Famotidine – MotherToBaby

This sheet is about exposure to famotidine in a pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.

What is famotidine?

Famotidine is a medication used to treat acid reflux, sometimes called heartburn or peptic ulcer disease. Famotidine reduces the amount of stomach acid that your body makes. It is a long-acting histamine (h3) receptor blocker and is sold under the brand names Pepcid®, Pepcid AC®, and Heartburn Relief®.

I just found out I am pregnant. Should I stop taking famotidine?

Talk with your healthcare providers before making any changes to how you take your medication(s). It is important to consider the potential benefits of treating your condition during pregnancy.

I take famotidine. Can it make it harder for me to get pregnant?

It is not known if taking famotidine could make it harder to become pregnant.

Does taking famotidine during my pregnancy increase the chance of miscarriage? 

Miscarriage can occur in any pregnancy. It is not known if famotidine could make it harder to get pregnant.

Does taking famotidine increase the chance of having a baby with a birth defect?

Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Available studies do not show an increased chance of birth defects or other pregnancy problems when famotidine is taken during pregnancy.

Could taking famotidine cause other pregnancy complications?

It is not known if taking famotidine during pregnancy increases the chance of pregnancy complications.

Will taking famotidine during pregnancy affect my baby’s behavior or cause learning problems?

It is not known if taking famotidine during pregnancy affects children’s long-term development.

Can I breastfeed while taking famotidine? 

Famotidine is found in the breast milk in small amounts and is used in newborn infants in higher dosages than the levels that have been found in breastmilk. Taking famotidine while breastfeeding is not expected to cause problems in breastfed infants. Be sure to talk to your healthcare provider about all your breastfeeding questions.

I take famotidine. Can it make it harder for me to get my partner pregnant or increase the chance of birth defects? 

It is not known if there are possible risks to a pregnancy from semen exposed to famotidine. After any exposure, substances might be present in small amounts in semen. However, in most cases, those small amounts would not increase the chance of birth defects. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.

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OTIS/MotherToBaby recognizes that not all people identify as “men” or “women.” When using the term “mother,” we mean the source of the egg and/or uterus and by “father,” we mean the source of the sperm, regardless of the person’s gender identity.

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Pepcid, Act (famotidine) dosing, indications, interactions, adverse effects, and more

More Evidence Heartburn Drug May Help COVID-19 Patients

More data from observational studies, this time in hospitalized patients, indicated that famotidine (Pepcid AC), which is used to treat heartburn, was associated with improved clinical outcomes in COVID-19 patients.

Use of famotidine in a small group of 83 patients was associated with a lower risk of in-hospital mortality and a combined outcome of death and intubation, reported Jeffrey Mather, MS, of Hartford Hospital in Connecticut, and colleagues.

Moreover, famotidine use was also associated with lower levels of serum markers indicating severe disease, the authors wrote in the American Journal of Gastroenterology.

Famotidine is a histamine-2 receptor antagonist. The authors noted the mechanism by which famotidine might improve COVID-19 outcomes is currently unknown, but hypothesized it might work via “inverse-agonism” of the histamine-2 receptor, which implies SARS-CoV-2 is “at least partially mediated by pathological histamine release,” the authors said.

The drug was tied to significant reductions in in-hospital death and a combined death and intubation outcome in hospitalized patients in China, as well as an improvement in symptoms in a small case series of non-hospitalized patients, mostly in the U.S.

Researchers performed a propensity-matched analysis using electronic data from patients testing positive for SARS-CoV-2 from February 24 to May 13 in a single medical center. “Use of famotidine” was defined as either oral or intravenous famotidine, at any dose, within 7 days of COVID-19 screening and/or hospital admission.

Primary outcomes were in-hospital death, requirement for mechanical ventilation, and a composite of death or requirement for ventilation. Secondary outcomes included serum markers of disease severity.

Of 878 total patients, about 10% received famotidine. Mean age of the whole group was 67, and 55% were men. About 22% of patients died during hospitalization, 27% required mechanical ventilation, and 12% met criteria for “combined death and intubation.”

About two-thirds of patients receiving famotidine received it only as an inpatient, while 29% took the drug prior to admission and received it as an inpatient. Oral famotidine was administered in the large majority of cases versus intravenous famotidine (83% vs 17%, respectively). Patients who received famotidine tended to be younger, but there were no other significant differences in baseline characteristics or pre-existing comorbidities, the authors noted.

Among the matched study group of 772 patients, 51% received hydroxychloroquine, 51% received azithromycin, 49% received corticosteroids, and about 4% received remdesivir.

Use of famotidine was associated with reduced risk of hospital mortality (OR 0.366, 95% CI 0.155-0.862, P=0.021), as well as a lower risk of the combined death or intubation endpoint (OR 0.495, 95% CI 0.228-0.965, P=0.04).

Intubation occurred in 22% of the famotidine group compared with 32% of the non-famotidine group.

Examining secondary outcomes, use of famotidine was associated with significantly lower median peak C-reactive protein levels and lower median procalcitonin levels. There was also a non-significant trend towards lower median ferritin levels in the famotidine group, the authors noted.

A sensitivity analysis found that the drug seemed to work especially well in patients with the highest national early warning scores (NEWS).

Researchers cautioned that this is a retrospective, observational, single-center study, whose findings should be interpreted with caution. They suggested further research into the effect of famotidine on COVID-19, including dose, route of administration, and timing.

Currently, famotidine is being evaluated in a randomized clinical trial under an investigational new drug waiver in combination with either hydroxychloroquine or remdesivir.

Last Updated August 18, 2020

• Molly Walker is deputy managing editor and covers infectious diseases for MedPage Today. She is a 2020 J2 Achievement Award winner for her COVID-19 coverage. Follow

Disclosures

The authors disclosed no conflicts of interest.

Should You Take Heartburn Medication for A Long-Term?

Your doctor puts you on acid reduction medication. Or you pick up an over the counter medication to treat your heartburn. And then you hear from your friend that these are bad medicines with lots of side effects, and now you’re scared. Are your bones going to break? Kidneys fail? Are you going to develop dementia?! Let’s see if we can make things a little clearer.

Proton pump inhibitors (“PPIs”) were initially introduced over 25 years ago. The first was Prilosec (omeprazole) and now there’s Nexium (esomeprazole), Prevacid (lansoprazole), Dexilant (dexlansoprazole), Protonix (pantoprazole) and Aciphex (rabeprazole). They are available in various forms and strengths – brand name and generic, prescription and over the counter. These medications all work by significantly decreasing the normal acid produced in the stomach. They are used to treat acid reflux and ulcers. Like almost all medications, they should not be considered “good” or “bad”. They have positive benefits as well as potential short and long term side effects.

For several years, there have been concerns that these medications might affect calcium absorption and increase the risk of osteoporosis when used for a prolonged period of time. It’s now felt that while this might be a concern for some patients, it will not affect everyone. For people who require ongoing use, they should discuss this issue with their physician to assess their risk and consider further evaluation or be on medication to mitigate this potential problem.

More recently, there have been reports of kidney injury with long term use of PPI. This is likely a rare event but individuals who take PPIs for months and years should have their kidney function monitored with blood tests. In addition, there are reports of a possible link to the development of dementia. This is not a proven cause and effect at this time but there has been an association with these medications reported in some studies – again only with long term use.

There have also been concerns about certain infections in patients who take these medications – for example a diarrheal illness called clostridium difficile/pseudomembranous colitis which is associated with antibiotic use. It’s been suggested that PPIs increase the risk of this infection. In the past there have been concerns about an increased likelihood of developing pneumonia while on PPIs but this has not been proven.

So, if you are on one of these medications, do you need to stop? The first question that needs to be asked is: Is the medication necessary. This should be a question you ask about any and all medications you might take either on your own or at the direction of a physician. And the follow up question is how long should I be taking it? Two weeks? Two months? Indefinitely? What are the benefits I am getting from this medication? What are the specific risks for me? And are there any alternatives that might be effective but without or with less risk of side effects or complications?

In the case of proton pump inhibitors there might be an alternative – the h3 blockers (histamine-2 blockers) – most commonly Zantac (ranitidine) and Pepcid (famotidine). These drugs are also available by brand and generic and prescription and over the counter. They also decrease acid production in the stomach but are not as strong as the PPIs. The h3 blockers were first introduced over 35 years ago and there have been almost no reports of significant problems with either short term or long term use. However, they do not decrease acid as much the PPIs and as a result might not relieve symptoms as effectively in some people.

What’s the right medication for you? And how long should you take it? As with all medications you should take the lowest amount for the shortest duration that achieves the objective – whether relieving a symptom such as heartburn/reflux or healing an ulcer. And is there an alternative that might have less potential for adverse effects? Discuss these issues with your doctor and then make your decision.

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Heartburn & Reflux (GERD)

Examining Nonprescription Options for Heartburn

US Pharm. 2014;39(12):8-11.

In a typical workday, the average pharmacist fields several questions from patients about stomach discomfort and heartburn. With a good knowledge of the various options for heartburn, pharmacists can make rapid and accurate decisions to ensure that patients obtain the optimal treatment.

The Problem of Heartburn

Heartburn is the lay term for a burning sensation in the general area of the heart, often due to gastroesophageal reflux disease (GERD).¹ Normally, swallowed food passes down the esophagus, reaching a muscular band known as the lower esophageal sphincter (LES). When the person swallows, the LES relaxes so that ingestants can enter the stomach. The LES is usually closed, and food remains in the stomach. However, in certain situations, stomach contents push upward (reflux) into the esophagus. Stomach contents are acidic and contain damaging materials (e.g., pepsin, enzymes) that induce esophageal damage and cause the characteristic midchest pain and associated symptoms of GERD.

