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heart burn



Antacids Part II 
We Highly Recommend You to Review Part I
Bismuth subsalicylate (Drug information)
Category and Usage
Bismuth subsalicylate relieves symptoms of gastrointestinal upset stomach caused by over indulgence in food and drink, including heartburn, nausea, fullness, belching, and gas.
Bismuth subsalicylate provides relief primarily by adhering to the mucosa (thin layer of cells lining the stomach wall) of the stomach and protecting it from direct contact with stomach acid. It has no antacid ability.
Warnings and precautions
Individuals taking anticoagulants (blood thinning drugs) should consult their physicians before use; there may be a temporary darkening of the tongue and stools from use of this drug. Bismuth subsalicylate products do not contain aspirin but could cause an adverse effect in those allergic to aspirin. It should not be used in children or teenagers who have or are recovering from chickenpox or flu-like symptoms (Reye’s syndrome warning).
Reye’s syndrome occurs in children and adolescents under 18 years of age after they have recovered from common viral infections. The risk of developing this condition is increased if aspirin and salicylate drugs are used.
N.B asprine and other analgesics produce a drug induced gastrointestinal symptoms 
Although Reye’s syndrome is relatively uncommon, it is a concern because it affects the liver and brain and may cause death.
Recommended dose
Adults and children over age 12 may take 2 tablets (525 mg) every 30 to 60 minutes, but should not exceed eight doses within 24 hours; children aged 9 to 12 may take one-half the adult dose (1 tablet (262 mg); children aged 6 to 9 may take two-thirds of the adult dose (175 mg); children aged 3 to 6 may take one-third of the adult dose (88 mg); children under age 3 require recommendation by a physician.


2- Histamine H2-receptor blockers or antagonists. (drug information)
The secretion of the acid in the stomach is triggered by the effect of histamine on its type II receptors in the stomach wall, all H2-blockers take longer to relieve symptoms than antacids, but they have a much longer duration of action. H2-blockers and antacids may be used together.
Category and Usage 
The histamine H2-receptor blockers are used for temporary relief, or prevention of symptoms of heartburn, indigestion, and sour stomach.
Rx–OTC switched drugs
Cimetidine, famotidine, nizatidine, and ranitidine are the H2-blockers available as OTC drugs. One formulation of famotidine combines it with calcium carbonate and magnesium hydroxide, two antacids, to provide both fast and prolonged relief.H2-blockers may be taken before or after meals to prevent or treat gastrointestinal symptoms.
Warnings and precautions
These drugs should not be taken for longer than 2 weeks or given to children under 12 years of age. A physician should be consulted if the symptoms persist or are more severe.
Cimetidine inhibits cytochrome P-450 enzymes (one of the main liver enzymes responsible for metabolism) and patients taking theophylline (medicine used as bronchodilator), phenytoin (anti-convulsion medicine), or warfarin (anti-coagulant medicine) should consult their physician before using cimetidine. Pharmacists should probably recommend the other H2-antagonists as a first choice instead of cimetidine because of its P-450 enzyme-inhibiting action.

3-Proton pump inhibitors.(drug information)
Category and Usage 
Proton pump inhibiting drugs (PPIs) are used for frequent heartburn, which is defined as heartburn that occurs two or more days a week.
Rx–OTC switched drugs
Omeprazole is the only OTC PPI available on the market at this time; however, the FDA approved the switch of lansoprazole
Warnings and precautions
The PPIs should not be taken for longer than 14 days or if symptoms persist or worsen, without consulting a physician. They should not be used by those under 18 years of age. PPIs may cause diarrhea, headache, abdominal pain, or a rash. Omeprazole inhibits the P-450 enzymes and should not be used without physician supervision by anyone taking warfarin (anti-coagulant), diazepam (anti-convulsion) , digoxin (heart failure medication) , ketoconazole (anti-fungal), or itraconazole (anti-fungal).
Recommended dose for gastrointestinal heart burn
Omeprazole, 20 mg, should be taken daily with a glass of water for 14 consecutive days, 15 to 60 minutes before eating breakfast or the first meal of the day. Omeprazole is most effective when taken before eating. This dosage regimen may be repeated once after 4 months if needed. If symptoms are not relieved after a second trial of 14 days of treatment, a physician should be consulted.

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