Treatment for Gastro Esophageal Reflux Disease
The adverse effects of abacavir that have been most often observed in clinical trials are fatigue, nausea and vomiting, abdominal pain, diarrhea, headache, rash, and dyspepsia (3,4). Allergic reactions lead to withdrawal of therapy in about 3 of patients (5). These can be severe, and anaphylaxis has been reported after rechallenge in a patient with an apparent allergic reaction to abacavir (6). It is wise to avoid rechallenge when allergy is suspected (7). In one study nausea and vomiting occurred in 3857 of patients, headache in 27-41 , malaise and fatigue in 28 , diarrhea in 18-23 , and weakness in 29 (8). There was also one case of agranulocytosis accompanied by a skin rash.
Allopurinol and meglumine antimoniate (Glucantime) have been evaluated in a randomized controlled trial in 150 patients with cutaneous leishmaniasis (2). They received oral allopurinol (15 mg kg day) for 3 weeks or intramuscular meglumine antimoniate (30 mg kg day, corresponding to 8 mg kg day of pentavalent antimony, for 2 weeks), or combined therapy. There were a few adverse effects in those who used allopurinol nausea, heartburn (n 3), and mild increases in transaminases (n 2). These symptoms subsided on drug withdrawal.
Prolonged-release mesalazine also reduced disease activity in patients with mild to moderately active Crohn's disease. In Crohn's disease, mesalazine was more effective in preventing relapse in patients with isolated small bowel disease than in those with colonic involvement. Prolonged-release mesalazine appears to be as well tolerated as placebo, and the incidence of adverse effects does not appear to be dose related. Nausea vomiting, diarrhea, abdominal pain, and dyspepsia are the most commonly reported. Reports of nephrotoxicity with this formulation are rare. Oral enteric-coated mesalazine is well tolerated in children aged 4-19 years and in adults who are intolerant of sulfasalazine. The most common adverse effects are headache, gas, nausea, diarrhea, and dyspepsia. The adverse effects can be severe enough to require withdrawal of the drug in up to 11 of patients.
Cimetidine, famotidine, nizatidine, ranitidine, and roxatidine promote the healing of stomach and duodenal ulcers by blocking the H2-receptors in the gastric mucosa. In this way, the stimulation by histamine, which induces the secretion of hydrochloric acid, is prevented. Pepsin production is reduced as well. H2-receptor antagonists are used to treat gastroesophageal reflux and pcptic ulcer disease. These agents are all well-absorbed and cross the placenta. Proton-pump inhibitors such as omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole suppress gastric acid secretion by inhibiting the H ' K -ATPase enzyme system on the surface of the parietal cell. Proton-pump inhibitors are used to treat gastroesophageal reflux and peptic ulcers. Omeprazole has been shown to be well-absorbed and to cross the placenta.
Gastric upset, heartburn, nausea, vomiting, anorexia, and gastrointestinal bleeding may occur with salicylate use. Although these drugs are relatively safe when taken as recommended on the label or by the primary health care provider, their use can occasionally result in more serious reactions. Some individuals are allergic to aspirin and the other salicylates. Allergy to the salicy-lates may be manifested by hives, rash, angioedema, bronchospasm with asthma-like symptoms, and ana-phylactoid reactions.
Xanthines have been given to infants at the risk of sudden infant death syndrome or idiopathic apnea of prematurity (see monograph on Theophylline). About 50 of 30 infants treated with caffeine (and 12 of 18 infants treated with theophylline) had significant increases in episodes of gastroesophageal reflux (36). The authors stressed that screening for reflux should precede the administration of caffeine (and theophylline) to infants at the risk of sudden infant death syndrome. As expected, the frequency of adverse effects such as tachycardia and gastroesophageal reflux is lower with lower doses of caffeine for example 2.5 mg kg qds (SEDA-17, 1).
The effect of cisapride 20 mg bd for 7 days in preventing symptoms of gastro-esophageal reflux disease induced by a provocative meal has been assessed in 122 patients who had had symptoms suggestive of gastro-esophageal reflux for at least 3 months (1). Cisapride prevented or reduced the symptoms of heartburn and related symptoms, such as belching and regurgitation. Mild to moderate diarrhea was the main adverse effect. In a randomized, double-blind study in 106 patients with non-ulcer dyspepsia, cinitapride 1 mg tds was as effective as cisapride 5 mg tds in relieving symptoms (2). Adverse events, mainly gastrointestinal, were transient and did not require drug withdrawal. In another randomized study in 28 children (aged 5-17 years) with diabetic gastroparesis, domperidone 0.9 mg kg day for 8 weeks was superior to cisapride 0.8 mg kg day in reversing gastric emptying delay and gastric electrical abnormalities, as well as in improving dyspeptic symptoms and diabetic control (3). No...
