Other medicines

Sucralfate

Sucralfate may be taken as tablets or liquid. It is composed of aluminium hydroxide and sulfated sucrose which forms a protective barrier against the acid, pepsin and bile attack in gastric and duodenal ulcers and lower oesophagus. It shuld be taken as directed by your doctor an hour before, or at least two hours, after a meal.

Possible side effect is constipation.

Anti-Emetics

The job of these drugs is to primarily to reduce nausea. 

For some people, their use may help prevent reflux, manage gastroparesis or relieve bloating.

Domperidone (Motilium), a "dopamine-2 receptor antagonist" is an antiemetic and a prokinetic drug that works by blocking the action of dopamine in the brain, which helps to stimulate the movement of the stomach and intestines helping peristalsis move food boluses from the oesophagus into the stomach and to a lesser extent from the stomach into the intestines. 

Metoclopramide (Reglan) is often prescribed to relieve symptoms such as nausea, vomiting, heartburn, and feelings of fullness after meals. It is better at helping move chyme via the pyloric sphincter into the duodenum.

Note (From 2019 study in Neurogastroenterology & Motility, "Cardiovascular safety of prokinetic agents":

Many prokinetic agents carry a small but increased risk of drug-induced arrhythmia.

Most prokinetic drugs are also tachyphylaxic meaning, with time larger doses may be required to obtain the same effect.

Contra-indicated medication

NSAIDs (Non-Steroidal Anti Inflammatory Drugs)

e.g. Ibiprofen. Naxoprofen, Aspirin

NSAIDs, or Nonsteroidal Anti-Inflammatory Drugs, work by inhibiting the activity of an enzyme called cyclooxygenase (COX) which plays a key role in the synthesis of prostaglandins, which are substances involved in inflammation, pain, and fever. The enzymes are also involved in protection of the stomach lining and regulation of blood clotting.

NSAIDs block the action leading to a reduction in the production of prostaglandins, thus relieving pain but also reducing protection of the lining.

While these medications are effective in managing pain and inflammation, they can also have side effects, such as gastrointestinal irritation or an increased risk of bleeding, particularly with prolonged use or at high doses. It's advisable to use NSAIDs under the guidance of a healthcare professional and to be aware of potential side effects.

If NSAIDS have to be taken by acid refluxers, reducing acid production further by increasing the dose of PPI medication, may be advised.

Celecoxib, sold under the brand name Celebrex among others, a COX-2 inhibitor and nonsteroidal anti-inflammatory drug used to treat the pain and inflammation in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, painful menstruation, etc, awas banned in EU as the clinical benefit of celecoxib has not been sufficiently demonstrated and is outweighed by the increased risk of cardiovascular and gastrointestinal side effects.

Vomovo is a combination of naxoprofen (NSAID) and esomeprazole (PPI). It is further described here.

A review published in 2011 found "In two well designed, 12-week studies, naproxen/esomeprazole fixed-dose combination was noninferior to celecoxib in treating the signs and symptoms of disease in patients with osteoarthritis" and "Two other studies showed that the cumulative incidence of gastric ulcers (primary efficacy measure) was significantly lower with naproxen/esomeprazole than with enteric-coated naproxen alone during up to 6 months' therapy in patients with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis or any other condition requiring daily NSAID therapy. The fixed-dose combination was generally well tolerated in these studies, with an upper gastrointestinal tolerability profile generally better than that of naproxen and similar to that of celecoxib."

Blood thinners 

Used to manage heart conditions etc, anti-platelet medicines like clopidogrel are contra indicated for acid refluxers due to the possibility of increased risk of bleeding from ulceration or gastro-oesophageal inflammation of oesophagitis or gastritis.

Statins

Statins like atorvastatin can interact with PPIs like omeprazole in some people.

The PPI may inhibit the action of the statin, leading to increased levels of atorvastatin in the blood. This interaction could potentially increase the risk of side effects associated with the statin. If both medications are necessary, your doctor may adjust the doses or choose alternative medicines to minimize the risk of interactions. 

Page updated 3 January 2024