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Antacids and heartburn treatments

Category: Medicines

Type

Involuntary

Introduction and description

These drugs are used to reduce the secretion of gastric acid, treating gastrointestinal conditions including peptic ulcers and gastroesophageal reflux disease.

They are an unfortunate class of drugs, as this is one case where the symptoms are a clear case of needing to find the cause – gastric acid is produced for a reason and peptic ulcers have a known cause, as such it is these causes that should be being tackled.

Food - On the odd occasion when very rich or over rich food, excessive consumption of fat, irritant spices or alcohol and other abuses of the stomach have occurred, doctors may say that a case has been made for their use. But the stomach is actually doing its best to handle this abuse by secreting gastric acids, as such to neutralise them does not help. The pain is there to tell you you have been a twerp and it may be better to grin and bear it.
Food intolerances - Severe stomach pain with bloating and wind is a symptom of coeliac disease and gluten and wheat intolerance, as well as other food intolerances, and this too needs to be tackled at source. Antacids applied here can make you feel extremely ill.
Heart disease - One of the early indicators of heart disease is a pain which is almost identical to heartburn. It starts in the chest and travels up and can reach the face and neck where it manifests as pain in the jaw, the eyes and between the eyes. It can be excruciatingly painful. Interestingly there may be no pain down the arms and none of the tight chested feeling that comes later with angina. Heartburn treatments are not a great deal of help here either!
Stress - Fear, worry, stress, anger, all very high emotions can upset the stomach balance. Extremely negative emotion tends to invoke the sympathetic nervous system - the fight or flight response and when invoked this has the effect of reducing the activity of the stomach. The logic is obvious - if we are fighting or 'flighting' our energy needs to be concentrated in our limbs not our stomach and thus digestion is put on hold. But if we eat when this stressed, we end up with a full stomach and nothing happening, which causes pain. As such the answer is to calm down before we eat - meditation, listening to nice music and not to eat in a hurry and when over wrought. Furthermore after a meal we need to sit down somewhere very comfortable and take the time to relax - calm down.
Ulcers - which need treatment

This mis-prescription or mis-self administration has resulted in a truly impressive number of hallucinations and experiences of delirium according to the eHealthme website.

Types of drug

There are different classes of drug within this overall heading

Antacids - Over the counter drugs - including such simple remedies as calcium carbonate - an alkali to neutralise the acid - are one class. Versions with magnesium may cause diarrhoea, and brands with calcium or aluminium may cause constipation, long-term use may cause kidney stones. Long term use of versions with aluminum may increase the risk for getting osteoporosis.

Antihistamines - are all H2 receptor antagonists. H2 antagonists, like H1 antagonists, are also inverse agonists and not true antagonists. H2 histamine receptors, are found principally in the parietal cells of the gastric mucosa. All drugs in this class decrease gastric intrinsic factor secretion. This can significantly reduce absorption of protein-bound vitamin B12. Elderly patients taking H2 receptor antagonists are more likely to require vitamin B12 or be vitamin B12 deficient. Histamine H2 receptor antagonists may also increase the risk of pneumonia and infectious diarrhea including traveller's diarrhea and salmonella.

Another side effect of these drugs is that H2 antagonists may increase the risk of developing food allergies. Patients who take these agents develop higher levels of IgE against food, whether they had prior antibodies or not. Even months after discontinuation there can still be an elevated level of IgE.
Theoretically there is a far lesser risk of having spiritual experiences under this class of drugs simply because they do not cross the blood brain barrier. But it does seem to be a particular risk when the liver or kidney is in some way ‘compromised’ during an overdose or if the liver is not that healthy or the kidneys.

Proton-pump inhibitors (PPIs) are the most potent inhibitors of acid secretion available today. More details of how they work is provided in the Science section.
They act by irreversibly blocking the gastric proton pump of the gastric parietal cells, this results in reduction of gastric acid secretion “by up to 99%”. Lack of stomach acid creates its own problems as the acid is required for the digestion of proteins and for the absorption of nutrients, particularly of vitamin B12 and of calcium. According to Wikipedia “The effectiveness of proton pump inhibitors has not been demonstrated in every case, despite their widespread use for these conditions”

Side-effects

Using the eHealthme web site and the Adverse Drug reports submitted by doctors to the FDA and SEDA, we can take a look at the types of side-effect actually being experienced by people on these drugs.