The effects of cisapride on the QTc interval, heart rate, and cardiac rhythm were reported in a controlled study of 83 infants aged 2-54 months who received cisapride for a minimum of 4 days for gastro-esophageal reflux and 77 controls, using continuous bipolar limb lead electrocardiography for 8 hours (8). The QTc interval was significantly prolonged by cisapride in infants under 3 months old. There was no significant difference in heart rates and there were no dysrhythmias. None of the infants was receiving drugs that inhibit the hepatic metabolism of cisapride via CYP3A4. The effect of cisapride 0.8 mg kg day for 14 days on the QTc interval has been studied prospectively in 50 infants with feeding intolerance, apnea, and bradycardia episodes secondary to gastro-esophageal reflux and gastrointestinal dysmotility (9). In 15 infants there was prolongation of the QTc interval at some time during the 14 days. Infants with a QTc interval on day 3 at least two standard deviations above...
What is of interest is why some women have them and others don't. Again, for many the answer is cultural and psychological. There have been some studies that suggest that there is a strong genetic tie for ability to orgasm. These studies did not look at DNA, but instead considered twins. Basically, they asked female twins about their orgasms and then did some statistical corrections for environment. They concluded that there was very strong evidence that some of the ability was inherited in identical twins. This is pretty lame evidence, but you have to understand that these sorts of studies are commonly used to see if there is justification for conducting more detailed (and expensive) DNA-based studies. There is certainly reason to believe that there are variable biological underpinnings to the big O, but in our uptight society geneticists can rarely, if ever, get funding to look at anything even remotely related to sex. So the orgasm gene may very well be there. Until we have some...
There is a risk of gastroesophageal reflux during nasogas-tric feeding, especially in mechanically ventilated and sedated patients (1). Gastroesophageal reflux during enteral nutrition is caused by a number of factors, including the presence of the nasogastric tube, the supine position, leakage from the tube at the teeth, and the administration of sucralfate. While the cause in this case was not entirely clear, it does show that mechanical obstruction of the esophagus due to reflux can occur without any obvious symptoms.
A catalepsy effect from marijuana may become stronger in mice if they also receive flurazepam, but the reason is unclear. Alcohol and flurazepam boost some of each other's effects. Experimenters find that caffeine can lessen flurazepam's adverse next-day effects on performance. The heartburn medicine cimetidine lengthens the time that flurazepam's metabolite de-salkylflurazepam stays in the body. In a monkey experiment, that metabolite
The DU-MACH study assessed the efficacy of two omeprazole-based triple therapies (omeprazole, amoxicil-lin, clarithromycin versus omeprazole, metronidazole, clarithromycin) given for 1 week to 149 patients for eradicating H. pylori, healing duodenal ulcers, and preventing ulcer relapse over 6 months after treatment (4). Both regimens achieved high eradication rates (about 90 ) and were well tolerated. Adverse effects were similar in the two groups, and included diarrhea, taste disturbance, headache, nausea, and dyspepsia.
Erythromycin is a motilin receptor agonist (2-4). Azithromycin also produced a significant increase in postprandial antral motility (5). Clarithromycin is also prokinetic, as shown in 16 patients with functional dyspepsia and Helicobacter pylori gastritis (6). For this reason, the macrolides have been used to treat gastroparesis (7).
C Recognize the problem (adapted from Intagliata 1979). What clues indicate a problem You get clues from your body (e.g., indigestion, craving), your thoughts and feelings (e.g., feelings of anxiety, depression, loneliness, fear), your behavior (e.g., have you been meeting your own behavioral standards ), the way you respond to others (e.g., anger, lack of interest, withdrawal), and the way others respond to you (e.g., they appear to avoid you, criticize you).
