Reflux Medications

The first class of medications designed to reduce acid production in the stomach were called H2 antagonists.  The stomach cells have an “on” switch that is activated by several factors.  One factor is chemical called histamine.  These first medications were designed to block the histamine from turning on the acid production factory in the cell.
 
The initial medication was cimetidine, marketed under the trade name Tagamet.   The second medication was ranitidine, marketed under the trade name Zantac.
 
Both of these medications are now over-the-counter medications.  They have changed the world by markedly reducing the number of ulcers people have developed since these medications became available.  Reducing ulcers occurs because of the decreased acid production in the stomach.
 
A more powerful class of acid-reducing medications is called proton-pump inhibitors.  If the H2 antagonists keep the factory from turning on, these medications shut down the factory altogether. Proton-pump inhibitors reduce acid production about 80%.  Omeprazole was the first to come on the market, and was sold under the trade name Prilosec.  It became famous for the “purple pill” commercials.  You can now get this as an over-the-counter medication.  Another over-the-counter medication in this class is Pepcid AC.
 
Some of the newer proton-pump inhibitors are still available by prescription only.  They include Protonix, Nexium, Aciphex, and Zegarid.  These medications can interfere with other medications, and can have side-effects, so it is important to speak with your physician about taking them.
 
So far, we have talked about medicines that only reduce the amount of acid in the stomach.  Remember that there are other factors.  Sometimes ulcers or gastritis can cause reflux.  Poor gastric emptying can also cause reflux.  A medicine called sucralfate, sold under the trade name Carafate, is used to coat the stomach and help gastritis and ulcers heal.  It may improve reflux as well.  Two medicines are commonly used to improve gastric emptying.  Metoclopramide, sold under the trade name Reglan, improves the pressure at the lower esophageal sphincter and improves gastric emptying.  Another medication, erythromycin, is mainly used as an antibiotic, but also has powerful gastric emptying properties as well.