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Peptic Ulcers (cont.)

Peptic Ulcer Medications

Several types of medications are used to treat ulcers.

Antacids: These nonprescription medications simply neutralize acid.

  • Most include aluminum hydroxide combined with magnesium or calcium. Examples are Maalox, Mylanta, Tums, and Rolaids.
  • These can cause constipation, although those containing magnesium can cause diarrhea.
  • These effects are especially likely if the medications are taken regularly.

Histamine (H2) blockers: These are acid-blocking medications widely used in the treatment of peptic ulcers.

  • H2 blockers include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid).
  • They prevent production of acid by blocking histamine, a chemical that promotes acid production.
  • Nonprescription strengths are available, but for most people the stronger prescription version are needed.
  • H2 blockers work very well at reducing acid and pain. (Reducing acid helps the ulcers heal.)
  • They may take a few days to start having an effect.
  • Treatment with H2 blockers usually takes 6-8 weeks.

Acid pump inhibitors: These drugs are also known as proton pump inhibitors (PPIs).

  • This group includes omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protnoix).
  • Acid pump inhibitors are even stronger than H2 blockers.
  • They work by stopping the "pump" that secretes acid into the stomach.
  • They are being used increasingly in triple and double regimens for infection.

Protective agents: These drugs do not affect the amount of acid in the stomach; instead, they protect the mucous lining of the stomach from acid.

  • One type is very thick and sticks to the ulcer, forming a physical barrier between the ulcer and the acid. An example is sucralfate (Carafate).
  • The other type increases the amount of mucus, which forms a physical barrier, and bicarbonate, which helps neutralize the acid. An example is misoprostol (Cytotec); this agent is used only for treatment of ulcers caused by medication.
  • Antacids and products containing bismuth subsalicylate (such as Pepto-Bismol) also have protective effects.

Antibiotics: As part of a combination regimen, antibiotics eradicate H pylori, the bacteria that causes ulcers in many people.

  • A 2 week triple therapy that includes two antibiotics and bismuth subsalicylate is the most effective regimen. It eliminates the bacteria and prevents recurrence of ulcers in 90% of people who receive this treatment. Unfortunately, triple therapy has side effects such as upset stomach, nausea, vomiting, bad taste in the mouth, loose or dark stools, dizziness, and yeast infections in women.
  • Any of several 2 week dual therapy regimens are simpler to follow, have fewer side effects, and work in about 80% of people who take them.
  • A newer triple therapy combining antibiotics and rabeprazole (Aciphex) works in just 1 week to eradicate H pylori.
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