Nitazoxanide 0.5 g bd and 1 g bd was given to 16 healthy volunteers for 7 days with food to study its pharmacoki-netics and tolerability (2). The pharmacokinetics of both tizoxanide and tizoxanide glucuronide were only slightly influenced by repeated administration of nitazoxanide 0.5 g bd the treatment group had no more adverse events than the placebo group and there was no accumulation. In contrast, repeated administration of nitazoxanide 1 g bd resulted in a significant increase in adverse events diarrhea (n 9), abdominal pain (n 9), flatulence (n 5), nausea (n 4), and dyspepsia (n 1). All reported discolored urine. Four subjects in the high-dose group reported headaches. Vital signs, electrocardiograms, and laboratory tests were normal. There was accumulation of nitazoxanide metabolites, because of solubility-limited or transport-limited elimination at the higher dose of nitazoxanide.
The efficacy and adverse effects of Nias-pan have been studied in 32 patients with type 2 diabetes (22C). Of 22 patients who completed 6 months of therapy, 17 received 1000 mg day, three 1500 mg day, and two 2000 mg day. Seven of 32 patients discontinued therapy. Of these, three withdrew after 2, 5, and 6 months because of flushing and itching. Three other patients withdrew within 2 months because of nausea, diarrhea, and dyspepsia. One patient withdrew after 7 days because of increased blood glucose concentrations. There were no significant increases in mean transaminase activities, which remained within the reference ranges in all patients.
In 2003, the pharmaceutical manufacturer AstraZeneca requested and obtained approval from the FDA to change its prescription heartburn medication, Prilosec, to over-the-counter status. This change was requested at the time the patent for Prilosec was about to expire. Simultaneously, AstraZeneca introduced a new prescription drug, Nexium, which is therapeutically comparable to Prilosec, although with a slightly different dosing format.
An uncontrolled retrospective study of patients who had taken proton pump inhibitors for an average of 33 months found gastric polyps in 17 of 231 patients who underwent two or more endoscopies for complicated gastro-esophageal reflux disease (33). The polyps were generally small (under 1 cm), sessile, and multiple, and were present in the proximal or mid gastric body. Of the 15 polyps removed endoscopically, nine were fundic gland type, four were hyperplastic, and two were inflammatory. None had any dysplasia or carcinoma.
Rabeprazole 10 and 20 mg day in the morning were effective in erosive or ulcerative gastro-esophageal reflux disease, gastric and duodenal ulcers, and long-term maintenance of gastro-esophageal reflux disease healing (1). Healing rates were equivalent to those with omepra-zole and superior (gastro-esophageal reflux disease healing and duodenal ulcer healing) or equal (gastric ulcer healing) to ranitidine. In an open study in 189 patients rabeprazole 20 mg day for 4 weeks was effective in functional dyspepsia (3). The incidence of adverse events was 8 , and included dys-geusia, diarrhea, constipation, and headache. In an open, multicenter trial in 2579 patients with erosive gastro-esophageal reflux disease, rabeprazole 20 mg day for 8 weeks relieved symptoms in most patients (in over 60 by day 1 and over 80 by day 7) (8). Rabeprazole was well tolerated, and the most common adverse effects were headache, diarrhea, abdominal pain, and nausea, each reported by under 2 of the patients. In...
Skin disorders are frequent (40 of all reported effects), and fixed drug eruption has occurred (SEDA-18, 107). Diarrhea (10 ) and upper gastrointestinal symptoms (including dyspepsia, nausea, vomiting, gastric pain, and ulcer) (6 ) are common (SEDA-19, 98). Hepatitis has been described with positive rechallenge. Six patients with pulmonary infiltrates, possibly caused by tolfenamic acid, were reported to the Finnish National Centre for Adverse Drug Reaction Monitoring over a 12-year period. In some patients with hemolytic anemia, a positive Coombs' test and antinuclear antibodies suggested an immunological mechanism (SEDA-13, 83).
Uses In Malaysia, a paste of Hedyotis capitellata Wall. ex G. Don. is used to counteract snake-poisoning, heal broken bones and to soothe inflammation. A decoction of the roots is used to invigorate health and to promote digestion. A decoction of the whole plant is used to treat colic, assuage heartburn, treat dysentery and lumbago, and to promote recovery from childbirth.
