Antireflux
See also Histamine 2 Antagonists, and Antacids
Generic and Trade Names
| Carafate | Sucralfate | ||
| Cisapride | Propulsid | ||
| Metoclopramide Reglan |
Description
These agents work in different ways to treat reflux disease. Cisapride works by increasing the release of acetylcholine at the myenteric plexus. The drug is not as strong as metoclopramide in dopamine receptor-blocking effects in certain animal testing models. It does not increase or gastric acid secretion. Cisapride is a serotonin-4 receptor agonist, this might cause increased GI motility and cardiac rate.
The exact mechanism of action of Metoclopramide is unknown, however it appears to stimulate motility of the upper GI tract. It seems to make tissues more sensitive to the action of acetylcholine. The drug effects the extent of gastric contractions and speeds up gastric emptying.
Although Sucralfate is used for reflux conditions, the drug has no effect on gastric acid production or gastric emptying. It is works primarily by adhering to the ulcer, and forming a blockade against hydrogen ion diffusion.
(Facts and Comparisons 1999)
Nutritional Considerations
Take sucralfate on an empty stomach. (Pronsky 1999)
Avoid alcohol. (Pronsky 1999)
Take calcium and magnesium supplements separated by at least 1/2 hr. (Facts and Comparisons 1999)
Avoid aluminum containing antacids with sucralfate due to possibility of excess aluminum build-up. (Facts and Comparisons 1999)
Caution with metoclopramide in diabetics: insulin requirements may change. (Pronsky 1999)
Avoid grapefruit juice with cisapride. (Pronsky 1999)
Herbal Considerations
Angelica, Black mustard, Calamus, Capsicum, Cinchona, Cinammon bark, Dandelion, Devils claw, Gentian, Ginger, Goldenseal, Wormwood and Yarrow all increase gastric acid and could therefore theoretically interact with these agents. (Brinker 1998)
Due to the metabolism of cisapride by the cytochrome P-450 pathway, St. John's Wort may interact with this drug. (FDA 2000)
Chasteberry may theoretically interact with metoclopramide due to its anti-dopaminergic properties. (PDR for Herbal Medicines, 1998)
References:
Brinker, F Herb Contraindications and Drug Interactions, Eclectic Medical Publications, 1999.
Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.
Lieber, CS: Interaction of alcohol with other drugs and nutrients. Implication for the therapy of alcoholic liver disease. Drugs 1990;40 Suppl 3:23-44.
Lieber, CS: Mechanisms of ethanol-drug-nutrition interactions. J Toxicol Clin Toxicol 1994;32(6):631-81.
May, JR et al: Drug interactions in surgical patients. Am J Surg 1987 Mar;153(3):327-35.
McKevoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
PDR for Herbal Medicines, 1998.
Pronsky, Z Food Medication Interactions, 11th edition, 1999.
Yue QY, Bergquist C, GerdÈn B. Safety of St John's wort (Hypericum perforatum). Lancet 2000;355(9203).
www.fda.gov/cder/drug/advisory/stjwort.
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