Gastroesophageal reflux disease, or GERD, is a condition where stomach contents "reflux," or back up, into the esophagus, producing uncomfortable symptoms such as heartburn, acid taste in the mouth and chest pain. These symptoms can lead to complications such as strictures of the esophagus and even cancer of the esophagus. GERD is initially treated with lifestyle modifications in an attempt to control the disease, but if these methods fail, medical treatment is initiated. Like all medical interventions, they have side effects the patient should be aware of before initiating therapy.
Histamine-2 Receptor Blockers
These medications are also known as H2 blockers, and examples include cimetidine, ranitidine and famotidine. Their main function is to block the H2 receptors, which increase stomach acid secretion when stimulated. Side effects of H2 blocker therapy are rare, and include headache, irritation, anxiety, confusion, paranoia and depression. Anti-androgenic effects, such as gynecomastia (abnormally large male breasts), nipple discharge, decreased libido and sexual dysfunction, can also occur. Gastrointestinal side effects such as diarrhea are also possible.
Prokinetic Drugs
These drugs, which include bethanechol and metoclopramide, work by causing the sphincter between the stomach and esophagus to tighten, and increasing the passage of stomach contents through the stomach. Bethanechol can cause flushing, diarrhea, headache, blurred vision, abdominal cramping and increased urination. Metoclopramide can cross into the brain, with side effects like fatigue, restlessness, lethargy, tremor and parkinsonian symptoms (rigidity, tremor, slow gait, etc.).
Proton Pump Inhibitors
Proton pump inhibitors, or PPIs, work on the proton pump in the stomach that secretes acid into the stomach. Examples include medications such as omeprazole and pantoprazole. Side effects are not very frequent, and occur primarily in the gastrointestinal system. Diarrhea, abdominal discomfort and constipation are some of the more frequent side effects noticed by patients. Headache and hypersensitivity reactions such as anaphylaxis can also occur with PPI therapy. PPI medications can also interact with the cytochrome P450 system in the liver; this is one of the mechanisms by which the liver breaks down and processes substances in the blood, including other medications. As a result of interactions with this system, higher blood levels of other medications the patient is on can result.
References
- "Sleisinger & Fordtran's Gastrointestinal and Liver Disease, 8th Edition;" Feldman; 2006
- "Archives of Internal Medicine"; Clinical review of histamine-2 receptor antagonists; Lipsy, R.J.; November 1990
- Protonix (pantoprazole) package insert; Wyeth Laboratories; 2005
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