A tetrahydroisoqunoline-based compound, YH-1885, discovered by Yuhan, is currently one of the most clinically advanced reversible proton-pump inhibitors (170). It is now being codeveloped with GlaxoSmithKline for stomach ulcers and gastroesophageal reflux disease. Clinical data on YH-1885 have demonstrated that it is safe and well tolerated when administered as a single dose (60 to 300 mg) or multiple doses (150 to 300 mg) to healthy volunteers. The compound significantly increased gastric pH and increased the fraction of time above pH 3 at doses above 150 mg. During multiple dosing, YH-1885 exhibited a reversible mode of action with no significant
Increase muscle mass or height Quality of life improvement Incontinence Impotence Influenza Lifestyle Postpone menstruation Smoking cessation Contraception Weight control Dyspepsia Sun protection Psychological Anti-depression Obsessive-compulsive disorder Social anxiety disorder
The efficacy, speed of action, and acceptability of ispa-ghula husk, lactulose, and other laxatives in the treatment of simple constipation in 394 patients have been studied by 65 general practitioners (3). Ispaghula was used by 224 patients and other laxatives by 170. After 4 weeks of treatment ispaghula husk was assessed by the GPs to be superior to the other laxatives. In patients' assessment, ispaghula users had a higher proportion of normal stools and less soiling than patients using other laxatives. Diarrhea and abdominal pain and gripes and were less common with ispaghula. Distension, flatulence, indigestion, and nausea were equally frequent in the two groups.
Promoted by the intense peristaltic contractions of the stomach antrum. In general, vagal stimulation increases the force and frequency of contractions, whereas sympathetic stimulation decreases both of these parameters. The endocannabinoid anandamide has recently been shown to attenuate cholinergically mediated contractions of isolated rat gastric smooth muscle preparation produced by EFS (Storr et al., 2002). Anandamide also attenuated nonadrenergic, noncholinergic-mediated relaxant neural responses (in the presence of atropine and guanethidine) produced by EFS in this preparation. Because the depressant effects of anandamide were countered by the CB1 antagonist AM630, it is suggested that CB1 receptors play an important role in the attenuation of excitatory cholinergic and inhibitory NANC neurotransmission in the rat isolated gastric fundus preparation. The aminoalkylindole cannabinoid WIN55212-2 also produces similar depressant effects in this fundus preparation. However, AM630...
Close to 30 drugs were reclassified from prescription to OTC status during the OTC Drug Review (24). Some of the common OTC cough cold actives such as diphenhydramine, brompheniramine, chlorpheniramine, and pseudoephedrine, together with hydrocortisone, were switched during that time. The switch can go in both directions. Meta-proterenol sulfate inhaler was switched by FDA during the OTC Drug review and was later reversed back to prescription status because of the objection of the medical community. Today Rx-to-OTC switch is achieved by submitting an NDA for the same indication or new indications or new dose. Three-year market exclusivity will be granted to the sponsor if new clinical studies that are essential to the switch of an existing prescription product are conducted (31, 32). All the H2 blockers that were switched received this type of exclusivity because additional studies were conducted to support the heartburn prevention claims. Five years exclusivity will be granted for a...
Primary esophageal histoplasmosis must be considered in patients who have a history of gastroesophageal reflux disease and are immunosuppressed by long-term glucocorticoids (SEDA-22, 450) (287). Oropharyngeal candidiasis is a well-described adverse effect of inhaled glucocorticoids. However, few cases of esophageal candidiasis have been reported (SEDA-22, 179).
Next we designed an experiment with mice to find out how garlic powder worked against living bacteria in the intestine. Briefly, 1 of garlic powder in water was administered orally to mice by catheter once daily for three days, and the number of living bacteria in feces were counted. It was found that oral administration of garlic powder worked effectively in vivo to reduce the number of living bacteria in the intestine (Table 4.4). This result suggests that garlic (powder) probably works in vivo against an invading pathogen. However, it is not recommended to take raw garlic in large doses, because it can cause numerous symptoms, such as stomach disorders, heartburn, nausea, vomiting, diarrhea, and others.
During prcgnancy, motility changes occur throughout the gastrointestinal tract. These changes are largely attributed to increased levels of progesterone and estrogen. The mechanisms promoting gastroesophageal reflux during gestation primarily involve decreased lower esophageal sphincter (LF.S) pressure and a decrease in the sphincter's adaptive responses, but mechanical factors may also be important. Gastroesophageal reflux and heartburn are common during pregnancy. In mild cases, lifestyle and dietary modifications alone may
Different doses of ranitidine (150 mg bd and 300 mg bd for 8 weeks) have been compared in resolving heartburn in 271 patients with gastro-esophageal reflux disease who had been symptomatic after 6 weeks of therapy with ranitidine 150 mg bd (24). Less than 20 of the patients in either group had complete resolution of heartburn at 4 and 8 weeks there was no significant difference in the efficacy between the two treatment groups. At least one adverse event was reported by 38 of the patients in each group. They included sinusitis, nausea, abdominal pain, dyspepsia, constipation, and increased liver enzymes.
