.
National Institute of Diabetes and Digestive and Kidney Diseases. http://www.niddk.nih.gov.
PharmInfoNet's Digestive Disease Center. 〈http://pharminfo.com/disease.gastro.html〉.
Stomach Ulcer (Gastric Ulcer). Fact sheet. Johns Hopkins Health Information Adult Health Advisor. 〈http://csi.intelihealth.com〉.
References in periodicals archive ?
wealthy countries; and regulation, with discussion of the Food, Drug, and Cosmetic Act of 1938, consumption externalities and diffusion for antiulcer drugs, price and welfare effects of pharmaceutical substitution reform in Sweden, UK regulations, and the timing of drug approvals in the US and abroad.
An abundance of plants with antiulcer properties has been reported in the traditional literature; some plants contain a vast repertoire of antiulcer molecules which may, after possible chemical modification, provide new and improved antiulcer drugs (Shah 2006).
Patients of diabetes mellitus, chronic kidney diseases, chronic liver disease including cirrhosis of liver and any patient with history of taking any antimalarial, antimotility, and antiulcer drugs before admission were also excluded.
Damage to this barrier leads to gastric ulcers, which antiulcer drugs purport to cure.
Plant extracts are some of the most attractive sources of news drugs, and have shown promising results for the treatment of gastric ulcer in several experimental models for evaluating antiulcer drugs (Borrelli and Izzo, 2000).
Network effects and diffusion in pharmaceutical markets: antiulcer drugs.
pylori via a "test and treat" strategy might curb the use of antiulcer drugs by patients who had been long-term users of antisecretory drugs.
Even so, he says, the new data will help researchers interested in designing antiulcer drugs or vaccines targeted against urease, "It's very exciting.
Pindyck, and Pierre Azoulay, Consumption Externalities and Diffusion in Pharmaceutical Markets: Antiulcer Drugs.
Our analysis of the per capita rates of paid prescriptions included all antiulcer drugs regulated by Florida's restrictive policy: cimetidine, famotidine, nizatidine, ranitidine, omeprazole, and sucralfate.
Pharmaceutical manufacturers who had enjoyed enormous profits from antiulcer drugs found their sales of these products beginning to dwindle.
She also is analyzing the information content of advertising and marketing for pharmaceutical products in the market for antiulcer drugs.