Alarm Symptoms

In discussions of GERD and its treatment, the National Institutes of Health (NIH) lists general alarm symptoms that necessitate a physician appointment.^1-3 They include worsening symptoms, symptoms that do not improve with lifestyle changes or medications, and daily or nocturnal symptoms. The list also includes choking, coughing, shortness of breath, feeling filled up quickly when eating, nausea and vomiting, frequent vomiting, blood in the vomitus or stools, black and/or tarry stools, bloating or cramping, severe and/or unremitting diarrhea, dysphagia, and odynophagia. Other alarm symptoms include sweating; bleeding from any other area not previously mentioned; hoarseness; fever in conjunction with abdominal pain; anorexia; abdominal pain in a nonepigastric area; unexplained weight loss; chest pain; pain in the lower belly, on the side, or in the back; and pain that radiates to the jaw, neck, or arm. These alarming referral symptoms could also be indicative of myocardial infarction, gastric cancer, appendicitis, peptic ulcer, gallstones, bowel problems, or other morbid conditions.^1-3

Antacids

Nonprescription antacids carry FDA-approved labeling for heartburn.^3,4 Each product label includes a minimum age below which the product should not be used without physician supervision. For patient safety, the pharmacist should urge the patient to closely observe these instructions. Antacid labels also warn patients not to use the product for longer than 2 weeks. The pharmacist should question the patient about the onset of symptoms and refer the patient if they have been present for

>2 weeks.^3,4

Magnesium hydroxide (e.g., Milk of Magnesia) is a common antacid, but it can cause diarrhea and kidney stones, and patients with renal problems can experience hypermagnesemia.³ Calcium carbonate (e.g., Tums) is a potent antacid with a rapid onset of action. The product is usually safe when used as directed, but it can cause constipation.^3,4 Regardless of the individual differences among them, antacids share one advantage over the other nonprescription heartburn medications—they act rapidly. However, they also share one major drawback—they cannot reduce the amount of acid produced.

Histamine-2 (H₂) Blockers

H₂ blockers, otherwise known as H₂ receptor antagonists (H₂RAs), have an inherent superiority over antacids in their ability to reduce the amount of acid produced, although they do not provide immediate relief. These nonprescription products include cimetidine (Tagamet HB 200), famotidine (Pepcid AC, Maximum Strength Pepcid AC), and ranitidine (Zantac 75, Zantac 150).^5-9 They should not be used without physician supervision in patients who are pregnant or breastfeeding, or in any patient <12 years of age.

Patients are cautioned against self-use if they are allergic to the ingredient or to other acid reducers, have trouble or pain when swallowing, or are using other acid reducers. All five product labels also advise against unsupervised self-use if the patient has vomiting with blood or has bloody or black stools, as those may be signs of a serious condition for which the patient should see a physician. The label of Maximum Strength Pepcid AC also carries an FDA-mandated warning against self-use if the patient has kidney disease, unless directed by a physician.⁷

Labels of all five products warn patients to speak to a physician before use if they have any of the following: 1) heartburn for more than 3 months; 2) lightheadedness, sweating, or dizziness with their heartburn; 3) chest pain or shoulder pain with shortness of breath, sweating, pain spreading to arms, neck, or shoulders, or lightheadedness; 4) frequent chest pain; 5) frequent wheezing, particularly with heartburn; 6) unexplained weight loss; 7) nausea or vomiting; and 8) stomach pain.^5-9

Patients are cautioned on all H₂-blocker labels to stop using the product and speak to a physician if their heartburn continues or worsens and if they need to take the product for more than 14 days. The label of Tagamet HB 200 also adds, “If stomach pain continues.”⁵

Tagamet HB 200 is the only nonprescription H₂ blocker that inhibits the CYP450 system. For this reason, it carries the following drug interaction warning: “Ask a doctor or pharmacist before use if you are taking theophylline (oral asthma medicine), warfarin (blood thinning medicine), or phenytoin (seizure medicine).”⁵

Patients are directed on all product labels to take one tablet with a glass of water to relieve symptoms.^5-9 They should not take more than two tablets in any consecutive 24-hour period. If they wish to prevent symptoms, they should take one tablet with a glass of water before eating or drinking anything that causes heartburn.

The products vary in the timing of dosing for prevention. Tagamet HB 200 may be taken just before or any time up to 30 minutes before the ingestion, while Pepcid AC may be taken from 15 to 60 minutes before the food/drink, and Pepcid AC Maximum Strength may be taken 10 to 60 minutes before eating or drinking.^5-7 Both Zantac products may be taken 30 to 60 minutes before the troublesome food or drink.^8,9

Proton Pump Inhibitors (PPIs)

PPIs lessen stomach acid production more effectively than the H₂ blockers. Single-entity nonprescription products include omeprazole 20-mg tablets (Prilosec OTC), lansoprazole 15-mg capsules (Prevacid 24HR), and the newest Rx-to-OTC switch product, esomeprazole 20-mg capsules (Nexium 24HR).^10-12 Zegerid OTC is a combination product containing 20 mg of omeprazole and 1,100 mg of sodium bicarbonate per capsule.¹³

The indications for PPIs differ from those for antacids and H₂ blockers. PPIs are approved only to treat frequent heartburn (occurring on two or more days a week). In other words, patients who have heartburn only one day a week (or less frequently) should use other products. Labels also advise patients of the following in regard to onset of action: “Not intended for immediate relief of heartburn; this drug may take 1 to 4 days for full effect.” Patients are warned not to use the product if they are allergic to the ingredients and are advised to speak to a healthcare professional before use if they are pregnant or breastfeeding.^10-13

Patients should not use PPIs if they have trouble or pain swallowing food, vomiting with blood, or bloody/black stools, as these may be signs of a serious medical condition that requires physician care. PPI labels warn patients to speak to a physician before use if they experience any of the following: 1) heartburn for >3 months; 2) lightheadedness, sweating, or dizziness with their heartburn; 3) chest pain or shoulder pain with shortness of breath, sweating, or pain spreading to arms, neck, or shoulders; 4) frequent chest pain; 5) frequent wheezing, particularly with heartburn; 6) unexplained weight loss; 7) nausea or vomiting; and 8) stomach pain.^10-13 The label of Zegerid OTC also provides a caution for patients who are on a sodium-restricted diet, and the label of Prevacid 24HR adds a warning for patients with liver disease.^11,13

All PPI labels include the warning to speak to a physician or pharmacist before use if the patient is taking warfarin, prescription antifungal medications, digoxin, or tacrolimus.^10-13 The labels of Prilosec OTC, Nexium 24HR, and Zegerid OTC warn against concomitant use with clopidogrel, cilostazol, and diazepam.^10,12,13 The label of Prevacid 24HR advises against use with theophylline.¹¹ The labels of Prilosec OTC, Nexium 24HR, and Zegerid OTC also carry a warning against use with prescription antiretrovirals for HIV,^10,12,13 while the label of Prevacid 24HR specifically warns against use with atazanavir (Reyataz) for HIV.¹¹ Finally, the label of Zegerid OTC carries a global warning against unsupervised use with any other prescription medication due to the possibility that sodium bicarbonate might cause an interaction.¹³

The PPI labels caution patients to stop use and speak to a physician in the following cases: 1) heartburn continues or worsens; 2) the patient needs to take the product for more than 14 days; or 3) the patient needs to take more than one course of treatment every 4 months.^10-13 Labels of Prilosec OTC, Nexium 24HR, and Zegerid OTC also warn patients to stop use and speak to a physician if they develop diarrhea.^10,12,13

The directions for all four PPIs are almost identical.^10-13 If the prospective patient is <18 years of age, the parent is advised to speak to a physician, since heartburn in children may be caused by a serious condition. Patients are instructed to take the PPI only once daily, every 24 hours for 14 days, and they are advised that it may take 1 to 4 days for full effect, although some people experience complete symptom relief within 24 hours. Patients should swallow one capsule/tablet with a glass of water before eating in the morning, every day for 14 days. They are not to use it for more than 14 days unless directed by their physician. They should swallow it whole, without chewing or crushing, and the label of Zegerid OTC also advises patients not to open the capsule to sprinkle it on food.¹³

A final set of instructions on all four PPI product labels is critical for preventing overuse in case the patient has a serious condition such as an ulcer. Patients are advised that, if needed, they may repeat the 14-day course of treatment every 4 months (i.e., three times yearly), but they are warned not to take the drug for more than 14 days or more often than every 4 months, unless directed to do so by a physician.^10-13

PATIENT INFORMATION

What Is Heartburn?

Heartburn is a common condition in which the food or drink you eat cannot stay in your stomach for digestion. Instead, it moves backward up into your esophagus (a process known as reflux), where the acids and enzymes cause burning and produce the troubling discomfort in your chest.

What Causes Heartburn?

The main problem lies in a small muscle between your esophagus and stomach that is supposed to shut down tightly after you eat or drink, so that your food and drink will remain in your stomach. When this muscle does not work properly, the damaging materials move upward into your esophagus.

How Can You Prevent Heartburn?

You can reduce the possibility of heartburn by making some lifestyle changes. Wear clothing that is loose around the waist to reduce pressure on the stomach. Eat smaller meals, and eat more slowly. Since reflux is common at night, make your last meal small and be sure to finish eating as long as 5 to 6 hours before bedtime. Heartburn also occurs more frequently in those who are overweight or pregnant.