Pseudomembranous colitis has been reported in a 86-year-old woman with non-ulcer dyspepsia a few days after she had taken triple eradication therapy (omeprazole 20 mg bd, metronidazole 400 mg tds, and clarithromycin 500 mg bd) she recovered after treatment with oral vancomycin (42A). The adverse effects of sulfasalazine 2-3 g day and mesalazine 1.2-2.4 g day in 685 patients have been reviewed for a median follow-up period of 7 and 5 years respectively (50c). Adverse effects were observed overall in 20 of patients taking sulfasalazine and 6.5 of those taking mesalazine. The commonest adverse effects due to sulfasalazine (reported by more than 10 of patients) were dyspepsia, rash, and headache, while the commonest due to mesalazine were rash, diarrhea, headache, fever, abdominal pain, impaired renal function, dyspepsia, and edema. Fertility was affected in all 42 male patients taking sulfasalazine who were assessed, but improved when they changed to mesalazine.
The use, efficacy, and adverse effects of non-prescription H2 receptor antagonists and alginate-containing formulations obtained from community pharmacies have been evaluated in 767 customers with dyspepsia (3). Most obtained some or complete symptom relief (75 ) and were completely satisfied with the product (78 ). H2 receptor antagonists were more likely to produce complete relief of symptoms than alginate-containing formulations. Only 3 reported adverse effects diarrhea, constipation, bloating, and flatulence from alginate formulations, and dry mouth, altered bowel habit, diarrhea, and constipation from H2 receptor antagonists.
Pharmaceutical interest Classical examples of Aristolochiaceae are Aristolochia reticulata (serpentary, red river snakeroot, and Texan snakeroot) and Aristolochia serpentaria (Virginian snakeroot), both of which are used to treat dyspepsia, considering their bitterness. Other examples are Aristolochia clematis (birthwort) and Asarum europeaum which were used in European medicine. The dried rhizomes, roots and leaves of Asarum europeaum (asarabaca) are used to induce vomiting, relieve the bowels of costiveness, and assuage headache, and are listed in the Spanish Pharmacopoeia 1954.The sodium salt of aristolochic acid has been given peros to treat a number of inflammatory conditions, but it is nephrotoxic in humans and in animals, as well as carcinogenic in rodent. About 20 species of plants classified within the family Aristolochiaceae are used for medicinal purposes in the Asia-Pacific. These are often used to counteract snake-poisoning, promote urination and menses, assuage...
The adverse effects of a single dose of silde-nafil 50 mg have been evaluated in a placebo-controlled study in 40 young healthy volunteers (5c). The most commonly reported adverse effects with sildenafil and placebo respectively were flushing (75 and 0 ), headache (50 and 5 ), and dyspepsia (15 and 5 ). This adverse effects profile was similar to that observed in clinical trials. Heart rate changed significantly, but blood pressure did not.
Bhang or Hashish is prepared from the dried leaves and flowers of both male and female plants, wild or cultivated, by infusing them with milk and other ingredients. It is given in dyspepsia, gonorrhea, bowel complaints, and also as an appetizer and a nerve stimulant. The dose of the dried leaves is one-fourth to two grains, and they may be used even without infusing them.
An increased incidence of GERD has been linked to the decrease in H. pylori infection produced by the current trend of eradication therapy. H. pylori may have a protective role by either reducing achlorhydria induced by PPIs or by increasing the activity of PPIs by increasing the formation of the active metab esophagitis is a disorder of the defense mechanisms at the esophagealjunction, which is caused by regurgitation of the gastric contents, especially of gastric acid. GERD is associated with decreased gastric emptying and or increased incidence of transient lower esoph-ageal relaxation (T-LESR). Smoking and obesity are factors that increase the incidence cf GERD-like symptoms such as heartburn, belching, and bloating. Reflux has been observed in humans and dogs but not in rodents. can be subdivided into T-LESR. free reflux, and stress reflux. H. pylori infection does not necessarily correlate with GERD, although a reduction in acid secretion reduces the chances of reflux. The...
