Most medications used to treat reflux fall into three groups based on how they work:
- break down or lessen intestinal gas
- decrease or neutralize stomach acid
- improve intestinal coordination
Medications that break down or lessen intestinal gas: Mylicon®, Gaviscon®
Medications that decrease or neutralize stomach acid: Antacids, Mylanta®, Maalox®, Carafate® (sucralfate)
Medicines that inhibit stomach acid secretion or production: Tagamet® (cimetidine), Zantac® (ranitidine), Pepcid® (famotidine), Axid® (nizatidine), Prilosec® (omeprazole), Prevacid® (lansoprazole), Nexium® (esomeprazole)
It is assumed that decreasing the amount of stomach acid will lessen reflux symptoms. This has clearly been shown in adults, but very few studies have examined the effectiveness of these medicines in young children. In theory, these types of medications should be helpful to babies who are having “heartburn”, and nearly three-fourths of parents report that their babies spit up or throw up less and seem to have less “heartburn” when they take Gaviscon®.
For the most part, medicines that decrease intestinal gas or neutralize stomach acid (antacids) are very safe. At high doses, Mylicon, Gaviscon, Maalox, and Mylanta may function as laxatives and cause some diarrhea. Chronic use of very high doses of Maalox or Mylanta may be associated with an increased risk of rickets (thinning of the bones).
Side effects from medications that inhibit the production of stomach acid are uncommon. A small number of children may develop some sleepiness when they take Zantac, Pepcid, Axid, or Tagamet. Tagamet may can increase blood levels of certain other medicines including the blood thinner coumadin and the anti-seizure medicine Dilantin.
Medications that improve intestinal coordination: Reglan® (metoclopramide), Propulcid® (cisapride), erythromycin
Reglan increases the pressure of the lower esophageal sphincter (LES) and helps the stomach empty more quickly. However, in most infants it does not improve reflux symptoms. It may rarely cause frightening side effects: young infants may develop dystonia (tenseness or stiffness of the muscles) and children with epilepsy appear to be at increased risk for seizures when taking Reglan.
Propulcid was withdrawn from the U.S. market in 2000 but is still available in Canada and Europe. Propulcid increases the pressure of the lower esophageal sphincter (LES), emptying of the stomach, and the rate at which food moves through the lower intestines. Nearly three-fourths of parents report that their babies spit up or throw up less and seem to have less “heartburn” when they take Propulcid. Serious side effects are uncommon. Some children will experience some cramping or diarrhea, particularly at higher doses. There have been some reports of children developing abnormal heart rhythms; this seems more likely if Propulcid is taken with certain other medicines including the antibitiotics erythromycin and clarithromycin and the anti-fungal medicines Nizoral (ketoconazole) and Diflucan (fluconazole).
Erythromycin is an antibiotic frequently used to treat a variety of common infections. One fairly common side effect is abdominal cramps due to vigorous stomach contractions. In some infants and children with reflux this side effect can be used to advantage, causing the food to be emptied out of the stomach more quickly than usual and lessening reflux symptoms.