Fatty foods worsen reflux, so you should avoid them as much as possible. The long list of high-fat foods includes chocolate, bacon, potato chips, margarine, butter, and fried foods. You may find that other foods cause problems, such as orange juice, pizza, or tomato-based sauces. When you have identified such an irritant, avoid it in the future. Nicotine and alcohol both worsen reflux, so you should avoid cigarettes, cigars, chewing tobacco, and all forms of alcohol.

How Can You Treat Heartburn?

When you first recognize possible reflux, your pharmacy is a good place to go for advice on when to see a physician. Your pharmacist will need to know your age, your status regarding pregnancy or breastfeeding, and a list of all of your symptoms. There are many dangerous symptoms that will require a physician visit to ensure that you do not have a serious condition such as an ulcer or stomach cancer.

If the pharmacist believes your problem to be nothing more than reflux, he or she may recommend nonprescription products. Whichever you choose, be sure to read every set of warnings, precautions, and instructions on the label. Failure to understand and follow all of these guidelines can have drastic consequences.

Some heartburn products are simple antacids, such as Tums and Alka-Seltzer. They are usually inexpensive and act rapidly, although they do not reduce the amount of acid produced. Other OTC products are effective at reducing the amount of stomach acid produced, although they may not give relief as quickly and tend to cost more. These stronger products fall into two groups. One is histamine-2 (H₂) blockers, including Tagamet HB 200, Pepcid AC, Maximum Strength Pepcid AC, Zantac 75, and Zantac 150. They can be used by those age 12 years or older. The second group is proton pump inhibitors (PPIs), which include Prilosec OTC, Prevacid 24HR, Nexium 24HR, and Zegerid OTC. They can only be used by those age 18 years or older.

Remember, if you have questions, Consult Your Pharmacist.

REFERENCES

1. Gastroesophageal reflux disease. MedlinePlus. www.nlm.nih.gov/medlineplus/ency/article/000265.htm. Accessed October 18, 2014.

2. Gastroesophageal reflux—discharge. MedlinePlus. www.nlm.nih.gov/medlineplus/ency/patient-instructions/000197.htm. Accessed October 18, 2014.

3. Taking antacids. MedlinePlus. www.nlm.nih.gov/medlineplus/ency/patientinstructions/000198.htm. Accessed October 18, 2014.

4. Tums Ultra 1000 product details. GlaxoSmithKline. www.tums.com/products/ultra-1000.html. Accessed October 18, 2014.

5. Tagamet HB 200. www.drugstore.com/tagamet-hb-200-reduces-stomach-acid-for-heartburn-control/qxp473528?catid=184249. Accessed October 18, 2014.

6. Original Strength Pepcid AC. McNeil Consumer Pharmaceuticals. www.pepcid.com/products/original-strength-pepcid-ac. Accessed October 18, 2014.

7. Maximum Strength Pepcid AC. McNeil Consumer Pharmaceuticals. www.pepcid.com/products/maximum-strength-pepcid-ac. Accessed October 18, 2014.

8. Zantac 75. Boehringer Ingelheim Pharmaceuticals. www.zantacotc.com/zantac-regular-strength.html#learn-more. Accessed October 18, 2014.

9. Maximum Strength Zantac 150. Boehringer Ingelheim Pharmaceuticals. www.zantacotc.com/zantac-maximum-strength.html. Accessed October 18, 2014.

10. Prilosec OTC clear labeling. Procter & Gamble. www.prilosecotc.com/hcp/ClearLabeling. Accessed October 18, 2014.

11. Prevacid 24HR drug facts and patient package insert. Novartis Consumer Health. www.prevacid24hr.com/hcp/patient-package-insert.jsp. Accessed October 18, 2014.

12. About Nexium 24HR. Pfizer. www.nexium24hr.com/us/about. Accessed October 18, 2014.

13. Zegerid OTC product labeling. MSD Consumer Care. www.zegeridotc.com/download/zegeridotc_product_labeling.pdf. Accessed October 18, 2014.

To comment on this article, contact [email protected].

What to do about the heartburn medication recall

Some drugs that contain ranitidine (best known as Zantac) have been found by the FDA to have unacceptable amounts of N-nitrosodimethylamine (NDMA), a possible cancer-causing chemical (which also triggered recalls of certain lots of the blood pressure drugs called angiotensin-receptor blockers).

On April 1, 2020, the FDA requested that all forms of ranitidine (Zantac, generic versions), including prescription and over-the-counter products, be removed from the market. They may contain unacceptable levels of a potential cancer-causing substance known as NDMA, or N-Nitrosodimethylamine. In some samples tested by the FDA, the impurity appears to increase over time, especially when stored at higher temperatures. So far, tests of other acid blockers do not show this potential increased cancer risk. 

People using over-the-counter ranitidine should stop taking it and consider a different acid blocking therapy, such as famotidine (Pepcid) or cimetidine (Tagamet). They’re all in a class of medications known as h3 blockers, which block a chemical that signals the stomach to produce acid. “They’re fairly interchangeable, working equally well for most people,” says Dr. Kyle Staller, a gastroenterologist with Harvard-affiliated Massachusetts General Hospital.

Stronger heartburn medications include a class of drugs called proton-pump inhibitors, or PPIs, such as over-the-counter lansoprazole (Prevacid) or omeprazole (Prilosec). Long-term use of PPIs has been linked to reduced blood levels of vitamin B₁₂  and magnesium. While the possibility of other health risks has been raised in the past, Dr. Staller says the data supporting those risks aren’t conclusive. There’s no evidence of risks from long-term use of h3 blockers.

For those taking prescription ranitidine, they should contact their doctor for advice.

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What Is Famotidine? Heartburn Medication Being Trialed as COVID-19 Treatment in New York

Researchers in New York are testing a common heartburn drug as a potential treatment for COVID-19.

The substance in question, known as famotidine, is the active compound in the over-the-counter heartburn medication Pepcid, Science magazine reported.

A team with Northwell Health—New York state’s largest health care provider—have been administering famotidine intravenously to critical COVID-19 patients since April 7 as part of a clinical trial.

The dose these patients—many of whom are on ventilators—have received is around nine times higher than the usual dose for heartburn treatment.

Northwell Health researchers say that, so far, 187 COVID-19 patients have been enrolled in the trial, and the team hopes to include nearly 1,200 people in total.

This trial—which will be randomized and double-blinded—has been approved by the Food and Drug Administration. Scientists use randomization and blinding—where one or more parties are kept unaware of which treatments patients received—in trials to try and limit the effects of conscious or unconscious bias.

In the trial, famotidine is being given in combination with the much-touted antimalarial drug hydroxychloroquine. According to Kevin Tracey—who leads Northwell’s research—hydroxychloroquine was included because otherwise they wouldn’t have been able to recruit enough patients.

Planning for the trial was taking place in March when hydroxychloroquine’s promise was being widely discussed, despite its potential risks. One group in the study are being administered famotidine and hydroxychloroquine, while another will only receive hydroxychloroquine. These groups will be compared to a control group of COVID-19 patients treated earlier in the pandemic.

High doses of famotidine can cause complications in people with decreased kidney function so COVID-19 patients with kidney problems are excluded from taking part in the study.

Famotidine is normally available as an oral tablet although there is also an injectable form, which is only administered by health care providers. The drug is usually used to relieve the symptoms of acid reflux and heartburn, which it does by reducing the amount of acid in the stomach. It can also be used to treat ulcers in the stomach and parts of the intestine.

Among the common side effects of the drug for adults are headache, dizziness, constipation and diarrhea, although these are only experienced infrequently, according to Healthline. Serious side effects are also rare, but include heart rate and rhythm, muscle, neurological, liver and skin problems.

Currently, it is not clear how effective the drug is for the treatment of COVID-19—despite some encouraging anecdotal evidence—but Kevin Tracey, who leads Northwell’s research, told Science that some preliminary data from the trial could be available in “a few weeks.”

Computer modeling research has indicated that famotidine may bind to a key enzyme on the novel coronavirus, known as SARS-CoV-2, raising the possibility that it could halt its spread throughout the body.

Tracey decided to conduct the trial after being contacted by a friend, infectious disease expert Michael Callahan from Massachusetts General Hospital in Boston. Callahan was the first researcher to highlight the drug as a potential COVID-19 treatment in the United States.

Stock photo: Famotidine oral tablets.
iStock

Callahan was in Wuhan, China during the city’s outbreak and had been examining medical records of COVID-19 patients when he noticed something unusual. While the disease was killing as many as one in five patients who were older than the age of 80, a significant portion of the survivors tended to be poor.

He then found out that many of these survivors had been suffering from chronic heartburn and were taking famotidine, a cheap alternative to omeprazole (Prilosec) that is commonly used in the United States and by more affluent Chinese people.

According to Callahan, the records of hospitalized COVID-19 patients he examined appeared to show that those who were taking famotidine were dying at a rate of around 14 percent, whereas those who were not on the drug were dying at a rate of roughly 27 percent.

This research has yet to be published and Callahan notes that the results of this preliminary analysis were not statistically significant, but he was sufficiently intrigued to notify public health authorities in the United States when he returned.

Dr. Stuart Ray, a professor of medicine in infectious diseases at Johns Hopkins University, who is not involved in the famotidine trial, said that he was skeptical about the preliminary data from China because it had not gone through the typical review process.

But despite his surprise that famotidine was being used for this purpose, he said that there is some scientific basis for the drug to be used in the treatment of COVID-19, while also noting that it is likely to be safe, even in large doses.

“I think this sort of off-label repurposing is sensible with drugs for which we have a long safety record,” Ray told ABC News. “And we really need a win.”