Lansoprazole 30 mg day and omeprazole 20 mg day for 8 weeks have been compared in the relief of heartburn in a multicenter, randomized, double-blind trial in 3510 patients with erosive esophagitis (27C). Symptom control was significantly more effective and faster with lansoprazole than omeprazole. Both drugs were well tolerated. The most common adverse effect was diarrhea. Rabeprazole 10 mg bd or 20 mg day, omeprazole 20 mg day, and placebo for 7 days in reducing esophageal acid exposure have been compared in a multicenter, randomized, double-blind trial in 82 patients with symptomatic gastro-esophageal reflux disease (28C). Esophageal pH was monitored for 24 hours before treatment and on day 7. Esophageal acid exposure was significantly reduced in all the treatment groups compared with placebo, with no significant difference in efficacy. Both rabeprazole and omeprazole were well tolerated. The most commonly reported adverse effects were diarrhea, abdominal pain, nausea, and headache.
A review of miglitol included data on adverse effects in 3585 patients in well-designed clinical trials (34). Only the adverse effects in the gastrointestinal tract occurred with a significantly greater incidence with miglitol 50 or 100 mg tds. The adverse effects were the same as with other drugs in this class flatulence, diarrhea, dyspepsia, and abdominal pain. There were no differences with monotherapy or combination therapy or in relation to age or ethnicity. There were more episodes of hypoglyce-mia when miglitol was combined with insulin but not with oral agents. The incidence of cardiovascular events was the same as with placebo.
Effects Contains cineole, a mild central nervous system stimulant, which may account for its reputation in Arab cultures as a male aphrodisiac. Cineole also kills bacteria that cause bad breath, and cardamom has been used to treat asthma, emphysema, gas, heartburn, acid indigestion, laryngitis, and vaginitis. Cardamom also contains the compound borneol, which is helpful in treating gallstones.
It is said to be good for abdominal pains, chills, colic, coughs, cramps, diarrhea, gastrointestinal problems, headache, heartburn, indigestion, insomnia, migraine headaches, nausea, nervousness, poor appetite, rheumatism, and spasms. Precautions It can worsen heartburn and gastroesophageal reflux disease, or acid reflux. Overdosage may cause heart problems.
Effects An antioxidant which also prevents the breakdown of acetylcholine. It acts as a stimulant and improves blood circulation, and Amay relieve mental fatigue, insomnia, and depression, and improve memory. It can protect the liver against toxins, and is also used by herbalists to treat colic, fevers, gas, headaches, high or low blood pressure, indigestion, menstrual cramps, and nausea.
Precautions It can cause heartburn or, less frequently, cramps. Rare symptoms include hives, rash, and difficult breathing. There are no known overdose symptoms, though initial large doses can cause temporary diarrhea. Taken by itself over an extended period of time may increase the need for B-l, leading to neuritis. There is no known toxicity. It should not be taken by those who are allergic to pantothenic acid, and those with hemophilia should consult a physician first.
Precautions People with ulcers, cardiovascular problems, or liver problems (xanthinol nicotinate can cause liver dysfunction) should avoid taking it. There may be minor reactions such as blurred vision, diarrhea, headaches, heartburn, heart palpitations, itchy skin, muscle cramps, nausea, skin flushing or a sense of warmth, skin rash, skin-color changes, or vomiting these generally disappear with continued use or when use is discontinued. It may cause postural hypotension, or a sudden drop in blood pressure when going from a sitting to a standing position.
Adverse reactions seen with the sulfonylureas include hypoglycemia, anorexia, nausea, vomiting, epigastric discomfort, weight gain, heartburn, and various vague neurologic symptoms, such as weakness and numbness of the extremities. Often, these can be eliminated by reducing the dosage or giving the drug in divided doses. If these reactions become severe, the health care provider may try another oral antidiabetic drug or discontinue the use of these drugs. If the drug therapy is discontinued, it may be necessary to control the diabetes with insulin.
In some instances, excessive oral use may produce nausea and vomiting. Some individuals may use sodium bicarbonate (baking soda) for the relief of gastric disturbances, such as pain, discomfort, symptoms of indigestion, and gas. Prolonged use of oral sodium bicarbonate or excessive doses of IV sodium bicarbonate may result in systemic alkalosis.
