Side effects of reflux meds
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Side Effects of Reflux Medications
Proton Pump Inhibitors (PPIs) and Histamine-2 Receptor Antagonists (H2RAs)
Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are commonly used to treat gastroesophageal reflux disease (GERD). However, these medications are associated with several adverse effects. Studies have reported that at least 34% of patients treated with PPIs and 23% of those treated with H2RAs experience side effects such as headaches, diarrhea, nausea, and constipation1 3. Additionally, long-term use of these medications can lead to more severe complications, including an increased risk of lower respiratory tract infections and nosocomial sepsis, particularly in immune-deficient children or those with indwelling catheters1.
Baclofen
Baclofen, a GABA(B) receptor agonist, has been shown to reduce GERD symptoms by decreasing transient lower esophageal sphincter relaxations (TLESRs). However, its use is not without side effects. Mild neurological and mental status deterioration are the most commonly reported adverse effects, occurring in less than 5% of short-term users and nearly 20% of long-term users2 9. Despite these side effects, baclofen may be beneficial for patients who do not respond to PPIs alone, especially those with concurrent conditions such as alcohol use disorder, non-acid reflux, or obesity2.
Metoclopramide and Domperidone
Metoclopramide and domperidone are prokinetic agents used to enhance gastrointestinal motility. Both drugs have been associated with significant side effects. Metoclopramide, in particular, has been linked to neurological and psychotropic symptoms such as drowsiness, lethargy, hyperactivity, and even acute torticollis and depression4 5 6. Domperidone, while generally better tolerated, can cause side effects such as galactorrhea5. Due to these adverse effects, the use of these medications is often limited to patients who do not respond to other treatments4 6.
Lesogaberan
Lesogaberan, a novel GABA(B) receptor agonist, has shown promise in reducing the number of TLESRs and reflux episodes in patients who do not fully respond to PPIs. However, common side effects include headaches and transient paresthesia7. While these side effects are generally mild, further evaluation is needed to fully understand the safety profile of lesogaberan as an add-on treatment for GERD7.
Conclusion
While medications for GERD, such as PPIs, H2RAs, baclofen, metoclopramide, domperidone, and lesogaberan, can be effective in managing symptoms, they are associated with a range of side effects. These adverse effects can vary from mild to severe and may limit the long-term use of these treatments. It is crucial for healthcare providers to weigh the benefits and risks of these medications and consider individual patient factors when prescribing them.
Sources and full results
Most relevant research papers on this topic
Adverse effects reported in the use of gastroesophageal reflux disease treatments in children: a 10 years literature review
Adverse effects from pharmacological agents for paediatric GERD include headaches, diarrhoea, nausea, and constipation, with potential risks for immune-deficient infants and children with indwelling catheters.
Systematic Review
Highly CitedBaclofen as a therapeutic option for gastroesophageal reflux disease: A systematic review of clinical trials
Baclofen may improve gastroesophageal reflux disease symptoms and may be particularly beneficial for patients with concurrent conditions like alcohol use disorder, non-acid reflux, or obesity.
Systematic ReviewSide effects of drug treatments for gastro-oesophageal reflux disease: current controversies
Proton pump inhibitors and histamine-2 receptor antagonists for gastro-oesophageal reflux disease treatment have been linked to a number of adverse effects, but their clinical significance is often based on associations rather than causal connections.
Literature ReviewTreatment of severe reflux esophagitis with cimetidine and metoclopramide.
Cimetidine and metoclopramide effectively manage chronic reflux esophagitis, but should be reserved for patients refractory to cimetidine alone due to frequent side effects.
RCTHighly CitedDomperidone, metoclopramide, and placebo. All give symptomatic improvement in gastroesophageal reflux.
All three drugs (placebo, domperidone, and metoclopramide) significantly improve symptoms of gastroesophageal reflux, with no significant difference in improvement between them.
RCTCimetidine, Metoclopramide, or Placebo in the Treatment of Symptomatic Gastroesophageal Reflux
Cimetidine or metoclopramide are more effective than placebo for relieving symptoms of gastroesophageal reflux disease, but metoclopramide has significant side effects.
RCTHighly CitedEffects of lesogaberan on reflux and lower esophageal sphincter function in patients with gastroesophageal reflux disease.
Lesogaberan reduces reflux episodes and increases lower esophageal sphincter pressure in patients with gastroesophageal reflux disease despite proton pump inhibitor treatment.
RCTHighly CitedComparative effects of metoclopramide and bethanechol on lower esophageal sphincter pressure in reflux patients.
Metoclopramide 20 mg effectively increases lower esophageal sphincter pressure, potentially aiding in treating gastro-esophageal reflux.
RCTHighly CitedReflux inhibitors: a new approach for GERD?
Reflux inhibitors targeting transient lower esophageal sphincter relaxations may offer a new approach to treat GERD, potentially improving symptoms without significant central side effects.
Oral cimetidine in reflux esophagitis: a double blind controlled trial.
Cimetidine is superior to placebo in treating reflux esophagitis, but its effect on symptomatology and antacid consumption remains unclear.
RCTHighly Cited