Centers for Disease Control and Prevention Advice on Using Face Coverings to Slow Spread of COVID-19

• CDC recommends wearing a cloth face covering in public where social distancing measures are difficult to maintain.
• A simple cloth face covering can help slow the spread of the virus by those infected and by those who do not exhibit symptoms.
• Cloth face coverings can be fashioned from household items. Guides are offered by the CDC. (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html)
• Cloth face coverings should be washed regularly. A washing machine will suffice.
• Practice safe removal of face coverings by not touching eyes, nose, and mouth, and wash hands immediately after removing the covering.

World Health Organization advice for avoiding spread of coronavirus disease (COVID-19)

Hygiene advice

• Clean hands frequently with soap and water, or alcohol-based hand rub.
• Wash hands after coughing or sneezing; when caring for the sick; before, during and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste.
• Maintain at least 1 meter (3 feet) distance from anyone who is coughing or sneezing.
• Avoid touching your hands, nose and mouth. Do not spit in public.
• Cover your mouth and nose with a tissue or bent elbow when coughing or sneezing. Discard the tissue immediately and clean your hands.

Medical advice

• Avoid close contact with others if you have any symptoms.
• Stay at home if you feel unwell, even with mild symptoms such as headache and runny nose, to avoid potential spread of the disease to medical facilities and other people.
• If you develop serious symptoms (fever, cough, difficulty breathing) seek medical care early and contact local health authorities in advance.
• Note any recent contact with others and travel details to provide to authorities who can trace and prevent spread of the disease.
• Stay up to date on COVID-19 developments issued by health authorities and follow their guidance.

Mask and glove usage

• Healthy individuals only need to wear a mask if taking care of a sick person.
• Wear a mask if you are coughing or sneezing.
• Masks are effective when used in combination with frequent hand cleaning.
• Do not touch the mask while wearing it. Clean hands if you touch the mask.
• Learn how to properly put on, remove and dispose of masks. Clean hands after disposing of the mask.
• Do not reuse single-use masks.
• Regularly washing bare hands is more effective against catching COVID-19 than wearing rubber gloves.
• The COVID-19 virus can still be picked up on rubber gloves and transmitted by touching your face.

90,000 reasons, how to get rid of, remedies for heartburn

The digestive tract is a conveyor of sequential chemical reactions, the result of which is the processing of food and the absorption of substances beneficial to the body. In the stomach, the most gross breakdown of food occurs under the influence of hydrochloric acid produced in it. Normally, it is safe for the body, since the stomach is protected from its harmful effects. However, if the defense mechanisms are disrupted, it can damage our digestive conveyor, causing pain and discomfort in the abdomen, a burning sensation in the chest and other symptoms that we used to call heartburn.

What is actually happening? Typically, heartburn manifests itself against a background of functional failure: the reflux of the acidic contents of the stomach (at pH <4) into the esophagus causes a burning sensation. Hydrochloric acid irritates the nerve endings of the mucous membrane, which leads to painful sensations ¹ , spreading from below, from the center of the sternum to the neck. And if hydrochloric acid acts on the mucous membrane for a long time, inflammation or even an ulcer develops ² . So heartburn is not just an unpleasant syndrome.

What are the causes of heartburn?

The development of heartburn provokes a number of factors ¹ , which can be roughly divided into five groups. 1) chronic diseases. 2) taking medications. 3) physiological conditions. 4) eating habits. 5) lifestyle.

• Let’s start with the chronicle: peptic ulcer of the stomach and duodenum, chronic gastritis, diseases of the biliary tract and liver, pathology of the pancreas, ischemic heart disease, angina pectoris, chronic obstructive pulmonary disease, diabetes mellitus, obesity, iron deficiency anemia.As you can see – a rather impressive list …
• Acceptance of drugs that provoke heartburn: These are mainly drugs that reduce sphincter tone or promote inflammation, such as non-steroidal anti-inflammatory drugs, as well as glucocorticosteroids, progesterone, antidepressants, doxycycline and drugs with caffeine.
• Physiological conditions such as flatulence, increased gastric secretion (hyperacidity), frequent and severe cough, the use of bandages or corsets that compress the upper digestive tract can also be recorded as causes of heartburn.Heartburn is also common during pregnancy.
• Now, about food habits – there is nothing new here: fatty, fried, flour, spicy, soda, coffee and chocolate increase the likelihood of a reverse reflux of stomach contents into the esophagus. As well as taking large amounts of food quickly and swallowing air.
• And, finally, the way of life: the custom to lie down after eating, stress, high physical activity, addiction to alcohol.

Is the burning sensation just a symptom?

Indeed, the main symptom of heartburn is a feeling of heat or burning in the chest region, which rises up to the throat.The sensation may be aggravated by lying down or tilting.

Sometimes heartburn is manifested by a sour taste in the mouth and pain in the epigastric region (that is, in the projection of the stomach onto the anterior abdominal wall – you can determine this area by placing your palm under your chest). In addition, with gastroesophageal reflux, which, as we have already found out, is the main cause of heartburn ³ , sore throat, hoarseness, prolonged dry cough, sensation of a lump in the throat may also appear.Heartburn is sometimes accompanied by a feeling of heaviness, fullness in the stomach, a feeling of early satiety, bloating that occurs after eating ³ .

How to get rid of heartburn?

The most obvious recommendation is to reduce the level of acidity and protect the gastric mucosa and esophagus from damage by hydrochloric acid of gastric juice. This is necessary not only in order to get rid of unpleasant sensations, but also in order to prevent inflammation in them (esophagitis or gastritis) and the formation of ulcers.In general, the advice is simple (just consult your doctor!)
¹ :

• Exclude products that stimulate acid formation (coffee, soda, fatty, fried and spicy)
• Exclude foods that increase gas formation in the intestine (peas, cabbage, beans, beans, radishes, pastry)
• Eat fractionally: 4-6 times a day in small portions, fewer calories, more protein (foods high in protein increase the tone of the esophageal sphincter)
• Eat slowly and take 15-20 minutes breaks between meals
• Don’t eat at night! At the latest – 3-4 hours before bedtime, and generally do not go to bed after eating (and avoid bending over).

The safe list for heartburn sufferers consists of light, low-fat foods ¹ : veal, chicken, turkey, lean meat, fish, skim milk and dairy products, boiled vegetables, apples, bananas, peaches, berries, low-fat desserts, mint and chamomile tea, juices (avoid citrus fruits!).

Of course, an instant transition to a healthy lifestyle and proper nutrition is from the realm of fantasy, and heartburn itself can be caused by other factors – the above – so one should not reject heartburn medicines that bring relief.

But drugs are chemistry?

Of course. We have already found out that we will have to fight with hydrochloric acid. This means that in order to get rid of unpleasant sensations, we need an antacid – a remedy for heartburn that neutralizes stomach acid ⁴ . If at school you
chemistry lessons were difficult, then you will have to read the next paragraph three times – although, in fact, everything is not difficult (just remember how soda extinguishes vinegar!).

All antacids are divided into two groups: absorbable and non-absorbable.

• Absorbable antacids dissolve in gastric juice, show a quick but short effect. These include sodium and calcium carbonates and bicarbonates. Sodium bicarbonate is essentially baking soda! What happens on contact with acid? Hissing and releasing large amounts of gas. But your stomach is not a cake! A quick response leads to the development of belching, bloating and acid rebound syndrome (i.e., a repeated increase in the production of hydrochloric acid ⁶ ).In general, it will do to stop an attack of heartburn once.
• Non-absorbable antacids act for a long time and neutralize hydrochloric acid, they are able to adsorb pepsin, bile and other substances that damage the walls of the stomach – drugs in this group have a more favorable efficacy and safety profile, especially with prolonged use.

Popular non-absorbable antacids include Maalox®. The combination of magnesium hydroxide and aluminum hydroxide in its composition combines high activity in neutralizing hydrochloric acid with a number of medicinal properties.Magnesium hydroxide increases the stability of the gastric mucosa and enhances mucus formation while aluminum hydroxide forms a protective film. In addition, the Maalox® components neutralize hydrochloric acid without the formation of carbon dioxide ⁴ . As a result – a complex therapeutic effect ⁷ :

• Neutralization of free hydrochloric acid of gastric juice;
• Coating effect and protection of the mucous membrane of the esophagus and stomach;
• Adsorption effect and reduction of the influence of damaging factors on the mucous membrane.

It is important to understand that Maalox® is a local antacid: magnesium and aluminum hydroxide are not absorbed into the bloodstream and do not exhibit systemic effects. And in general, serious requirements are imposed on modern antacids, primarily regarding the minimum development of side effects. An important advantage of drugs in this group is the availability of various dosage forms that can be selected individually ⁵ . However, only a consultation with a doctor will help determine the root cause of heartburn and choose a specific medicine to relieve the symptom if necessary.

Maalox® is widely used to relieve pain and heartburn associated with various diseases and conditions ⁷ , errors in nutrition, the use of drugs, etc. doses in 80% of patients to prevent their recurrence ⁶
.

If unpleasant symptoms persist, despite following the recommendations and using medications, a second consultation with a specialist is required.Perhaps additional examinations will allow diagnosing other diseases that caused unpleasant symptoms: for example, gastritis with high acidity, gastroesophageal reflux disease, erosion in the gastric mucosa and, finally, gastric ulcer or duodenal ulcer, which can lead to the development of a number of adverse consequences. Finding out the causes of long-term persistent heartburn will help the doctor prescribe appropriate and adequate treatment.

