Gastric Acid Inhibitors Health Article

Proton pump inhibitors

The proton pump inhibitors are also very safe, but have been associated with rare but severe skin reactions. Patients should be sure to report any rash or change in the appearance of the skin when taking these drugs. The following adverse reactions are also possible:

• stomach cramps
• weakness
• chest pain
• constipation
• diarrhea
• dizziness
• drowsiness
• gas pains
• headache
• nausea with or without vomiting
• itching
• blood in urine

The PPIs make some people feel drowsy, dizzy, lightheaded, or less alert. Anyone who takes these drugs should not drive, use heavy machinery, or do anything else that requires full alertness until they have found out how the drugs affect them.

Before using proton pump inhibitors, people with liver disease should make sure their physicians are aware of their condition.

Taking gastric acid reducers with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side effects

The most common side effects of both types of gastric acid reducer are mild diarrhea, nausea, vomiting, stomach or abdominal pain, dizziness, drowsiness, lightheadedness, nervousness, sleep problems, and headache. The frequency of each type of problem varies with the specific drug selected and the dose. These problems usually go away as the body adjusts to the drug and do not require medical treatment unless they are bothersome.

Serious side effects are uncommon with these medications, but may occur. Patients should consult a physician immediately if they notice any of the following:

• skin rash or such other skin problems as itching, peeling, hives, or redness
• fever
• agitation or confusion
• hallucinations
• shakiness or tremors
• seizures or convulsions
• tingling in the fingers or toes
• pain at the injection site that lasts for some time after the injection
• pain in the calves that spreads to the heels
• swelling of the calves or lower legs
• swelling of the face or neck
• difficulty swallowing
• rapid heartbeat
• shortness of breath
• loss of consciousness

Other side effects may occur in rare instances. Anyone who has unusual symptoms after taking gastric acid inhibitors should get in touch with his or her physician.

Interactions

Gastric acid inhibitors may interact with other medicines. When an interaction occurs, the effects of one or both of the drugs may change or the risk of side effects may be increased. Anyone who takes gastric acid inhibitors should give their physician a list of all the other medicines that he or she is taking.

Of the drugs in this class, cimetidine has the highest number of drug interactions, and specialized reference works should be consulted for guidance about this medication.

The drugs that may interact with H₂-receptor blockers include:

• itraconazole (Sporanox)
• ketoconazole (Nizoral)
• warfarin (Coumadin)
• dofetilide (Tikosyn)
• drugs given to open the airway (bronchodilators), including aminophylline, theophylline (Theo-Dur and other brands), and oxtriphylline (Choledyl and other brands)

Drugs that may interact with proton pump inhibitors include:

• itraconazole (Sporanox)
• ketoconazole (Nizoral)
• phenytoin (Dilantin) and other anticonvulsant drugs
• cilostazol (Pletal)
• voriconazole (Vfend)

The preceding lists do not include every drug that may interact with gastric acid inhibitors. Patients should be careful to consult a physician or pharmacist before combining gastric acid inhibitors with any other prescription or nonprescription (over-the-counter) medicine.

BOOKS

"Factors Affecting Drug Response: Drug Interactions." Section 22, Chapter 301 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

"Peptic Ulcer Disease." Section 3, Chapter 23 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Reynolds, J. E. F., ed. Martindale: The Extra Pharmacopoeia, 31st ed. London, UK: The Pharmaceutical Press, 1996.

Wilson, Billie Ann, RN, PhD, Carolyn L. Stang, PharmD, and Margaret T. Shannon, RN, PhD. Nurses Drug Guide 2000. Stamford, CT: Appleton and Lange, 1999.

ORGANIZATIONS

American Society of Health-System Pharmacists (ASHP). 7272 Wisconsin Avenue, Bethesda, MD 20814. (301) 657-3000. <www.ashp.org>.

United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. (888) INFO-FDA. <www.fda.gov>.

OTHER

<www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682256.html>.

<www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601106.html>.

<www.nlm.nih.gov/medlineplus/druginfo/uspdi/500275.html>.

<www.nlm.nih.gov/medlineplus/druginfo/uspdi/202283.html>.

<www.nlm.nih.gov/medlineplus/druginfo/uspdi/202283.html>.

Samuel Uretsky, PharmD