A Comparative Overview of the Adverse Effects of Antiulcer Drugs

Abstract

During the past 2 decades, great advances have been made in the treatment of ulcer disease. This has involved the development of new drugs that are not only well tolerated, but are relatively inexpensive. The lack of significant adverse effects has revealed a degree of tolerability that, to write a review of the adverse effects, poses a difficult task. Most of the adverse effects are related to an excessive reaction to the relevant pharmacological characteristic that mediates the therapeutic response. The drug dosage can be reduced, freeing the patient of the adverse reaction, but leaving behind a background activity adequate to produce a therapeutically beneficial effect. The adverse effects of H2-antagonists fall into 2 groups. Firstly, there are poorly defined symptoms that have a prevalence similar to that in the community; these include headache, giddiness, dizziness, fatigue, constipation and diarrhoea. Secondly, they may delay the metabolism of drugs metabolised by the the cytochrome P450 system, and rarely be androgenic. Many antacids and the site-protective agent sucralfate contain aluminium, which can be absorbed, producing elevation of serum aluminium levels. In view of the possible association of aluminium with Alzheimer's disease, anxiety has arisen as to whether aluminium from these sources may, in those on prolonged treatment, cause Alzheimer's disease. However, the evidence so far indicates that aluminium is not a risk factor for Alzheimer's disease. The association of gastric cancer with achlorhydria has led to the fear that long term use of potent acid inhibitors may cause cancer. This fear has been accentuated by the observation that some rats, given omeprazole over their lifetime, developed carcinoid tumours of the stomach. However, enthusiastic research, both clinical and epidemiological, indicates that drug-induced achlorhydria is unlikely to be a problem in humans. Site protective agents have a role in certain conditions such as pregnancy where the systemic effect of a drug may produce adverse effects.

A computer-automated touchscreen paired-associates learning (PAL) task for mice: impairments following administration of scopolamine or dicyclomine and improvements following donepezil

“…However, treatment of donepezil using a 0.3 mg/kg dose has been shown to reverse behavioral deficits in middle-aged mice completing an episodic contextual memory task (Béracochéa et al 2007), improve Morris Water Maze performance in a APP23 mutant mouse model of AD (Van Dam et al 2005), and improve shortterm working memory in aged mice (Marighetto et al 2008). Pirenzepine (0.02, 0.2, and 2.0 mg/kg) was also given to these animals in a crossed Latin square design; however, there were no effects of this drug (data not shown), likely due to its suspected inability to cross the blood-brain barrier (Piper 1995). The second pharmacological study (drug study B) was carried out using a Latin square design to investigate the role of the non-specific muscarinic antagonist, scopolamine.…”

Antiulcerogenic activity of Zizyphus lotus (L.) extracts

“…A number of drugs including proton pump inhibitors and H 2 receptor antagonists are available for the treatment, but clinical evaluation of these drugs showed an incidence of relapses, side effects, and drug interactions (McIntosh et al, 1991;Piper, 1995;Sontag, 1997). This medication has been the cause for the development of new antiulcer drugs and the search for novel molecules has been extended to herbal drugs that offer better protection and decreased relapse.…”

Antazida und H2‐Antihistaminika bei Hyperazidität: Wissenswertes zu Nebenwirkungen und Interaktionen

“…Diese Esterspaltung ist abhängig vom Magen-pH-Wert und erklärt eventuell die veränderte Bioverfügbarkeit unter gleichzeitiger Antazidagabe. Cefpodoxim-proxetil oder Cefuroxim-axetil zeigen eine deutliche Reduktion der Bioverfügbarkeit bei der parallelen Gabe von H 2 Wasser Cimetidin Natriumhydrogencarbonat Magnesium-Aluminium-Hydroxidgel uminiumhydroxid oder Natriumhydrogencarbonat [6]. Für Cefalexin, Cefixim, Ceftamet-pivoxil oder Cefprozil konnte unter den gleichen Umständen keine veränderte Pharmakokinetik festgestellt werden.…”

“…Bei Antazida spielt Erhöhung des pH-Wertes auf Grund der kurzen Wirkdauer in diesem Zusammenhang keine Rolle. Bei den länger wirksamen H 2 -Blockern gibt es jedoch Hinweise auf eine Risikoerhöhung für durch Clostridium difficile ausgelöste Anaphylaxien oder durch Streptokokken ausgelöste Pneumonien [2][3][4][5].…”