Although, of course, proper nutrition, a healthy lifestyle and knowledge of chemistry in the top five have not harmed anyone yet.And let the soda sizzle only in vinegar.

Natural Methods to Fight Heartburn | Weekly PHARMACY

You and I live in a time of great change. Now people can easily change everything – their place of residence, climate, life partners. What can we say about eating habits! No one is surprised that you can enjoy fresh fruits and vegetables all year round, that game and seafood can be on our table at any time. The only limitation of desires, it seems, is only the size of the wallet.

However, a moment comes when our body tells us: “Stop! Enough!”. This means that we have gone too far in disrupting the diet and expanding the range of dishes.

It’s time for heartburn.

Heartburn, which is defined as a burning sensation behind the breastbone, is a common symptom of diseases of the upper gastrointestinal tract. But it can also be a consequence of the so-called errors in the diet, which we all make to one degree or another.

The cause of heartburn is a chemical burn of the lower esophagus.This happens when, with a simultaneous contraction of the upper (cardiac) part of the stomach and relaxation of the lower esophageal sphincter, the contents of the stomach enter the esophagus and affect the cells of its mucous membrane. The contents of the stomach are gastric juice, the main components of which are the digestive enzyme pepsin, its precursor pepsinogen and hydrochloric acid – a very aggressive acidic environment for the vulnerable mucous membrane of the esophagus.

However, in the pathogenesis of heartburn, the key point is not the degree of aggressiveness (acidity) of the thrown in gastric juice, but the throw itself.After all, acidic stomach contents perform a number of important functions in our body:

• The digestive enzyme pepsin, which is responsible for the digestion of proteins, goes from an inactive state to an active one only in an acidic environment;
• food proteins are more easily broken down by pepsin after preliminary exposure to hydrochloric acid;
• we constantly, together with food, take in billions of foreign microorganisms, their spores and worm eggs, and it is the high acidity of gastric juice that helps us to survive in this unequal struggle;
• fluctuations in the acidity of gastric juice not only depend on the regulatory mechanisms of the stomach, but are themselves the starting point of such regulation.For example, only with low acidity of gastric contents in the area of ​​transition of the stomach into the esophagus, a valve (gatekeeper) opens and the food lump enters the duodenum for further digestion, and when the acidity of the same section increases, the gatekeeper closes, preventing acidic gastric juice from entering the intestine and, on the contrary, the alkaline contents of the intestine end up in the stomach.

The key point in the occurrence of heartburn is gastroesophageal reflux – a mechanical reflux of stomach contents, often with absolutely normal stomach acidity, into the esophagus.

Based on this, all methods aimed at reducing the acidity of gastric juice are purely symptomatic. You need to either prevent the development of reflux, or fight it. How to do it?

You can prevent heartburn by changing your daily habits. So, the following is recommended [1]:

• avoid overeating, especially before bedtime;
• after eating for several hours, avoid physical exertion, especially those associated with bending forward;
• Give up tight, tight clothing such as corsets, tight belts;
• sleep with the edge of the bed raised, on which the head is located;
• to normalize body weight, since overweight, especially with the distribution of fat according to the abdominal type, significantly increases the risk of developing regular bouts of heartburn [2];
• stop smoking or try to smoke fewer cigarettes per day;
• to minimize the consumption of alcohol, especially carbonated alcoholic beverages, dry red wine and beer;
• give up chocolate, black coffee, strong tea and carbonated drinks;
• Limit the consumption of citrus fruits and raw sour fruits and vegetables.

In addition, everyone experiencing heartburn, as a rule, knows exactly what factors provoke the occurrence of this pathology in him. It is these factors that he needs to avoid.

What to do when heartburn has already occurred? You, standing at the first table, often see people who are ready to do almost anything to get rid of this painful symptom. Is it possible to quickly and effectively get rid of it using the forces of nature?

You can! With the help of alginate preparations.

Alginates are water-soluble biopolymers of natural origin obtained from brown algae of the genus Laminaria. They were first studied by the British chemist E.S. Stanford (E.C. Stanford) at the end of the XIX century. And it took more than 50 years before the industrial production and use of alginates began. Since that time, scientists have been discovering new properties of this versatile product. At the moment, enough features of alginates are already known, such as gel formation, film formation, thickening and stabilization of the medium.These characteristics contributed to the fact that alginates are currently used as additional substances in solid dosage forms with modified release of active substances, thickeners and disintegrating agents in the food industry, the wide density corridor of the gel formed by them allows the use of alginates in dentistry, and their ability to form films, foam and fiber gives wide opportunities for their use in dermatology and wound treatment [3].

For us, this product of natural origin is interesting because in the acidic environment of the stomach it forms a strong raft-barrier of low density, which, being located on the surface of the gastric contents, prevents it from being thrown into the esophagus.Thus, alginates mechanically prevent the reflux of gastric contents into the esophagus, in addition, with severe reflux, alginate gel enters the esophagus first, protecting the esophageal mucosa from aggressive components of gastric juice [4].

The only representative of alginate preparations in Ukraine is Gaviscon ^® [5]. It is an over-the-counter drug, which is a combination of alginates and a small, one might say gem-quality, amount of carbonates, calculated for the formation of such a volume of carbon dioxide, which will contribute to the buoyancy of the alginate raft, as well as neutralize the acid exclusively in the upper stomach [6].

The group of alginates is represented on the Ukrainian pharmaceutical market by the preparations Gaviscon ^® mint tablets, Gaviscon ^® mint suspension, Gaviscon ^® Forte mint suspension and Gaviscon ^® Double action. Medicines differ from each other in the form of release (suspension and chewable tablets), the content of sodium alginate in one dose (250 mg and 500 mg in one tablet / 5 ml of suspension) and the amount and quality of antacids (sodium bicarbonate, potassium bicarbonate, calcium carbonate) …The different composition of drugs and 2 dosage forms of release allow you to individualize the choice that meets the needs of a particular patient. Separately, it should be noted that all forms of Gaviscon ^® preparations can be recommended for pregnant women, since their effectiveness in this category of patients has been confirmed in several European clinical trials [7], and the only contraindication to the use of these drugs is hypersensitivity to any or component [4].

Thus, Gaviscon ^® in all its forms is an effective remedy based on ingredients of natural origin, characterized by a favorable safety profile and intended for the symptomatic treatment of heartburn in adults, including pregnant and lactating women, the elderly and children over the age of 12 years. At the same time, Gaviscon ^® mint suspension can be used in children from 6 years old.

Providing a pharmacist to a pharmacy visitor with heartburn, you can recommend Gaviscon ^® – a preparation based on ingredients of natural origin, acting quickly – from the 3rd minute [8] and effectively, which has a favorable safety profile and is approved for use in pregnant women.

List of used literature:

1. GERH. Unifikovaniy Klinichny protocol of the first, second (special) medical aid. Order of the Ministry of Health of Ukraine issued on October 21, 2013. No. 943.
2. Boeckxstaens G., El-Serag H.B. et al. Symptomatic reflux disease: the present, the past and the future. Postgrad Med J, 2015: 91; 46-54.
3. McHugh D. J. Production, properties and uses of alginates // Production and Utilization of Products from Commercial Seaweeds. FAO. Fish.Tech. Pap. – 1987 .– T. 288 .– S. 58-115.
4. Instructions for medicinal preparation of lykarsky zasob Gaviskon ^® mint suspension, Gaviskon ^® mint tablets, Gaviskon ^® Forte m’yatna suspension, Gaviskon ^® Suspension
5. Zgіdno Sovereign Registry of Likarskie Zasobіv Ukraine as of 01.02.2016.
6. Rohof W.O., Bennink R.J. et al. An Alginate-Antacid Formulation Localizes to the Acid pocket to Reduce Acid Reflux in Patients With Gastroesophageal Reflux Disease.// Clinical Gastroenterology and Hepatology. – 2013 .- # 11.-P.1585-1591.
7. Strugala V., Bassin J. et al. Assessment of the Safety and Efficacy of a Raft-Forming Alginate Reflux Suppressant (Liquid Gaviscon) for the Treatment of Heartburn during Pregnancy // Obstetrics and Gynecology.-2012.-Vol.2012.-Artickle ID 4818870.
8. Strugala, V., Dettmar, P. W. et al. (2010). A randomized, controlled, crossover trial to investigate times to onset of the perception of soothing and cooling by over-the-counter heartburn treatments. Journal of International Medical Research , 38 (2), 449-457.

Press service of “Weekly APTEKA”

Gaviskon

Tsikava information for you:

90,000 Clinical trials of a well-known heartburn remedy in the fight against coronavirus

begin in New York

Hello, Marina Astvatsaturyan is at the microphone! Another candidate has been added to the list of possible drugs for the new coronavirus: famotidine, the active ingredient in an over-the-counter heartburn drug sold under the name Pepsid, Sciencemag reports.org. As it became known to the publication, on April 7, a patient with COVID-19, being treated at the Northwell Health clinic in New York, became the first to receive famotidine intravenously at a dose nine times the amount of the drug taken for heartburn. Unlike other drug trials in 23 New York hospitals, such as the immune-suppressing sarilumab and the antiviral remdesivir, famotidine’s trials go quietly. “If the wrong people find out about it or if we rush to announce it, there could be a shortage of the drug,” Sciencemag said in a comment.org Kevin Tracey, a former neurosurgeon now engaged in clinical research in the hospital system. Research is being conducted on critically ill patients with COVID-19. Chinese scientists and molecular simulations suggest that famotidine binds to a key enzyme responsible for the development of acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and this may have a therapeutic effect.

