Drugs for acid-related disorders

There are several classes of drugs for acid-related disorders, such as dyspepsia, peptic ulcer disease (PUD), gastroesophageal reflux disease (GORD/GERD), or laryngopharyngeal reflux.

The World Health Organization gives drugs in these classes the categorization code ATC code A02.

H2 antagonists
Main article: H2 receptor antagonists

The H2 receptor antagonists are a class of drugs used to block the action of histamine on parietal cells in the stomach, decreasing the production of acid by these cells. H2 antagonists are used in the treatment of dyspepsia, although they have been surpassed in popularity by the more effective[1] proton pump inhibitors. H2 receptor blockers lead to roughly a 40% improvement.[2]

H2 receptor antagonists are named using the suffix "-tidine".

Proton-pump inhibitors
Main article: Proton-pump inhibitors

Proton-pump inhibitors (PPIs) are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available. The group followed and has largely superseded another group of pharmaceuticals with similar effects, but a different mode of action, called H2-receptor antagonists. These drugs are among the most widely sold drugs in the world, and are generally considered effective.[3] When these medications are used long term, the lowest effective dose should be taken.[4] They may also be taken only when symptoms occur in those with frequent problems.[5]

Proton-pump inhibitors are named using the suffix "-prazole".

There is a purported correlation (but no proven causal link) between the use of PPIs and the risk of dementia.[6] However, this remain controversial as chronic and co-morbid pathology, and resultant polypharmacy (including increased consumption of PPIs), will probably itself also give rise to an increased risk of dementia as a whole.

Three large epidemiological studies (two in Germany and one in Taiwan) showed that long-term exposure to PPIs may increase the risk of developing dementia in the elderly. Conversely, two other large studies (one in Finland and one in the United States), found no association between the use of PPIs and the risk of Alzheimer's dementia. Several systematic review and meta-analysis suggest that there is no association between PPIs use and increased risk of dementia or Alzheimer's Dementia.[7]

Prostaglandins
Main article: Prostaglandins

A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring.

They are mediators and have a variety of strong physiological effects, such as regulating the contraction and relaxation of smooth muscle tissue.[8] There are many prostaglandins with many effects. Prostaglandin E2 has effects including reducing gastric acid and increasing gastric mucus, which among other effects treat acid-related disorders.[9]

Prostaglandins are named using the root term "-prost-".

Other drugs

Other drugs which have been used to treat acid-related disorders are not part of the above categories and function through a variety of mechanisms.

Alternative methods for reducing acid production

Availability of drugs
Availability of drugs for acid-related disorders
drug class Examples of countries where some dosages are available without prescription Examples of countries where available in generic form
Omeprazole PPI United States[10] United States[10]
Lansoprazole PPI United States[10]
Omeprazole/sodium bicarbonate PPI United States[10]
Pantoprazole PPI United States[10]
Ranitidine H2 antagonist United States[10]
Famotidine
(only 10 mg)		 H2 antagonist Russian Federation[11]
Ranitidine
(both 75 and 150 mg)		 H2 antagonist Russian Federation[12] Russian Federation

In the United States, all four FDA-approved members of the group—cimetidine, ranitidine, famotidine, and nizatidine—are available over the counter in relatively low doses.

References
  1. Eriksson S, Långström G, Rikner L, Carlsson R, Naesdal J. Omeprazole and H2-receptor antagonists in the acute treatment of duodenal ulcer, gastric ulcer and reflux oesophagitis: a meta-analysis [published correction appears in Eur J Gastroenterol Hepatol. 1996;8:192]. Eur J Gastroenterol Hepatol. 1995;7:467-475
  2. Tran, T.; Lowry, A. M.; El-Serag, H. B. (2007-01-15). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies". Alimentary Pharmacology & Therapeutics. 25 (2): 143–153. doi:10.1111/j.1365-2036.2006.03135.x. ISSN 0269-2813. PMID 17229239.
  3. The Health Strategies Consultancy LLC (March 2005). "Follow The Pill: Understanding the U.S. Commercial Pharmaceutical Supply Chain". The Kaiser Family Foundation.
  4. Kahrilas, Peter J.; Shaheen, Nicholas J.; Vaezi, Michael F.; Hiltz, Stephen W.; Black, Edgar; Modlin, Irvin M.; Johnson, Steve P.; Allen, John; Brill, Joel V. (2008). "American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease". Gastroenterology. 135 (4): 1383–1391, 1391.e1–5. doi:10.1053/j.gastro.2008.08.045. ISSN 1528-0012. PMID 18789939.
  5. Katz, Philip O.; Gerson, Lauren B.; Vela, Marcelo F. (2013). "Guidelines for the diagnosis and management of gastroesophageal reflux disease". The American Journal of Gastroenterology. 108 (3): 308–328, quiz 329. doi:10.1038/ajg.2012.444. ISSN 1572-0241. PMID 23419381.
  6. read, Rick Nauert PhD Last updated: 8 Aug 2018 ~ 1 min (2016-02-16). "Medications for GI Reflux and Ulcers Tied to Higher Risk for Dementia". psychcentral.com. Retrieved 2019-01-10.
  7. Torres-Bondia, Francisco; Dakterzada, Farida; Galván, Leonardo; Buti, Miquel; Besanson, Gaston; Gill, Eric; Buil, Roman; de Batlle, Jordi; Piñol-Ripoll, Gerard (3 December 2020). "Proton pump inhibitors and the risk of Alzheimer's disease and non-Alzheimer's dementias". Scientific Reports. 10 (1): 21046. doi:10.1038/s41598-020-78199-0. ISSN 2045-2322. PMC 7713356. PMID 33273636.  This article incorporates text available under the CC BY 4.0 license.
  8. Nelson, Randy F. (2005). An introduction to behavioral endocrinology (3rd ed.). Sunderland, Mass: Sinauer Associates. p. 100. ISBN 978-0-87893-617-5.
  9. Robinson, Dwight R. (1983-10-31). "Prostaglandins and the mechanism of action of anti-inflammatory drugs". The American Journal of Medicine. 75 (4): 26–31. doi:10.1016/0002-9343(83)90325-X. ISSN 0002-9343. PMID 6416064.
  10. Consumer Reports; Drug Effectiveness Review Project (May 2010). "Drugs to Treat Heartburn and Stomach Acid Reflux: The Proton Pump Inhibitors - Comparing Effectiveness, Safety, and Price" (PDF). Best Buy Drugs. Consumer Reports: 2. Retrieved 12 April 2013.
  11. "State Register of Medicinal Products. "Quamatel mini" (famotidine 10 mg tablets) Full Prescribing Information". Russian State Register of Medicinal Products (in Russian). p. 3. Archived from the original on 19 June 2015. Retrieved 18 June 2015.
  12. "State Register of Medicinal Products. "Ranisan" (ranitidine 75 and 150 mg tablets) Full Prescribing Information". Russian State Register of Medicinal Products (in Russian). Retrieved 18 June 2015.
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