Ulcer Medications

Antireflux
Sucralfate (Carafate)
Metoclopramide (Reglan)

Histamine 2 (H2) Antagonists
Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)

Proton Pump Inhibitors
Lansoprazole (Prevacid)
Omeprazole (Prilosec)

Nutritional Considerations

Avoid alcohol. (Pronsky 1999)

Take sucralfate on an empty stomach. (Pronsky 1999)

With sucralfate, take calcium and magnesium supplements separated by at least 1/2 hr. (Facts and Comparisons 2000)

Avoid aluminum containing antacids with sucralfate due to possibility of excess aluminum build-up. (Facts and Comparisons 2000)

Caution with metoclopramide in diabetics: insulin requirements may change. (Pronsky 1999)


Folic acid may be diminished in long-term use of H2 antagonists. Consult your pharmacist concerning supplementation. (McKevoy 1998) (Pronsky 1999) (Russell 1988)

With cimetidine, take calcium, magnesium or iron supplements separated by at least 1 hour. (Pronsky 1999)

Limit caffeine. H2 antagonists increase the effect of caffeine. (Pronsky 1999) (Brinker 1998)

Avoid smoking if on therapy with antireflux drugs and H2 antagonists. (Facts and Comparisons 2000)

Sugar levels must be monitored periodically in diabetics while taking H2 antagonists. (Pronsky 1999)

Vitamin B12 levels may be reduced with use of H2 antagonists or proton pump inhibitors. Discuss supplementation with your pharmacist. (Bradford 1999) (Marcuard 1994) (Pronsky 1999)

Iron absorption is decreased with use of proton pump inhibitors. Ask your pharmacist whether supplementation would be beneficial. (Bellou 1996) (Pronsky 1999)

Herbal Considerations:

Avoid angelica, black mustard, calamus, capsicum, cinammon bark, dandelion, devils claw, gentian, ginger, goldenseal, and yarrow with ulcer medications. They all increase gastric acid and could therefore theoretically interact with these agents. (Brinker 1998)


Avoid black tea, cocoa, coffee, cola nut, guarana, green tea and mate because the caffeine can interfere with H2 antagonists. (Brinker 1998)

Licorice may theoretically provide an added protective effect with H2 antagonists. Ask your pharmacist regarding the benefit and safety of taking this herb with H2 antagonists. (Brinker 1998)

Do not take tobacco with cimetidine. It blocks the drug. (Brinker 1998)

References

Bellou A, Aimone -Gastin I, De Korwin JD, et al: Colbalamin deficiency with megaloblastic anemia in one patients under long-term omeprazole therapy, J Intern Med, 1996, 240(3): 161-4

Bradford GS, Taylor CT: Omeprazole and vitamin B12 deficiency, Ann Pharmacother 1999 May;33(5):641-3

Brinker, F. Herb Contraindications and Drug Interactions. Eclectic Medical Publications, 1998.

Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000.

Marcuard SP, Albernaz L, Khazanie PG. Omeprazole therapy causes malabsorption of cyanocobalamin (Vitamin B12). Ann Intern Med 1994;120:211-15.

McKevoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.

Pronsky, Zaneta. Food Medication Interactions. 11th edition. 1999.

Russell RM, Golner BB, Krasinski SD, et al: Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid, J Lab Clin Med, 1988, 112(4):458-63

Yue QY, Bergquist C, Gerd?n B. Safety of St John's wort (Hypericum perforatum). Lancet 2000;355(9203).