The unjustified hype surrounding antimalarial drugs with unproven efficacy has kept Dr. Tracy and his colleagues from showing premature enthusiasm for famotidine.He is silent about the preliminary results obtained in 391 patients. “If the treatment proves to be effective, we will know about it in the next few weeks,” says the researcher. The idea to test famotidine as a means of fighting the new coronavirus arose from the observation of thousands of patients in China who had chronic diseases such as hypertension and chronic obstructive pulmonary disease, were over 80 years old, but survived the coronavirus infection. It turned out that many of them also suffered from chronic heartburn and had been taking famotidine for many years, but not its more expensive analogue, omeprazole.Before the start of the current trials, there was an encouraging incident: after learning from colleagues about the possible effect of heartburn medication on coronavirus, one employee of the Cold Spring Harbor Laboratory recommended it to his sister, who was diagnosed with COVID-19 and had many symptoms. diseases, primarily hypoxia. After taking a megadose of famotidine, the woman began to breathe normally the very next day. You will also find news of world science on the page of our program in the newspaper of the scientific community “Poisk”.

Heartburn: Causes, Diagnosis, Treatment | Allegro

Heartburn is a pathology accompanied by a burning sensation and discomfort behind the breastbone. According to statistics, this condition is experienced by 20 to 50% of the world’s population. Heartburn usually appears within half an hour or an hour after eating. Frequent attacks cannot be ignored as they can be a symptom of a serious illness. A gastroenterologist will help to conduct an examination, make an accurate diagnosis and prescribe an effective treatment.

Causes of heartburn

Burning sensation and discomfort in the epigastric region occurs due to the weakening of the esophageal sphincter. As a result, gastric juice penetrates from the stomach into the esophagus, and the acid acts on the mucous membrane of the latter. In addition to acid, pepsin, lysolecithin and pancreatic enzymes also have a negative effect. The return of stomach contents through the sphincter is called gastroesophageal reflux. Such conditions are observed from time to time in healthy people.However, if they are repeated often, this is a reason to consult a specialist.

Causes of heartburn are:

• non-compliance with the food intake: overeating, fast food intake, snacks, irregular lunches and dinners;
• unhealthy food: fatty and spicy foods, fresh flour products, a lot of coffee;
• taking medications that reduce the tone of the lower esophageal sphincter. These include NSAIDs, glucocorticosteroids, some groups of antibiotics, antidepressants, bronchodilators, some heart and sedative drugs, substances containing iron;
• bad habits;
• constant stress and nervous tension;
• overweight;
• In some cases, the factors contributing to the appearance of heartburn are wearing uncomfortable clothes, lifting weights.

Heartburn can occur with various diseases:

• Hernial protrusion of the esophageal opening of the diaphragm. In parallel, belching may occur, pain in the lower chest, passing into the arm and shoulder, radiating to the back. Lying down and bending forward aggravate the condition.
• stomach ulcer. Discomfort occurs at night, accompanied by chest pain, and interferes with rest and sleep.
• cancer of the cardiac stomach. Discomfort is observed when food moves through the esophagus, then pain in the chest and difficulty swallowing are added to this symptom.
• Hypersensitive esophagus. This is an individual characteristic of the organism. It occurs with an increase in the sensitivity of the walls of the esophagus.

Other reasons include:

• functional dyspepsia. This is a temporary dysfunction of the digestive tract. The patient may also complain of stomach pain, nausea, and bloating. Examinations do not reveal serious diseases of the gastrointestinal tract.
• pregnancy. In this case, discomfort occurs due to hormonal changes, namely the production of large amounts of progesterone.The hormone helps the fetus to grow and form, and supports pregnancy. But together it acts on the gastrointestinal tract, reduces the motility of the sphincter, due to which the contents of the stomach penetrate into the esophagus. In addition to progesterone, the appearance of heartburn during pregnancy is facilitated by an actively growing uterus, which presses on the stomach and provokes reflux.
• chronic obstructive pulmonary disease.
• enlargement of the spleen or liver.

Causes of childhood heartburn

In children, this pathology is rare.It can be provoked at an early age by:

• Chronic gastritis due to malnutrition, abuse of junk food;
• Insufficiency of the esophageal sphincter, which may be a congenital disease.

Diagnostics

Includes:

• detailed collection of anamnesis;
• laboratory methods of examination, including general and biochemical blood tests, coprogram, etc .;
• fibrogastroduodenoscopy;
• esophagomanometry;
• PH-metry.

The last three methods of examination have contraindications: old age, severe pathologies of the cardiovascular system and lungs, problems with blood coagulation.

How to get rid of heartburn

It is important to identify the nature of the pathology in order to choose the right therapy. The condition triggered by an eating disorder can be easily corrected by adjusting the diet. In the presence of serious diseases, you cannot do without the use of drugs.

Treatment of heartburn with drugs

Most often, the doctor prescribes the simultaneous administration of different drugs. In milder forms, therapy is designed to eliminate symptoms, reduce reflux and protect the esophageal mucosa from the aggressive effects of acid.

The specialist can assign:

• Antacids . They have a quick but short-term effect. The drug is used as an additional agent. With long-term use or exceeding the recommended dose, side effects occur – loose stools, constipation, etc.p.
• alginates. Reacting with hydrochloric acid, they form a film with neutral PH, which protects the walls of the esophagus from the effects of aggressive acid.
• gastroprotective agents. They also form a thin film, thereby protecting the walls of the stomach. The drug is prescribed in conjunction with antacids or alginates. It not only affects the symptoms, but also removes the causes of pathology.

Frequent attacks require more serious and prolonged treatment.A gastroenterologist, in addition to the above drugs, prescribes:

• antisecretory agents. h3-blockers of histamine receptors are taken for long courses. When taken in small quantities, side effects are not observed. The drug helps produce mucus and increases the resistance of the stomach lining. Proton pump inhibitors affect the production of hydrochloric acid. With short-term treatment, there are no side effects.
• prokinetics. Improves gastrointestinal motility, increases the tone of the esophageal sphincter and prevents reflux.

Change in lifestyle and nutrition

• It is worth giving up alcohol and cigarettes.
• It is important to establish clear rules for eating behavior:
• eat several times a day in small portions, but no later than a couple of hours before bedtime;
• Exclude spicy, fried foods, soda, strong tea, oranges, lemons, tomatoes and sour berries;
• more often include steamed vegetables, cereals, lean meat and fish, low-fat dairy products in the diet.

If heartburn does not go away even with a strictly established diet and diet, attacks occur often and interfere with active pastime, rest and sleep, you should see a specialist. A timely diagnosis of the disease and the treatment carried out will help to avoid complications.

FIND OUT PRICES

90,000 How to neutralize heartburn – we answer customer questions

Cheat sheet to help the first-timer for competent advice on antacids

At least one big feast in the series of New Year’s holidays is over, which means that customers with a burning sensation in the esophagus have already paved their way to the nearest pharmacy.Overeating and high doses of alcohol almost inevitably lead to problems with the gastrointestinal tract, even in those who usually do not suffer from it. Those who celebrate the holiday are demanding that the pharmacy worker let go of “something for heartburn.” How to answer your strangest or trickiest questions about antacids? We offer you the following answer options.

I have taken different medications for heartburn and have not noticed the difference between them. Is it there at all, or is it just the packages that differ?

In fact, antacids work and are tolerated in different ways.Some of them are absorbed in the digestive tract, for example – sodium bicarbonate, calcium and magnesium carbonate. Others, such as aluminum-magnesium antacids, are not absorbed. The former enter into a direct reaction with hydrochloric acid in the lumen of the stomach, act quickly, but not for a long time, and, moreover, have a number of side effects. The latter adsorb hydrochloric acid, so their effect develops more slowly than in the case of absorbed antacids. However, it is more prolonged, and the safety profile of drugs in this group is much higher.

If you take antacids only occasionally, with heartburn associated with inaccuracies in nutrition, you may really not notice the difference between them. And yet, today, doctors recommend the use of nonabsorbable drugs as having an optimal balance of efficacy and safety [1].

Advise me something for heartburn to last longer.

Modern antacids that are not absorbed in the digestive tract, such as aluminum phosphoric acid or aluminum-magnesium preparations, are suitable for you.They bind hydrochloric acid rather quickly – usually within a few minutes after ingestion – while their effect lasts up to several hours. The maximum duration of action of is typical for preparations containing exactly aluminum hydroxide. They work for 2.5–3 hours [2].

When is the best time to take this heartburn medication – before or after meals?

According to experts, taking antacids before meals is irrational. Food itself serves as a buffer to reduce gastric acidity.Therefore, it is advisable to take medications for heartburn after meals, approximately after 60–90 minutes, when the production of hydrochloric acid reaches a maximum value of [3]. In addition, antacids taken after meals are cleared from the stomach later than those taken on an empty stomach and, therefore, last longer [3].

The doctor prescribed a medicine for heartburn, but soda works great for me. So why are pills better than a natural and also very cheap remedy?

Soda, or sodium bicarbonate, really quickly neutralizes hydrochloric acid by reacting with it.However, the result is carbon dioxide, which causes the stomach to distend. The body perceives this as a signal of food intake and reacts by releasing another portion of hydrochloric acid. This effect is called rebound syndrome . Thus, soda, neutralizing acid in the lumen of the stomach, stimulates its further production, not solving the problem, but only masking it for a very short time [4]. In addition, sodium bicarbonate is completely absorbed in the digestive tract and has a systemic effect.With prolonged use, the acid-base balance may shift [4] with the development of alkalosis. And this is already very serious: it leads to impaired cerebral and cardiac circulation, a decrease in blood pressure and activity of the respiratory center, as well as an increase in neuromuscular excitability up to seizures, suppression of intestinal motility and other consequences. Unlike baking soda, nonabsorbable heartburn medications are well tolerated and do not cause rebound syndrome and systemic effects. Therefore, doctors strongly advise against taking sodium bicarbonate on an ongoing basis, but preferring non-absorbable modern drugs.

