Acid reflux prescription medications currently include two major classes of drug although newer drugs are just around the corner. The two classes of drug include:
The real breakthrough in managing acid related disorders came with the invention of H2 receptor antagonists or H2RAs in the 1970s. They revolutionised the treatment of stomach and duodenal ulcers, which had previously been treated simply by bland diets and antacids.
How do H2RAs work?
The cells which make acid in the stomach are called parietal cells. These can be induced to make hydrochloric acid by various messages, which are received, for example, when a person starts eating.
One of the transmitters of these messages is the chemical histamine. Histamine has many functions throughout the body including regulating sleep and protecting against stress amongst others. In the stomach, histamine induces acid production by stimulating receptors on the surface of the parietal cells. These receptors are call histamine 2 receptors (as opposed to histamine 1 receptors which are found particularly in the brain).
The interaction between histamine and the histamine 2 receptors can be antagonised (interfered with) by histamine 2 receptor antagnoists (H2RA) drugs such as cimetidine (tagamet) and ranitidine (zantac).
H2RAs are particularly good at blocking ‘background’ acid production, when a person is not eating. They are thus, particularly beneficial at decreasing acid production at night. For this reason, the drugs are often prescribed to be taken just before going to bed.
Unfortunately, H2RAs are not very successful for most people with acid reflux which usually occurs soon after eating.
The invention of the PPI class of medicines in the 1980s revolutionised the lives of people who suffer from acid reflux. Now, at least two thirds of people with acid reflux will have major improvement in symptoms within 3-5 days of starting these medicines.