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Common Medications Used to Treat
Reflux In Infants and Children
Prokinetic Drugs for Children, Agents that Increase
Motility:
Propulsid--Cisapride Janssen Pharmaceuticals
Muscarinic receptor agonist, acts on the esophagus.
***Has
some very serious drug interactions. Should not be taken if history of prolonged
electrocardiographic QT intervals; renal failure; history of ventricular arrhythmias,
ischemic heart disease, and congestive heart failure; uncorrected electorlyte
disorders(hypokalemia, hypomagnesemia); respiratory failure; and concomitant medications
known to prolong the QT interval and increase the risk of arrhythmia, such as certain
antiarrhythmics, including those of Class 1A(such as, quindidine and procainamide) and
Class III(such as sotalol); trycyclic antidepressents(such as amitriptyline); certian
tetracyclic antidepressents(such as maprotiline); certain antipsychotic medications(such
as certain phenothiazines and sertinadole); astemizole, bepridil, sparfloxacin,
terodiline; Should not be taken with clarithromycin, erythromycin, troleandomycin,
nefazodone, fluconazole, itraconazole ketoconazole, indinavir and ritonavir.
See June 1998 Propulsid
Warning Letter.
Reglan--Metoclopramide RxList
Info
Dopamine antagonist, acts on the esophagus
and stomach.
***Has some potentially harmful neuromuscular side effects. This drug acts on the
muscles within the wall of the upper intestinal tract causing them to contract and to move
food and fluid along. It also crosses from the blood stream into brain cells and may cause
significant side effects.
An interaction generally means that one drug may increase or
decrease the effect of another drug. Also, the more medications your child takes, the more
likely there will be a drug interaction. Interactions with this drug may occur with the
following:
- cimetidine (Tagamet)
- acetaminophen (Tylenol)
- cyclosporine (Sandimmune, Neoral)
- digoxin (Lanoxin)
- insulin
- monoamine oxidase (MAO) inhibitors (Nardil, Parnate)
- levodopa (Sinemet)
- narcotic pain medication (Percocet, Demerol)
- sleeping pills (Dalmane, Ambien)
- tetracycline (Achromycin)
- tranquilizers (Valium, Xanax)
Bethanechol--Bethanechol Muscarinic receptor angonist. Acts on the esophagus. Interactions
with this drug may occur with the following::
- myasthenia gravis drugs (Mestinon, neostigmine)
- blood pressure medications
- quinidine (Quinidex)
- procainamide (Procanbid)
- cholestyramine (Questran)
- isoniazid (Rifater)
- phenytoin (Dilantin)
- blood thinners (Coumadin)
- zidovudine (Retrovir)
- birth control pills
- non-steroidal anti-inflammatory drugs-commonly called NSAIDs
Domperidone--Peripheral dopamine
antagonist. Acts on the esophagus and stomach. In contrast to metoclopramide,
it will not cross the blood-brain barrier. Domperidone increases LES pressure,
inhibits relaxation of the gastric fundus, enhances contractility of the antrum, and
improves antroduodenal coordination. Side effects in children have been minimal, and
have included transietn diarrhea. Central nervous system side effects have been
reported in a few infants and in patients given more than 0.6 mg/kg. Domperidone may
be useful in the treatment of gastroparesis in some children and in those with GERD in
whom side effects or lack of response make metoclopramide and propulsid undesirable.
Erythromycin--Motilin receptor
agonist. Acts on the Gastric antrum.
The following drugs may interact with Erythromycin.
•astemizole
•carbamazepine
•colchicine
•cyclosporine
•digoxin
•dihydroergotamine
•other antibiotics
•ergotamine
•terfenadine
•theophylline
•triazolam
•warfarin
•propulsid(cisipride)
H2 Blockers:
Zantac--Ranitidine This drug is one of the H2 blockers. It partially blocks
the production of acid in stomach cells. Since stomach acid plays an important role in
causing ulcers and other tissue injury, the drug has been very helpful in treating these
conditions. An interaction generally means that one drug may increase or decrease the
effect of another drug. Also, the more medications your child takes, the more likely there
will be a drug interaction.
Interactions with this drug may occur with the following:
- antacids
- blood thinners (Coumadin)
- diazepam (Valium)
- glipizide (Glucotrol)
- glyburide (Micronase, Diabeta)
- itraconazole (Sporanox)
- ketoconazole (Nizoral)
- metoprolol (Lopressor)
- nifedipine (Procardia)
- phenytoin (Dilantin)
- procainamide (Procanbid)
- sucralfate (Carafate)
- theophylline (Theo-Dur, Slo-bid)
Tagamet--Cimetidine Cimetidine was the very first drug specifically designed to block the acid
producing cell in the stomach. The location of cimetidine's action within the cell is the
histamine 2 site so this and other drugs like it are called histamine 2 receptor
antagonists or H2RA for short. The drug proved to be remarkably effective in healing and
preventing the return of ulcers. It has been found to be fairly safe for long-term use as
well. Since the generic form is the least expensive way of controlling stomach acid, many
physicians recommend this preparation for various stomach acid conditions when it proves
to be effective.