Other adverse effects include heart palpitations, high blood pressure, muscle twitches, rapid heartbeat, low blood sugar, nervousness, insomnia, increased urination, anxiety, indigestion, increased production of gastrointestinal acid, rectal itching, constipation, impaired concentration, a weakened immune system, bladder irritation and urinary problems (especially in women), and interference with DNA replication. It has been shown to trigger panic attacks in susceptible people which it does by lowering the body's production of DHEA and increasing its production of cortisol and interfere with the ability to sleep in most coffee drinkers. Decaffeinated coffee still contains some caffeine and can also cause these symptoms. More severe and infrequent symptoms include confusion, nausea, stomach ulcers, indigestion, and a burning feeling in the stomach. Overdose symptoms include excitement, insomnia, rapid heartbeat, confusion, fever, hallucinations, convulsions, and coma.
The effect of cisapride 0.2 mg kg tds for 8 weeks on cardiac rhythm has been studied in a placebo-controlled, double-blind trial in 49 children aged 0.5-4 years with gastroesophageal reflux resistant to other medical therapy (2C). None had underlying cardiac disease or electrolyte imbalance. Cisapride had no effect on cardiac electrical function. However, in a prospective study cisapride 2 mg kg qds given for 72 h to 10 premature infants caused a significant increase in the QTc interval compared with pretreatment values (3c). The relation between cisapride plasma concentrations, QTc interval, and cardiac rhythm has been evaluated in a controlled study in 211 infants undergoing routine 8-hour polysomnography (4C). Cisapride was given for at least 4 days. At comparable doses of cisapride and comparable plasma concentrations, the QTc was significantly higher in infants below 3 months of age. A dose-ranging, randomized, placebo-controlled, multicenter trial has been performed in 320...
In 517 patients taking a modified-release formulation the most commonly reported adverse events were headache in 92 patients, pain in any part of the body except the abdomen in 46, abdominal pain in 54, diarrhea in 97, dyspepsia in 46, nausea in 72, vomiting in 38, rhinitis in 30, pruritus in 56, and rash in 51 (24). The efficacy and adverse effects of a modified-release formulation have been studied in 32 patients with type 2 diabetes (42). Of 22 patients who completed 6 months of therapy, 17 took 1000 mg day, 3 1500 mg day, and 2 2000 mg day. Seven of 32 patients discontinued therapy. Of these, three withdrew after 2, 5, and 6 months because of flushing and itching. Three other patients withdrew within 2 months because of nausea, diarrhea, and dyspepsia. One patient withdrew after 7 days because of increased blood glucose concentrations. There were no significant increases in mean transaminase activities, which remained within the reference ranges in all patients.
In a randomized, placebo-controlled, four-way, crossover study of the effects of low-dose raniti-dine and an antacid on meal-induced heartburn and acidity in 26 subjects, ranitidine 75 mg significantly reduced gastric but not esophageal acidity, calcium carbonate 420 mg significantly reduced esophageal but not gastric acidity, and ranitidine plus calcium carbonate reduced both esophageal and gastric acidity (22c). Both drugs given alone reduced heartburn severity compared with placebo.
The use of rabeprazole in acid-related disorders has been reviewed (40R). Rabeprazole has proven efficacy in healing, symptom relief, and prevention of relapse of peptic ulcer and gastro-esophageal reflux disease and can form part of effective Helicobacter pylori eradication regimens. It was generally well tolerated in both short-term and long-term studies of up to 2 years. Headache was the most important reported adverse effect. Other commonly reported adverse effects were diarrhea, rhinitis, nausea, pharyngitis, abdominal pain, and flatulence. The changes in serum gastrin concentrations were consistent with proton pump inhibitor pharmacology, and no study has reported mean values at end-point that were outside the reference range. In controlled trials, the frequency of abnormalities of hepatic amino-transferases was similar to that of placebo. Scoring of enterochromaffin-like cells in gastric biopsies taken prospectively from patients in studies of up to 2 years have shown some...
Common side effects include abdominal or stomach discomfort, nausea, breathing problems, constipation, gas, diarrhea, and ulcers. Less common side effects include difficulty in swallowing, muscle pain, and headache. Rare side effects include taste perception changes and vomiting. Overdose symptoms include upset stomach, heartburn, throat irritation, ulcer, and low levels of calcium and phosphate in the blood.
