Acidsuppressive treatment

1. Patients who continue to have symptoms should be offered an acid-suppressive treatment

2. The four available H2-blockers are equally safe and effective. A twice-daily schedule should be used to provide 24-hour acid control.

Agent

Dosage

Histamine-2 blockers: Inhibit gastric acid secretion

Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (Axid) Cimetidine (Tagamet)

150-300 mg bid 20-40 mg bid 150-300 mg bid 400-800 mg bid

Cimetidine may cause impotence and gynecomastia; many drug interactions

Agent

Dosage

Prokinetic drugs: Increase lower esophageal sphincter pressure, increase peristalsis

Cisapride (Propulsid)

Up to 20 mg qid [10 mg]

Mild diarrhea

Proton-pump inhibitors: Inhibit gastric acid secretion

Omeprazole (Prilosec) Lansoprazole (Prevacid)

20 mg qd or bid 30 mg qd

8 weeks of treatment

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