Medicines for Hyperacidity

1. Antacids

• How they work: Directly neutralize stomach acid already present in the stomach.
• Onset: Fastest - relief within minutes.
• Duration: Short - only 1-2 hours.
• Best for: Occasional, mild heartburn or acidity.
• Notes: Not useful for frequent or severe acidity. Available over the counter.

2. H2-Receptor Antagonists (H2 Blockers)

• How they work: Block histamine H2 receptors on stomach parietal cells, reducing acid secretion.
• Onset: 15-30 minutes; effect lasts 6-10 hours.
• Best for: Mild-moderate GERD, peptic ulcer disease, prevention before meals.
• Notes: Very safe; side effects in less than 3% (headache, diarrhea, fatigue). Cimetidine can cause gynecomastia with long-term use and has more drug interactions. Can be taken prophylactically before meals. If stopped without treating the underlying cause, ulcers recur in more than 50% of patients within 1 year.
• Katzung's Basic and Clinical Pharmacology, 16th Ed.

3. Proton Pump Inhibitors (PPIs) - First-Line for Most Conditions

• How they work: Irreversibly block the H+/K+-ATPase (proton pump) on gastric parietal cells - the final common pathway of acid secretion.
• Onset: Full effect builds over 3 days of daily dosing; 60-70% acid suppression persists at 24 hours.
• Best for: Moderate-severe GERD, erosive esophagitis, peptic ulcer disease (heals >90% of duodenal ulcers within 4 weeks), H. pylori eradication regimens, NSAID-induced ulcers, stress ulcer prophylaxis.
• Duration of treatment: Typically 4-8 weeks for ulcers; long-term for complicated or recurrent disease.
• Superiority over H2 blockers: Faster symptom relief, higher healing rates. PPIs heal erosive esophagitis in 85-90% with once-daily dosing vs. less than 50% with H2 blockers.
• Key drug interactions: May interact with warfarin, diazepam, clopidogrel (note with omeprazole), atazanavir, and cyclosporine.
• Mulholland and Greenfield's Surgery, 7th Ed.; Katzung's Basic and Clinical Pharmacology, 16th Ed.

4. Sucralfate (Mucosal Protective Agent)

• How it works: Acts locally on mucosal defects, coating ulcer craters - does not reduce acid.
• Best for: Supplement to acid suppression; sometimes used in pregnancy or where acid-lowering drugs are contraindicated.
• Schwartz's Principles of Surgery, 11th Ed.

5. Antacids + Antibiotics - for H. pylori-Related Acidity/Ulcers

• Triple therapy (14 days): PPI twice daily + Clarithromycin 500 mg BD + Amoxicillin 1 g BD (or Metronidazole)
• Quadruple therapy (for clarithromycin resistance): PPI + Bismuth + Metronidazole + Tetracycline - all for 14 days
• After antibiotics, continue PPI once daily for 4-6 weeks for full ulcer healing.

Quick Comparison Table

When to See a Doctor

• Symptoms more than 2-3 times per week
• Symptoms not relieved by over-the-counter antacids or H2 blockers
• Difficulty swallowing, unintentional weight loss, or black/tarry stools - these need urgent evaluation

Note: This is general educational information. Medication selection, doses, and duration should be guided by a healthcare professional based on diagnosis and individual factors.