Proton pump inhibitors

Taking a drug like Omeprazole - a Proton Pump Inhibitor which is used in the treatment of dyspepsia, peptic ulcer disease, gastroesophageal reflux disease, and laryngopharyngeal reflux; is also one of the most widely prescribed drugs internationally; is available over the counter in some countries and which is on the World Health Organization's List of Essential Medicines, we find the most common side effects by gender are [see also figures for deaths below]:

Female	Male
Nausea	Pyrexia
Dyspnoea	Dyspnoea
Pain	Nausea
Vomiting	Diarrhoea
Pyrexia	Anaemia
Diarrhoea	Vomiting
Fall	Renal Failure Acute
Fatigue	Pneumonia
Asthenia	Fatigue
Drug Ineffective	Asthenia

Now comparing this with Pantoprazole another PPI we find the most common Pantoprazole side effects are :

Nausea (1,976 reports)
Breathing Difficulty (1,738 reports)
Diarrhea (1,714 reports)
Nausea And Vomiting (1,581 reports)
Fatigue (1,516 reports)
Weakness (1,515 reports)
Anaemia (1,433 reports)
Pneumonia (1,420 reports)
Fever (1,410 reports)
Pain (1,395 reports)

Antihistamines

Again taking an example drug - Nizatidine - the most common side effects by gender are:

Female	Male
Pyrexia	Pyrexia
Condition Aggravated	Pleural Effusion
Haemoglobin Decreased	Platelet Count Decreased
Nausea	Condition Aggravated
White Blood Cell Count Decreased	Haemoglobin Decreased
Platelet Count Decreased	Anxiety
Hypotension	Aspartate Aminotransferase Increased
Dyspnoea	Alanine Aminotransferase Increased
Malaise	Anaemia
Chest Pain	Malaise

Death

Again, using the eHealthme web site and the Adverse Drug reports submitted by doctors to the FDA and SEDA, we can now take a look at the ultimate spiritual experience - death.

Milk of Magnesia - On Aug, 31, 2015: 2,828 people reported to have side effects when taking Milk of magnesia. Among them, 125 people (4.42%) have Death.

Gaviscon - On Aug, 27, 2015: 3,432 people reported to have side effects when taking Gaviscon. Among them, 58 people (1.69%) have Death

Esomeprazole and trade names:

On Aug, 31, 2015: 4,530 people reported to have side effects when taking Esomeprazole magnesium. Among them, 71 people (1.57%) have Death
On Aug, 8, 2015: 71,275 people reported to have side effects when taking Nexium. Among them, 1,339 people (1.88%) have Death

Lansoprazole and its trade names:

On Aug, 31, 2015: 34,930 people reported to have side effects when taking Lansoprazole. Among them, 554 people (1.59%) have Death
On Aug, 23, 2015: 39,816 people reported to have side effects when taking Prevacid. Among them, 684 people (1.72%) have Death.
On Aug, 31, 2015: 407 people reported to have side effects when taking Prevacid 24 hr. Among them, 4 people (0.98%) have Death

Omeprazole - On Aug, 6, 2015: 90,056 people reported to have side effects when taking Omeprazole. Among them, 1,677 people (1.86%) have Death.

Pantoprazole and its alternative names

On Aug, 21, 2015: 29,119 people reported to have side effects when taking Pantoprazole. Among them, 737 people (2.53%) have Death
On Aug, 12, 2015: 13,063 people reported to have side effects when taking Pantoprazole sodium. Among them, 259 people (1.98%) have Death
On Aug, 25, 2015: 34,719 people reported to have side effects when taking Protonix. Among them, 939 people (2.70%) have Death

Rabeprazole and its trade names

On Aug, 31, 2015: 10,126 people reported to have side effects when taking Rabeprazole. Among them, 151 people (1.49%) have Death.
On Aug, 31, 2015: 9,021 people reported to have side effects when taking Rabeprazole sodium. Among them, 140 people (1.55%) have Death

Cimetidine and its trade names

On Aug, 29, 2015: 5,189 people reported to have side effects when taking Cimetidine. Among them, 82 people (1.58%) have Death
On Aug, 24, 2015: 5,664 people reported to have side effects when taking Tagamet. Among them, 82 people (1.45%) have Death

Famotidine and its trade names

On Aug, 20, 2015: 22,064 people reported to have side effects when taking Famotidine. Among them, 408 people (1.85%) have Death.
On Aug, 31, 2015: 22,372 people reported to have side effects when taking Pepcid. Among them, 448 people (2.00%) have Death
On Aug, 31, 2015: 3,176 people reported to have side effects when taking Pepcid ac. Among them, 22 people (0.69%) have Death
On Aug, 31, 2015: 1,126 people reported to have side effects when taking Pepcid rpd. Among them, 8 people (0.71%) have Death

Nizatidine and its trade names

On Aug, 31, 2015: 2,322 people reported to have side effects when taking Axid. Among them, 27 people (1.16%) have Death
On Aug, 30, 2015: 1,845 people reported to have side effects when taking Nizatidine. Among them, 16 people (0.87%) have Death

Ranitidine and its trade names

On Aug, 31, 2015: 516 people reported to have side effects when taking Ranitidine. Among them, 3 people (0.58%) have Death
On Aug, 3, 2015: 4,255 people reported to have side effects when taking Ranitidine hydrochloride. Among them, 61 people (1.43%) have Death
On Aug, 31, 2015: 34,323 people reported to have side effects when taking Zantac. Among them, 489 people (1.42%) have Death
On Aug, 30, 2015: 3,513 people reported to have side effects when taking Zantac 150. Among them, 10 people (0.28%) have Death
On Aug, 31, 2015: 98 people reported to have side effects when taking Zantac 300. Among them, 1 people (1.02%) has Death
On Aug, 18, 2015: 1,009 people reported to have side effects when taking Zantac 75. Among them, 1 people (0.10%) has Death

In summary

Using the eHealthme web site and the Adverse Drug reports submitted by doctors to the FDA and SEDA, the number of deaths caused by these products in totality, as of mid August 2015, was

8,446

this figure only applies to the US and excludes all deaths in the rest of the world.

