Peptic Ulcers - Medications

Famotidine (Pepcid AC). Famotidine (Pepcid AC) is the most potent H2 blocker. The most common side effect of famotidine is headache, which occurs in 4. 7% of people who take it. Famotidine is virtually free of drug interactions but it may have significant adverse effects in patients with kidney problems.

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Cimetidine. Cimetidine (Tagamet) has few side effects; approximately 1% of people taking cimetidine will experience mild temporary diarrhea, dizziness, rash, or headache. Cimetidine interacts with a number of commonly used medications, such as phenytoin, theophylline, and warfarin. Long term use of excessive doses (more than 3 grams a day) may cause impotence or breast enlargement in men; these problems resolve after the drug is discontinued.

Ranitidine. Ranitidine (Zantac) interacts with very few drugs. In one study, ranitidine provided more pain relief and healed ulcers more quickly than cimetidine in people younger than 60, but there was no difference in older patients. A common side effect of ranitidine is headache, which occurs in about 3% of the people who take it.

Nizatidine. Nizatidine (Axid) is a new H2 blocker. It is nearly free of side effects and drug interactions.

Long-Term Concerns. In most cases, these agents have good safety profiles and few side effects. H2 blockers can interact with other drugs, although some less so than other. In all cases, however, the doctor should be made aware of any other drugs a patient is taking. There are also some concerns about possible long-term effects.

Also of concern are reports that long-term acid suppression with these drugs may cause cancerous changes in the stomach in patients who also have untreated H. pylori infections. More research is needed.

Liver damage. (This is more likely with ranitidine than other H2 blockers, but is rare in any event.)
Kidney-related complications. Adverse effects on the central nervous system in patients with even moderate renal (kidney) insufficiency have been reported with famotidine and may result in anxiety, depression, and mental disturbances.
Increased risk for pneumonia in hospitalized patients.
Ulcer complications (perforation, bleeding). Some experts are concerned that the use of acid-blocking drugs may actually increase the risk for serious complications from ulcers by masking their symptoms.

Misoprostol

Misoprostol (Cytotec) increases prostaglandin levels in the stomach lining, which protects against the major intestinal toxicity of NSAIDs.

Actions Against Ulcers. Misoprostol can reduce formation of ulcers in the upper small intestine by two-thirds and in the stomach by three quarters. It does not neutralize or reduce acid, so although the drug is helpful for preventing NSAID-induced ulcers, it is not useful in healing existing ulcers.