Give me some heartburn medicine. And it is desirable that it still helps against bloating – are there such remedies?

Yes, today there are combination drugs that simultaneously neutralize hydrochloric acid and stop manifestations of flatulence due to the inclusion of simethicone in the defoamer. It lowers the surface tension of gas bubbles in the digestive tract, facilitating their rupture. An example of such a drug is a combination of aluminum, magnesium hydroxide and simethicone in the form of a suspension.It simultaneously neutralizes hydrochloric acid, reduces gas formation in the intestine, and also envelops the mucous membrane of the digestive tract, protecting it from the damaging effects of aggressive substances [5].

What is the difference between pills and suspensions from heartburn? Do they act differently?

The mechanism of action of a drug does not depend on the form (tablets, gel, suspension), but on its components. But the pharmacokinetic properties – the speed of the onset of the effect, the duration of action – may differ for tablets and suspensions.It is believed that tablet forms maintain the acidity of gastric juice at a level of more than 4 longer ( acidity of gastric juice is considered normal in the range of 1.3–7.5 pH, – ed. ) than suspensions. With the correct intake of chewable tablets for heartburn, acid-neutralizing components enter the digestive tract evenly, which has a positive effect on the result. At the same time, for heartburn, suspensions may start to work faster than tablets [3]. In addition, they are optimally distributed over the surface of the mucous membrane, and in the lumen of the esophagus and stomach they form small drops with a large surface area, which enhances their healing properties [6].

And yet it cannot be said unequivocally that any form has an advantage. To draw such conclusions, it is necessary to consider the properties of a particular drug.

What is the difference between heartburn remedies, which contain two components at once, from single-component ones? Are they stronger?

For heartburn drugs, two points are important: the speed and duration of the neutralization of hydrochloric acid. It is known that absorbable antacids (for example, magnesium oxide) provide a quick but short-term effect, while non-absorbable ones (aluminum hydroxide, magnesium trisilicate) begin to act later, but work longer.That is why most modern drugs are a combination containing different components, which makes it possible to achieve optimal both in terms of development time and in duration of the result.

The doctor prescribed me a remedy for heartburn, but I started having problems with stool. Give some laxative.

Constipation is a fairly common side effect of antacids, primarily those containing aluminum, the salts and hydroxides of which can inhibit intestinal motility [7].Complex remedies for heartburn, in which aluminum derivatives are combined with magnesium salts, which exhibit some laxative effect, allow minimizing the likelihood of developing this adverse reaction. In all likelihood, you would be better off choosing another medicine with a balanced composition that ensures normal bowel function, such as a combination of aluminum and magnesium hydroxide [4].

I have 28 weeks of pregnancy and terrible heartburn, the doctor advised me to take antacids for heartburn.Is it really possible in my case?

Antacids are one of the most commonly used drug groups during pregnancy [8]. They are accepted by about 30-50% of expectant mothers [8]. Animal studies have confirmed that antacids, which are not absorbed in the digestive tract, do not have a teratogenic effect, therefore they are widely prescribed during pregnancy [8]. However, it is up to the physician to decide on the prescription of a particular drug.

The doctor prescribed both omeprazole and a heartburn remedy.But omeprazole is also drunk for heartburn. Maybe it makes sense to leave something alone?

Omeprazole, as a member of a group of drugs called “proton pump inhibitors”, suppresses the production of hydrochloric acid in the stomach, while drugs for heartburn, or antacids, neutralize the already synthesized aggressive substances contained in gastric juice. In addition, antacids that are not absorbed in the digestive tract (for example, the aluminum salt of phosphoric acid) are able to bind pepsin and bile acids.These substances, along with hydrochloric acid, irritate the mucous membrane of the stomach and esophagus. Thus, omeprazole and antacids have different points of application, and in some cases they are used in combination [9]. In your case, the doctor believes that the combined appointment of these two drugs is justified, and I advise you to follow this recommendation.

I am constantly tormented by heartburn. Give some effective remedy, but more, so that it lasts for a long time.

Of course, the mechanism of action of antacids allows you to stop the symptoms of heartburn.However, it should be borne in mind that with long-term use, even in low doses, side effects can develop – for example, a violation of mineral metabolism or deterioration of kidney function. Products containing aluminum can form aluminum phosphate salts in the small intestine, as a result of which the absorption of phosphates is impaired. This, in turn, may increase the risk of osteoporosis and osteomalacia, which are characterized by decreased bone density and softening. Calcium absorption may also be impaired [7].Therefore, it is best to find out the cause of heartburn. I recommend that you see a doctor immediately. But while the diagnosis is underway, it is advisable to alleviate the condition with modern non-absorbable antacids, such as aluminum salt of phosphoric acid, aluminum-magnesium preparations with the addition of alginate, etc. They not only relieve heartburn, but also protect the mucous membrane of the digestive tract from the action of aggressive substances such as pepsin and bile acids [4].

The doctor prescribed medication for heartburn.But I take so many drugs that I doubt if another drug can be taken with them.

It is not in vain that you are worried: remedies for heartburn, or antacids, can interfere with the absorption of other drugs when used together, in particular, cardiac glycosides, anticoagulant drugs, antihistamines, hypnotics and many others. To eliminate the likelihood of drug interactions, it is important to observe the time interval between taking antacids and other medications. It should be at least two hours [7].

I heard that recently there have been some radically new remedies for heartburn that are different from the traditional ones. What are they good for?

Most likely, we are talking about alginates – natural polysaccharide polymers that are isolated from brown algae and included in antacid drugs. The mechanism of action of alginates is really fundamentally different from traditional drugs. After ingestion in the acidic environment of the stomach, alginates turn into a gel-like state.This gel envelops the mucous membrane, acting as a protective barrier, and adsorbs carbon dioxide, which is formed when hydrochloric acid is neutralized. The acid, in turn, neutralizes the second component of the complex preparation (for example, sodium bicarbonate, potassium bicarbonate, etc.). In the intestine, alginates, being dietary fibers, exhibit prebiotic properties, that is, they are a nutrient medium for the intestinal microflora [10]. In addition, they exhibit a mild laxative effect by delaying the absorption of water in the stomach.

Sources of

1. Ivashkin V.T., Baranskaya E.K., Shifrin O.S., Yurieva E. Yu. The place of antacids in modern therapy of peptic ulcer // Russian Medical Journal. Diseases of the digestive system, 2002. V.4. No. 2.
2. Ushkalova E. A. Clinical pharmacology of modern antacids // Pharmateka, 2006. No. 11. S. 1-6.
3. Arutyunov A. G., Burkov S. G. The use of antacids in general clinical practice // RMZh, 2006. No. 15.S. 1094.
4. Kharchenko NV, Chernenko VV Have antacids exhausted themselves? // Embassy of Medicine, 2008. No. 3.
5. Minushkin ON, Elizavetina GA Antacids in modern therapy of acid-dependent diseases // Gastroenterology of St. Petersburg, 2010. № 2-3. S. 9-12.
6. Shulpekova Yu. O., Ivashkin VT Antacids and their place in the treatment of pancreatitis // Rus. honey. f. Diseases of the digestive system, 2004. T. 6. No. 2. P. 14-16.
7. Antonenko O.M., Grishchenko E.B.The place of antacids in the treatment of acid-dependent diseases // Consilium Medicum. Gastroenterology. (Suppl.), 2010. No. 2. P. 73–78.
8. Elokhina T.B., Tyutyunnik V.L. Gastroesophageal reflux disease during pregnancy // Experimental and clinical gastroenterology, 2009. No. 3.
9. Yurgel V.V., Dusheba E.E., Livzan M.A.Combined therapy with a proton pump inhibitor and an antacid: when it is needed // Attending physician, 2010. V. 11.
10. Uspensky Yu.P., Baryshnikova N.V., Pakhomova I.G. Clinical prospects for the use of drugs based on alginic acid in the treatment of gastroesophageal reflux disease // Ros. zhurn. gastroenterol., Hepatology, Coloproctology, 2009. V. 19.No. 2. P.

Decreased stomach acidity / Blog / Clinic EXPERT

Stomach acid plays an important role in the human body is a defense mechanism against swallowed pathogens, an activator of gastric acid enzymes and an assistant to enzymes in the digestion of proteins.

Decreased gastric acidity develops as a result of 3 main reasons:

1. Stomach atrophy
2. Taking drugs that reduce gastric acidity (proton pump inhibitors, H2-histamines)
3. Removal of a part of the stomach due to stomach cancer or as an option for bariatric treatment (in case of severe obesity of the patient, part of his stomach is removed for subsequent rapid weight loss)

I think it is worthwhile to cover in more detail the topic of atrophic gastritis as the cause of a decrease in the production of hydrochloric acid by the stomach.

With atrophy of the gastric mucosa, the number of glands gradually (over many years and decades) decreases and finally completely disappears. The production of hydrochloric acid first decreases and then stops altogether.

The main causes of gastric atrophy are Helicobacter Pylori infection and autoimmune gastritis.

Helicobacter Pylori is a bacterium that can lead to inflammation in the stomach, persistent chronic inflammation contributes to glandular atrophy.This process usually affects the antrum (outlet) part of the stomach.