Of alosetron in patients with functional dyspepsia. Aliment Pharmacol Ther 2001 15 525-37. 21. Paul K, Redman CM, Chen M. Effectiveness and safety of nizatidine, 75 mg, for the relief of episodic heartburn. Aliment Pharmacol Ther 2001 15 1571-7. 22. Robinson M, Rodriguez-Stanley S, Ciociola AA, Filinto J, Zubaidi S, Miner PB Jr, Gardner JD. Synergy between low-dose ranitidine and antacid in decreasing gastric oesophageal acidity and relieving meal-induced heartburn. Aliment Pharmacol Ther 2001 15 1365-74. 25. Richter JE, Kahrilas PJ, Johanson J, Maton P, Breiter JR, Hwang C, Marino V, Hamelin B, Levine JG. Efficacy and safety of esomeprazole compared with omeprazole in GERD patients with erosive esophagitis. A randomized controlled trial. Am J Gastroenterol 2001 96 656-65. 27. Richter JE, Kahrilas PJ, Sontag SJ, Kovacs TOG, Huang B, Pencyla JL. Comparing lansoprazole and omeprazole in onset of heartburn relief. Results of a randomized, controlled trial in erosive esophagitis patients....
The therapy for gastric acid-related gastrointestinal disorders has evolved from nonspecific gastro-protective agents to treatments directed at specific sites regulating the secretion of gastric acid. H2-receptor antagonists and PPIs are currently the major therapies used to inhibit the production of gastric acid. The discovery that H. pylori infection was highly correlated with the presence of duodenal ulcer and hypersecretion of gastric acid has introduced an additional therapy that targets the eradication of H. pylori. This combination therapy of an antisecretory agent and an antibiotic has been shown to dramatically reduce the number of patients in which ulcer formation recurs (1).The incidence of upper gastrointestinal disorders such as ulcer and GERD shows an element of global variation. For example, in Western countries duodenal ulcers are more common, whereas in Eastern countries gastric ulcers predominate (2).These dif- * ferences may be attributable to any of a number of...
Krska J, John DN, Hansford D, Kennedy EJ. Drug utilization evaluation of nonprescription H2-receptor antagonists and alginate-containing preparations for dyspepsia. Br J Clin Pharmacol 2000 49(4) 363-8. 7. Friis H, Bode SH, Rumessen JJ, Gudmand-Hoyer E. Dimetikon ved laktuloseindusceret dyspepsi. Effekt pa H2-produktion og symptomer. Dimethicone in lactulose-induced dyspepsia. Effect on H2 production and symptoms. Ugeskr Laeger 1993 155(42) 3378-80.
To assess symptom control, esomeprazole 20 mg on demand has been compared with placebo on demand (maximum of one dose a day) for 6 months in a multicenter, doubleblind study in 342 endoscopy-negative patients with gastro-esophageal reflux disease (30C). There was complete resolution of heartburn after 4 weeks of daily esomeprazole therapy. On-demand therapy with esomeprazole was significantly more effective than placebo in controlling symptoms. The frequencies of adverse effects and laboratory profiles were similar in the two groups when adjusted for the time spent in the study.
Precautions It may create symptoms of toxicity when taken alone these may be alleviated when taken in combination with Aldosterone. It is recommended that those with cardiovascular problems (particularly hypertension and angina pectoris) should not use vasopressin, as it narrows the blood vessels. Some say that angina patients will experience heart pain Pearson and Shaw discourage use in such cases. It should also be avoided by those with kidney disease and epilepsy. For others, it occasionally results in nasal congestion, runny nose, itching or irritation of nasal passages, nasal ulcerations, abdominal cramps, heartburn, nausea, headaches, and more frequent bowel movements. Vasopressin should be snorted into the upper nasal cavities, as inhaling it deep into the lungs may trigger spasms of the larynx and shortness of breath.
The use of omeprazole in the treatment of acid-related disorders in children has been reviewed (32R). Different formulations of the drug have been used in children aged 2 months to 18 years for the treatment of erosive esophagitis, gastric and duodenal ulcer, Helicobacter pylori infection, and related conditions in dosages of 5-80 mg day (0.2-3.5 mg kg day). The initial dose most consistently reported to heal esophagi-tis and relieve symptoms of gastro-esophageal reflux disease appears to be 1 mg kg day. Omeprazole was well tolerated during both acute and chronic use. Omeprazole, in a starting dose of 0.7 mg kg day, was effective in the treatment of severe esophageal reflux after failed fundoplication in 18 children (mean age at presentation 7.8 years) over a mean follow-up period of 4.4 years (33c). It was also well tolerated. A hyperplastic polyp was noted in one child after 38 months of treatment and persisted without any dysplastic change. One to three gastric nodules were seen in...
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