Gastrointestinal Medications

Aluminum hydroxide, magnesium hydroxide (Mylanta, Maalox)
Calcium carbonate (Tums, Rolaids, Chooz)
Bismuth subsalicylate (Pepto-Bismol)
Sodium bicarbonate (Alka-Seltzer)

Proton Pump Inhibitors
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Esomeprazole (Nexium)
Pantoprozole (Protonix)

Histamine2 Blockers
Cimetidine (Tagamet)
Ranitidine hydrochloride (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)

Promotility Agents
Metoclopramide (Reglan)

Many people with lupus suffer from gastrointestinal problems, especially heartburn caused by gastroesophageal reflux disease (GERD). Peptic ulcers can also occur, often due to certain medications used in lupus treatment, including NSAIDs and steroids. Occasional heartburn or acid indigestion can be treated with an over-the-counter antacid, such as Rolaids, Maalox, Mylanta, Tums, Pepto-Bismol, or Chooz. Your doctor may also include an antacid in your treatment regimen in addition to another form of GI medication. Antacids contain basic salts (ions), which interact with and neutralize the acid in your stomach on contact. Some antacids also contain simethicone, which helps relieve symptoms of gassy stomach. Antacids are effective when used to treat occasional symptoms, but you should try to avoid heartburn and acid indigestion altogether by eating smaller meals, remaining upright after eating, and cutting down on caffeine. If heartburn and acid reflux persist (e.g., for more than two weeks), you should speak with your doctor, because your heartburn symptoms could be part of a larger problem.

If you experience persistent heartburn, stomach acid, or ulcers, your doctor may prescribe a proton pump inhibitor (PPI), such as Nexium, Prevacid, Prilosec, Protonix, or Aciphex. These medications are used to treat people with heartburn, stomach or intestinal ulcers, or excess stomach acid. Proton pump inhibitors reduce acid by shutting down the tiny pumps within cells in your stomach that secrete it. Evidence also suggests that PPIs may inhibit Helicobacter pylori, a type of bacteria that can cause peptic ulcers, gastritis, and other gastrointestinal problems. Most PPIs come as over-the-counter or prescription tablets, but pantoprazole (Protonix) may also be given intravenously at the hospital for people who are admitted with a bleeding ulcer. Taking a PPI reduces the chance that an ulcer or gastrointestinal bleeding will occur again.

Your doctor may also prescribe histamine2 blockers (H2 blockers) for symptoms of GERD, esophagitis, or peptic ulcers. While both PPIs and H2 blockers suppress the production of acid in your stomach, they work in different ways and over different time periods. For example, H2 blockers work within an hour but last only about 12 hours, whereas PPIs need more time to take effect but last up to 24 hours. Also keep in mind that many PPIs and H2 blockers are available in both over-the-counter and prescription forms; while these medications vary in potency, over-the-counter forms may be more cost-effective. Talk to your doctor about these various options.

H2 blockers work to reduce the amount of acid that your stomach produces by blocking histamine2, a chemical in your body that signals the parietal cells of your stomach lining to make acid. In doing this, H2 blockers reduce the amount of acid made by your stomach. Different H2 blockers vary in potency. Over-the-counter forms are less potent, while prescription doses can be more potent.

In addition, your physician may prescribe a medication called a promotility agent if you experience GERD symptoms due to slow gastric emptying, or if H2 blockers and PPIs are not enough to control your GERD symptoms. Promotility agents help speed digestion by stimulating the movement of GI contents through your esophagus, stomach, and intestines. This helps to prevent acid from lingering in your stomach too long, thus reducing the amount of damage that acid can inflict on your GI tract and decreasing the occurrence of the acid reflux. Metoclopramide is the main promotility agent currently on the market. It works by increasing muscle contractions in the upper digestive tract, which in turn speeds the rate with which stomach contents move into the intestines.

While taking any GI medication, you should avoid drinking alcohol, since it can further upset your stomach and cause an increase in the side effects of certain medications. In addition, tell your doctor about any other medications you may be taking, since certain drugs can interact with your GI medications.