Autoimmune gastritis is a chronic disease that develops due to the fact that the human body, for unknown reasons, begins to perceive its own stomach cells as foreign and produces antibodies against them, which leads to inflammation and atrophy of the stomach glands. With autoimmune gastritis, the body and fundus of the stomach are mainly affected.

In the world, about 50% of people are infected with Helicobacter, and autoimmune gastritis occurs in about 1-2% of the population.

Of course, not all people infected with Helicobacter will develop such a pronounced atrophy of the stomach that the secretion of hydrochloric acid will decrease. Moreover, with mild atrophy, the secretion of hydrochloric acid often remains normal.

In the presence of autoimmune gastritis, usually over the course of many years atrophy becomes quite serious , and the presence of a concomitant Helicobacteron infection aggravates the situation.

On average, the prevalence of atrophic gastritis worldwide is about 30%, most of the patients are people over 40 years old.

About 2.5–5% of these people have progressive (moderate or severe) atrophic gastritis and an almost achloride stomach in people over the age of 50.

Decreased acidity and atrophy of the stomach leads to an increased risk of developing various infections , overgrowth of bacteria in the stomach and small intestine, impaired digestion of food, and, accordingly, impairs the absorption of vitamins and minerals. The absorption of vitamin B12, iron slows down especially sharply, and calcium, folic acid, vitamin C are also less absorbed.

Gastric atrophy and decreased secretion of hydrochloric acid can manifest symptoms from the gastrointestinal tract, as well as from other organs, but you should be aware that in about half of cases, a person does not feel any symptoms for a long time.

Main symptoms of hypoacid stomach

Main gastrointestinal symptoms include: epigastric pain, heaviness in the abdomen after eating, early satiety, heartburn (due to non-acid reflux), bloating, diarrhea or constipation.

Also, clinically, atrophic gastritis and decreased gastric acidity are often manifested by anemia, which develops as a result of vitamin B12 and / or iron deficiency. The most common symptoms are as follows: general weakness and fatigue, shortness of breath, pallor of the skin and mucous membranes, irritability and deterioration of mood, decreased cognitive abilities, taste perversion – desire to eat inedible objects (for example, earth or chalk), peripheral neuropathy and paresthesia ( violation of the sensitivity of the hands and feet – a tingling sensation and tingling, numbness or, on the contrary, increased skin sensitivity), muscle weakness, impaired coordination.A decrease in the absorption of vitamin B12 and folic acid is accompanied by an increase in blood homocysteine ​​levels, which can increase the risk of thrombosis, heart attacks and strokes.

Also, deterioration in calcium absorption can lead to osteoporosis (excessive fragility of bones), which manifests itself as pain in the bones / muscles, frequent bone fractures with minor trauma.

How to diagnose gastritis with reduced secretion of hydrochloric acid?

There are many methods described in the literature for the diagnosis of decreased gastric acid secretion, but most of them are either too difficult to carry out and uncomfortable for the patient, or have very low sensitivity and insufficient evidence base.

I would like to note that quite often people over 50 come to the reception and report with full confidence that their acidity is very low, the stomach “almost does not work.” And their confidence in this appeared due to the fact that once upon a time they underwent EGD with a quick acidity test and were told that their stomach was hypoacid, that is, there was very little acid. But I would like to note that in the overwhelming majority of these patients with acidity, everything is in order (as it turns out during the follow-up examination), and the tests carried out at that time were extremely unreliable and almost all showed hypoacidity .And now there is a reverse trend – similar rapid tests performed with EGD, only now they diagnose high acidity in most patients. However, in the foreign literature and recommendations, these tests are not mentioned as methods for diagnosing the level of acidity, which means that these tests did not pass reliable studies of sensitivity and specificity, therefore, the quality of these tests should also be questioned.

Therefore, in real clinical practice, it is worth relying on a blood test called “gastropanel” (the ratio of pepsinogen I / pepsinogen II, gastrin-17 and antibodies against H.pylori), as well as informative EGD with multiple biopsy (according to OLGA or OLGA-M) to determine the activity of inflammation in the stomach, the degree of atrophy and the presence of H. pylori – by the degree of atrophy, one can indirectly judge the ability of the stomach to produce hydrochloric acid.

EGD with biopsy according to OLGA or OLGA-M is the gold standard for diagnosing atrophic gastritis and detecting precancerous changes in the stomach.

If atrophic gastritis is detected, the patient is always tested for Helicobacter Pylori infection.However, it must be remembered that with severe atrophy of the stomach with reduced secretion of hydrochloric acid, tests such as the C13-urease breath test and feces for antibodies to Helicobacter may turn out to be false-negative. Therefore, in the case of serious atrophy, the best indicator of the presence of a microbe will be a biopsy of the gastric mucosa or the detection of antibodies to Helicobacter IgG (antibodies in the blood – only if this microbe has not been previously eradicated).

When detecting the presence of Helicobacter pylori infection, it must be eliminated with antibiotics.

In the presence of B12 deficiency and / or atrophy of the body or fundus of the stomach, in addition to tests for Helicobacter, the doctor will always examine the patient for the presence of autoimmune gastritis. In this case, blood is taken for antibodies to parietal cells of the stomach, Castle’s internal factor.

Currently, there is no specific treatment for autoimmune gastritis, only observation and elimination of vitamin and mineral deficiencies is shown.

Patients with reduced gastric acidity, depending on the localization of atrophy, can be prescribed for life vitamin B12 (usually intramuscular injection once a month), iron preparations, calcium preparations, folic acid, as well as other macro- and microelements, depending on their lack in a particular patient.

Patients with atrophic gastritis have an increased risk of developing stomach cancer and should regularly undergo EGD with biopsy (at least once every 3 years).

As for drugs containing gastric enzymes (such as acididin, pepsin), their effectiveness has not been proven, they are not mentioned in any recommendations and their use is more likely to be considered alternative medicine. Also, the effectiveness of any specific diet with reduced gastric acidity has not been proven, therefore food should be regular, correspond to modern ideas about proper nutrition, and also take into account the individual tolerance of the patient’s food (if any foods cause pain or other unpleasant sensations, it is recommended to avoid eating them).

Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Acid Controller Max St [OTC]; Acid Controller Original Str [OTC]; Acid Reducer [OTC]; Famotidine Maximum Strength [OTC]; Famotidine Orig St [OTC]; Heartburn Relief Max St [OTC]; Heartburn Relief [OTC]; Pepcid; Pepcid AC Maximum Strength [OTC]

Trade names: Canada

ALTI-Famotidine; APO-Famotidine; BCI-Famotidine [DSC]; CO Famotidine; Famotidine Omega W-O Preserv; Famotidine Omega W-Preserv; GMD-Famotidine; MYLAN-Famotidine [DSC]; TEVA-Famotidine

What is this drug used for?

• Used for the treatment and prevention of gastrointestinal ulcers.
• Used to treat gastroesophageal reflux disease (GERD; acid reflux).
• It is used to treat heartburn and gastric acidity.
• Used to treat symptoms caused by excessive amounts of stomach acid in the body.
• This medicinal product can be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
• If you have any of the following health problems: black or bloody stools; heartburn with dizziness, sweating, or dizziness; chest pain; shoulder pain with shortness of breath; pain that spreads to the arm, neck, or shoulders; dizziness; excessive sweating; vomiting of blood; difficulty or pain in swallowing food.
• If you are taking any of the following drugs: cefditoren, dasatinib, delavirdine, or fosamprenavir.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking.Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

All forms of issue:

• Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• Do not take this drug for longer than your doctor prescribed.
• If you have kidney disease or if you are 65 years of age or older, consult your doctor. Patients with kidney disease and the elderly have hallucinations (visual and auditory images that do not exist in reality), seizures, agitation, confusion, lethargy, and malaise.
• This drug may interfere with other drugs taken by mouth. If you are taking other drugs, you may need to take them at a different time from the time you take this drug.Consult your doctor.
• Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The benefits and risks for you and your child will need to be discussed.

Injection:

• Some preparations contain benzyl alcohol. These drugs should not be given to newborns or infants. If you want to know if this drug contains benzyl alcohol, talk to your doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Dizziness or fainting.
• Increased or abnormal heart rhythm.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

• Headache.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

All oral preparations:

• Take this medication with or without food.
• Talk to your doctor before using antacids with this drug.

Chewable Tablets:

• Chew or crush thoroughly.Do not swallow whole.

Liquid (suspension):

• Shake well before use.
• Care should be taken to measure liquid doses. Use the dispenser that comes with the medicine. If a dispenser is not included in the package, ask your pharmacist for a dosing product for this drug.

Injection:

• For intravenous injection.

What to do if a dose of a drug is missed?

All oral preparations:

• Take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
• Do not take 2 doses at the same time or an additional dose.
• In most cases, this drug is used as needed. Do not take this medicine more often than prescribed by your doctor.

Injection:

• Call your doctor for further instructions.

How do I store and / or discard this drug?

All oral preparations:

• Store at room temperature in a dry place.Do not store in the bathroom.

Liquid (suspension):

• Throw away all unused portions after 1 month.

Injection:

• If you need to store this drug at home, ask your doctor, nurse, or pharmacist for information about how it is stored.

All forms of issue:

• Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information about medicines

• If your health does not improve or even worsens, see your doctor.
• You should not give your medicine to anyone and take other people’s medicines.
• Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• Some medicines may have different patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• If you think there has been an overdose of a drug, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient.This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional.Check with your doctor for complete information on the possible risks and benefits of taking this drug. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

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