Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Histamine-2 (H2) receptor antagonists/blockers are considered the first-line agents for patients who have mild to moderate symptoms
of GERD. Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac) are examples of H2 blockers. Several of these drugs are available over-the counter and can be purchased without a prescription in low doses to treat mild, occasional heartburn. Higher doses require a doctor's prescription.
How H2 blockers work: These drugs decrease the amount of acid produced by the stomach.
Who should not use these medications: Individuals who have experienced an allergic reaction to H2 blockers should not take them.
Use: Various dosage regimens are used. If using an over-the-counter nonprescription product, carefully follow the directions for use on the package. For prescription-strength products,
the doctor will instruct the patient on how to take the medication. H2 blockers are available in tablet, capsule, and oral liquid forms.
Drug or food interactions: Many drugs interact with H2 blockers (particularly with cimetidine). If
taking other medications, ask a doctor or pharmacist for information on interactions with H2 blockers. These drugs decrease the body's ability to excrete caffeine. Individuals who consume large quantities of caffeine may experience tremors, insomnia, or
heart palpitations. Cimetidine may increase the likelihood of alcohol intoxication.
Side effects: Confusion, depression, and hallucinations have been reported, particularly in elderly individuals or those who are unable to adequately excrete the drugs (for example, people with kidney disease). High doses taken over a long period of time have caused breast enlargement and sexual dysfunction in men. Rarely, H2 blockers cause liver toxicity or decreased platelet counts. (Platelets are blood cells that form clots and decrease bleeding.) If you take these drugs regularly,
a doctor will monitor the patient's blood for adverse effects.
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