Medical Health Encyclopedia

Misoprostol (Cytotec) increases prostaglandin levels in the stomach lining, which protects against the major intestinal toxicity of NSAIDs.

Actions Against Ulcers. Misoprostol can reduce formation of ulcers in the upper small intestine by two-thirds and in the stomach by three quarters. It does not neutralize or reduce acid, so although the drug is helpful for preventing NSAID-induced ulcers, it is not useful in healing existing ulcers.

Side Effects.

• Diarrhea and other gastrointestinal problems are severe enough to cause 20% of patients to stop taking the drug. Taking misoprostol after meals should minimize these effects. One study indicated that taking the drug two or three times a day instead of the standard regimen of four times may prove to be just as effective and cause fewer side effects.
• Misoprostol can induce abortion or cause birth defects and should not be taken by pregnant women. If pregnancy occurs during treatment, the drug should be discontinued at once and the doctor contacted immediately.

Proton-Pump Inhibitors (PPIs)

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Actions Against Ulcers. Proton-pump inhibitors (PPIs) are the drugs of choice for managing patients with peptic ulcers from any cause. They suppress the production of stomach acid. These drugs work by blocking the gastric acid pump – the molecule in the stomach glands that is responsible for acid secretion.

PPIs can be used as part of a multi-drug regimen for H. pylori or used alone for preventing and healing NSAID-caused ulcers. They are also useful in the treatment of ulcers caused by Zollinger-Ellison syndrome. Some people carry a gene that reduces the effectiveness of proton-pump inhibitors. This gene may be present in between 18% and 20% of people of Asian descent.

Standard Brands. Most PPIs are available by prescription. They can all be taken by mouth. There is no evidence that one brand of PPI works better than another. Brands approved for ulcer prevention and treatment include:

• Omeprazole (Generic, Prilosec OTC)
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Rabeprazole (Aciphex)