Cimetidine is metabolized at a certain place in the liver where
many other drugs are also broken down. So there are potential interactions with many other
drugs. However, in clinical practice, physicians have seen remarkably few problems. Still,
if your child takes any of the following, you should check with your pediatrician.
Interactions with this drug may occur with the following:
- amoxicillin (Augmentin)
- anti-depressants (Elavil)
- anti-diabetic drugs (Micronase, Glucotrol)
- benzodiazepine tranquilizers (Valium, Xanax, Librium)
- beta-blockers (Inderal, Lopressor)
- blood thinners (Coumadin)
- calcium-blockers (Cardizem, Calan, Procardia)
- carbamazepine (Tegretol)
- chemotherapy drugs - some
- chlorpromazine (Thorazine)
- cisapride (Propulsid)
- clozapine (Clozaril)
- cyclosporine (Sandimmune, Neoral)
- digoxin (Lanoxin)
- fluconazole (Diflucan)
- ketoconazole (Nizoral)
- medication for irregular heartbeat (Cordarone, Tonocard,
Quindex, Procanbid)
- metoclopramide (Reglan)
- metronidazole (Flagyl)
- narcotic (Demerol, morphine)
- nicotine ( Nicoderm, Nicorette)
- paroxetine (Paxil)
- pentoxifylline (Trental)
- phenytoin (Dilantin)
- quinidine (Quinidex, Quinaglute)
- sucralfate (Carafate)
- theophylline (Theo-Dur)
Pepcid--Famotidine This drug is one of the H2 blockers. It partially blocks the
production of acid in stomach cells. Since stomach acid plays an important role in causing
ulcers and other tissue injury, the drug has been very helpful in treating these
conditions.
Interactions with this drug may occur with the following:
- itraconazole (Sporanox)
- sucralfate (Carafate)
- arthritis medications (ibuprofen, Advil, Lodine, many others)
- ketoconazole (Nizoral)
- antacids
Other GI Drugs:
Carafate--Sucralfate Sulcrafate is a sugary drug that binds up with protein-like material in the
base of intestinal ulcers. It is not an antacid nor does it reduce stomach acidity. Very
little of the drug is absorbed into the body. Sucralfate is approved by the FDA for
healing of duodenal ulcers. However, physicians also use it for ulcers or erosions in the
mouth, esophagus (food pipe), and stomach, although its effectiveness in these areas has
never been clearly proven.
It is best to administer other medications at least 1 hour
before taking sucralfate as this drug may interfere with absorption of other drugs.
Interactions with this drug may occur with the following:
- cimetidine (Tagamet)
- ciprofloxacin (Cipro)
- digoxin (Lanoxin)
- enoxacin (Penetrex)
- ketoconazole (Nizoral)
- norfloxacin (Noroxin)
- ofloxacin (Floxin)
- quinidine (Quinaglute)
- phenytoin (Dilantin)
- tetracycline (Achromycin)
- blood thinners (Coumadin)
- antacids (Maalox, Mylanta)
Prilosec--Omeprazole
About Prilosec
This medicine belongs to a group of
drugs called proton pump inhibitors (PPI). The proton pump is the site within the stomach
cell where hydrochloric acid is actually made and pumped out into the stomach. The PPIs
block the formation of acid in the stomach from 80% to over 90% if enough of the drug is
taken
Interactions with this drug may occur with the following:
- diazepam (Valium)
- phenytoin (Dilantin)
- blood thinners (Coumadin)
Certain other drugs require stomach acid to be changed into
their active form to be absorbed. Since omeprazole eliminates stomach acid so effectively,
the absorption of the following drugs may be adversely affected:
- ampicillin (Polycillin, Omnipen)
- digoxin (Lanoxin)
- iron preparations
- ketoconazole (Nizoral)
If your child takes any of the above medications, ask your
pediatrician. It is okay to take antacids.
Levsin--Hyoscyamine
This drug acts on the muscle in the
wall of the gut and also the urinary bladder. It relaxes the muscle and prevents spasms
from occurring. It also can slightly reduce the production of stomach acid.
Interactions with this drug may occur with the following:
- monoamine oxidase (MAO) inhibitors (Nardil, Parnate)
- sedatives (Ambien, Dalmane, Restoril)
- antidepressants (Haldol, Elavil)
- antacids
- antihistamines (Benadryl)
- cimetidine (Tagamet)
- prednisone
- digoxin (Lanoxin)
- metoclopramide (Reglan)
- thiazide diuretics (Dyazide, hydrochlorothiazide)
- amantadine (Symmetrel)
- cardiac rhythm regulators (Pronestyl, quinidine)
Lactulose--Lactulose
Lactulose is a sugar which is
not metabolized and absorbed by the body. Rather, the bacteria in the colon or large bowel
break this sugar down into acids. These acids, in turn, pull water into the colon and
soften the stool. Another thing that happens is that ammonia then moves from the blood
into the colon.
Interactions with this drug may occur with the following:
- other laxatives
- neomycin
- antibiotics
- diabetic medications
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