How it works

Why the hallucinations? It depends on the type of pharmaceutical, but logically all these pose a threat to a system already stressed and trying its best to deal with inappropriate food intake or some other cause.

When threatened, the reasoning and memory go on hold and this allows the composer to take action and we get a hallucination, vision or similar.

Physically we can see that inappropriate use of these drugs may cause dehydration, hepatitis, vitamin deficiency, mineral deficiency and poisoning.

Vitamin deficiency - Because the body uses gastric acid to release B12 from food particles, decreased vitamin B12 absorption may occur with long-term use of these drugs and may lead to Vitamin B12 deficiency.
Pneumonia - It has been observed that gastric acid suppression is associated with an increased risk of community-acquired pneumonia. It is suspected that acid suppression results in insufficient elimination of pathogenic organisms. Pneumonia is described in the section on Hypoxia.
Mineral deficiency - The hallucinations experienced with these drugs in this case are principally caused by long term use or over use – misuse in other words, because they should not be used for long or in large doses. The effect of a single dose on acid secretion usually persists up to 2–3 days. This is because of accumulation of the drug in parietal cell canaliculi and the irreversible nature of, for example, proton pump inhibition. It is thus easy to overdose if you are not aware of the fact that effects are long lasting.

Both long term use and overdose are associated with hypomagnesemia. Hypomagnesemia (or hypomagnesaemia) is an electrolyte disturbance in which there is an abnormally low level of magnesium in the blood.
Deficiency of magnesium causes weakness, muscle cramps, cardiac arrhythmia, increased irritability of the nervous system with tremors, athetosis, jerking, nystagmus and an extensor plantar reflex. In addition, there may be confusion, disorientation, hallucinations, depression, epileptic fits, hypertension, tachycardia and tetany!

Ultimately the physical cause is poisoning

Observations

The figures show the number of hallucinations as recorded on the eHealthme web site derived from SEDA and the FDA. The link takes you to the eHealthme web site where an up-to-date list of all the side effects can be found

The table below is a summary of the number of hallucinations

Observation no	Name	No of hallucinations
	Alka seltzer	-
	Andrews antacid	-
	Rolaids	-
	Tums	-
005543	Gaviscon	17
000542	Milk of magnesia	27
005556	Cimetidine and Tagamet	41
005558	Famotidine and Pepcid	261
005560	Nizatidine brand names Tazac and Axid	31
5562	Ranitide brand names Zantac	241
017590	Esomeprazole [brand names Nexium, and many others worldwide - see below]	21
017591	Nexium brand names Sompraz, Zoleri, Lucen, Esopral; Axagon , Esotrex	418
015669	Lansoprazole	227
ditto	Prevacid, [Helicid, Zoton, Inhibitol, Monolitum, Levant, Lupizole and Prevacid 24HR]	293
017592	Omeprazole [Losec, Prilosec, Antra, Gastroloc, Mopral, Omepral, Omez, Zegerid, Segazole, Xelopes, Opal, Lomac and Ulcozol]	606
015648	Pantoprazole [also known by names below]	215
015678	Pantoloc, Protium, Pantecta and Protonix , Somac, Pantozol, Zurcal, Zentro, Pan, Controloc	300
015687	Rabeprazole brand names: Zechin, Rabecid, Nzole-D, AcipHex, Pariet, Rabeloc. Dorafem: combination with domperidone	115
	TOTAL	2,813

The following drugs appear to have no figures for them

Burimamide is an antagonist at the H2 and H3 histamine receptors. It is largely inactive as an H2 antagonist but its H3 affinity is 100x higher. Burimamide was first developed to develop a histamine antagonist for the treatment of peptic ulcers. The discovery of buriamide ultimately led to the development of cimetidine (Tagamet).
Ebrotidine is an H2 receptor antagonist with gastroprotective activity. The antisecretory properties of ebrotidine are similar to those of ranitidine, and approximately 10-fold greater than those of cimetidine.
Dexlansoprazole (trade names Kapidex, Dexilant) is a proton pump inhibitor available in Asia
Ilaprazole (trade name Noltec) is a proton pump inhibitor (PPI) available in Asia and being trialed in the USA
Lafutidine is a second generation histamine H₂ receptor antagonist marketed in Japan and India
Niperotidine is a histamine antagonist selective for the H₂ subtype. It was trialled as a treatment for excessive gastric acidity, but withdrawn after human trials showed liver damage
Roxatidine acetate is a histamine H2 receptor antagonist available in China, Japan, Korea, Germany, Italy, the Netherlands, Greece and South Africa

Related observations

Calcium carbonate [chalk] 005553

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Antacids and heartburn treatments

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Introduction and description

Types of drug