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Clinician’s Corner: ‘Stomach Drugs’

Back in November we talked about the fact that Tagamet was the first billion-dollar drug.  The second drug to reach the billion-dollar drug rank was Zantac. By 1990 Zantac hit the two-billion-dollar mark.  In the 1980’s there was a lot of interest in developing drugs for peptic ulcers, along with gastroesophageal reflux disease (GERD).  A lot of us believe that the proliferation of these “stomach drugs” parallels the exponential increase in restaurants and fast food—especially on Plank Road in Altoona!  We’ll wrap the last of the stomach drugs of the 1980’s three drugs with unique mechanisms of actions.

SUCRALFATE    (Carafate®)      approved October 1981

Indications: indicated in the short-term (up to 8 weeks) treatment of active duodenal ulcer. Because it does not suppress acid formation or release it is minimally effective for GERD.

Mechanism: Sucralfate protects the lining of the stomach. It binds to the injured tissue and protects it from pepsin and acid.

Warnings/precautions/adverse effects

  • Constipation, metallic taste, high phosphate levels
  • Because it is dosed 4 times a day it might be difficult to remember to take all of the doses.

Drug interactions – the aluminum salt is responsible for the impairment in the absorption of several drugs.  Ask your Thompson pharmacist to check your medication profile especially for interactions with certain antibiotics, thyroid medications or seizure medications.

What you should know:

Sucralfate should be given on an empty stomach about half hour before meals to “coat” the lining of the stomach.

Reglan® (metoclopramide)                   approved December 1980

Indications: short term use (4-12 weeks) for GERD who fail to respond to conventional therapy. Also, used for diabetic with slow stomach activity.  Interestingly metoclopramide can be used to improve lactation, in nursing mothers.

Mechanism: causes an increase in the movement of the stomach and its contents.

What you should know:

  • Do not use for more than 12 weeks.
  • Dosed 5mg-10mg four times daily 30 minutes before meals and bedtime
  • Report any signs of tremor. A local neurologist tole me “Pete, before I check a suspected patient for Parkinson’s disease I always check the med list and look for metoclopramide”

MISOPROSTOL   (Cytotec®)        Approved December 1988

Indications: is used to prevent stomach ulcers from non-steroidal anti-inflammatory drugs like ibuprofen  (Motrin), naproxen (Aleve), aspirin and prescription arthritis drugs.

Mechanism: helps restore the protective hormones (prostaglandins) in our stomach to prevent ulcers.

Warnings/precautions/adverse effects

  • Pregnancy Category-X: it causes contractions of the uterus.
  • Diarrhea, abdominal pain up to 40% (usually dose related-take with food)
  • Use Contraceptives in female patients
  • Must have negative pregnancy test in the past 2 weeks.

As we have learned the past couple of months your Thompson Pharmacist is the best resource available for stomach acid conditions like GERD.  Patients can be left on these medications too long and cause other problems.  Go ahead and ASK… at Thompson Pharmacy it’s all for YOU!