Peptic Ulcers - Treatment for NSAID-Induced Ulcers

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All four drugs have good safety profiles and few side effects. There are some differences between these drugs:

• Famotidine (Pepcid AC) is the most potent H2 blocker. The most common side effect is headache, which occurs in 4.7% of people who take it. Famotidine is virtually free from drug interactions, but it may have significant adverse effects in patients with kidney problems.
• Cimetidine (Tagamet) has few side effects. However, about 1% of people taking it experience mild temporary diarrhea, dizziness, rash, or headache. Cimetidine interacts with a number of commonly used medications, including phenytoin, theophylline, and warfarin. Long-term use of excessive doses (more than 3 grams a day) may cause erectile dysfunction or breast enlargement in men. These problems go away after the drug is stopped.
• Ranitidine (Zantac) interacts with very few drugs. Ranitidine may provide more pain relief and heal ulcers more quickly than cimetidine in people younger than age 60, but there doesn't seem to be a difference in older patients. A common side effect of ranitidine is headache, which occurs in about 3% of people who take it.
• Nizatidine (Axid) has virtually no side effects and drug interactions.

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PPIs are more effective than H2 blockers at healing ulcers in people who take NSAIDs. Treatment effectiveness for PPIs is between 65% and 100%, versus 50% and 85% for H2 blockers, depending on which drugs are used.

Long-Term Concerns. In most cases, H2 blockers have good safety profiles and few side effects. Because H2 blockers can interact with other drugs, be sure to tell your doctor about any other medications you are taking. There are also some concerns about possible long-term effects -- for example, that long-term acid suppression with these drugs may cause cancerous changes in the stomach in patients who also have untreated H. pylori infection. More research is needed to prove this risk.

However, the following concerns are well documented:

• Liver damage. This is more likely with ranitidine than with the other H2 blockers, but it is rare with any of these drugs.
• Kidney-related central nervous system complications. Famotidine is removed by the body primarily by the kidney. This can pose a danger in people with kidney problems. Use of the drug in people with impaired kidney function can affect the central nervous system and may result in anxiety, depression, insomnia or drowsiness, and mental disturbances. As a result, people with kidney failure should reduce the dose and increase the time between doses.
• Increased risk for pneumonia in hospitalized patients, as well as in the community.
• Ulcer perforation and bleeding. Some experts are concerned that the use of acid-blocking drugs may increase the risk for serious complications by masking ulcer symptoms.