What medicine helps with an upset stomach

Almost on a daily basis, pharmacists come into contact with someone with a stomach ailment. It is important to find out what caused the patient's stomach upset and then to offer tips on how to treat it (Table 1).

Stomach Pain or Cramping

Gas, indigestion, or perhaps gastritis (an inflammation of the lining of the stomach) can cause abdominal pain. The problem can result from overeating, or it can be a reaction to alcohol, caffeine, or even medication. Diet restrictions, such as taking only bland foods and clear liquids, could relieve the symptoms.

Antacids, which are neutralizing agents, are often used to relieve the symptoms of heartburn (Table 2). For instance, the ingredient in Pepto-Bismol (bismuth subsalicylate) coats the esophagus, acts as a barrier to reflux, and alleviates pain and other symptoms. Pepto-Bismol is indicated for indigestion, heartburn, upset stomach, nausea, and diarrhea. Children with flu-like symptoms should not take it, because it can lead to Reye's syndrome.

Flatulence (Intestinal Gas)

Gas is a natural part of the digestive process. It can be caused by beans and some fruits and other vegetables. Natural products to treat gas include chamomile and peppermint. OTC formulations contain simethicone, a defoaming agent. In addition to simethicone, Flatulex, for example, contains activated charcoal, which absorbs substances that may cause gas and also relieves gas pain and bloating. New formulations of antacids and simethicone are now available (Table 3).

Beano, another product approved for treating flatulence, comes from the Aspergillus niger mold and is a solution of an enzyme known as alpha-Galactosidase. This enzyme breaks down oligosaccharides (which high-fiber foods contain) and can be a prophylactic treatment for gas caused by high-fiber foods.

Diarrhea

Diarrhea can occur as a result of a stomach virus, food poisoning, stress, and certain medications, and it can lead to dehydration. Patients should be counseled to drink plenty of clear fluids that do not contain too much sugar. In addition to diet restrictions, Pedialyte may be recommended for electrolyte loss (Table 4). If diarrhea lasts longer than 48 hours, a physician should be consulted.

Heartburn

Whereas many factors contribute to heartburn, it generally is caused by a poorly functioning lower esophageal sphincter, which allows the contents of the stomach to back up into the esophagus. Pregnancy, obesity, smoking, caffeine, alcohol, chocolate, and spicy foods may cause or aggravate heartburn.

Antacids are first-line therapy (Table 2). Taken before a meal, they provide relief for about 40 to 60 minutes, and up to 3 hours if taken after a meal. Frequent use of antacids containing aluminum, however, can cause constipation, and those containing magnesium can cause diarrhea. Antacids can affect certain medications, so it is advisable to separate doses by at least 2 hours.

Gaviscon, containing alginic acid as well as sodium bicarbonate, aluminum, and magnesium, coats the stomach. Tablets should be chewed and taken with plenty of water.

Pepcid Complete is a combination of famotidine (a histamine2-receptor antagonist [H2RA]) and magnesium hydroxide and calcium carbonate. It offers the advantage of prompt relief from the antacids and acid reduction from the H2RA. Experts have found that this combination offers more sustained relief.

Proton pump inhibitors (PPIs) have a longer duration of action than H2RAs. Prilosec OTC, a 20-mg tablet, is the only PPI currently available over the counter. PPIs may interact with certain drugs, such as warfarin and diazepam, however.

You know the signs all too well. Your stomach starts gurgling, your chest starts burning, you start cramping—and you begin your frantic search for the bathroom. Digestive problems can be embarrassing, and not something people want to talk about openly—even with their doctor. But as I tell my patients, these problems are strikingly common, and affect many people on a daily basis.

While digestive problems often go away on their own, over-the-counter medications can help to relieve many of the symptoms that are interfering with your every day life. Here’s a guide to the OTC medicines you can use to soothe tummy or digestive troubles.

Remember: These medicines are only meant for occasional, short-term use; if your problems persist or worsen, talk to your doctor. He or she can help you come up with a treatment plan (including lifestyle changes) that can bring you long-lasting relief.

For Heartburn

If you suffer from heartburn, you’re probably all too familiar with that burning sensation in your stomach, chest or throat that can cause discomfort. This irritation is caused by an imbalance of acid in your stomach.

Heartburn is often triggered by eating a big meal or certain foods, and occurs when your stomach contents rise into your esophagus, causing a burning sensation in the chest, behind the breastbone and in the mid-abdomen.

Several types of over-the-counter medicines can help to relieve your symptoms and reduce your stomach’s acidity:

• Antacids provide quick, short-term relief by neutralizing stomach acid. Antacids may include ingredients like baking soda, calcium carbonate or magnesium compounds.
• Alginic acids are often combined with antacids to provide quick relief. While antacids help to neutralize stomach acid, alginic acids form a protective barrier within your GI tract, coating and protecting inflamed areas.
• H2 blockers, like famotidine and cimetidine, lower the amount of acid your stomach makes. While it takes up to an hour for H2 blockers to work, the effects last longer than antacids, up to 12 hours.Proton Pump Inhibitors (PPIs) provide long-lasting reduction, up to 24 hours,  in stomach acid production. Lansoprazole and omeprazole are both types of proton pump inhibitors.

Side effects of these three drug classes are usually minor and often resolve on their own. They include nausea, constipation, diarrhea, and headaches. Your doctor can let you know which type of OTC medicine will work best for you. Talk to your doctor before using antacids if you are pregnant, breastfeeding, taking prescription medications, or if you have problems with ulcers, the liver or your kidneys.

For Nausea and Vomiting

Last night’s Chinese take-out leftovers seem like a great meal idea—until your stomach clearly begins to disagree with you. Nausea and vomiting are one of your body’s major defenses against food poisoning, and can also arise from problems like motion sickness and overeating. While the best way to cure an upset stomach from most cases of food poisoning is to let your body rid itself of the bacteria causing your discomfort, over-the-counter antiemetics can come in handy when dealing with nausea and vomiting symptoms caused by motion sickness and certain other conditions. There are two main types of OTC medications used to treat nausea and vomiting:

• Bismuth subsalicylate, the active ingredient in OTC medications like Kaopectate® and Pepto-Bismol™, protects your stomach lining. Bismuth subsalicylate is also used to treat ulcers, upset stomach and diarrhea.
• Other medicines include cyclizine, dimenhydrinate, diphenhydramine, and meclizine. These can be found in medicines such as Dramamine, Bonine, or others, and they dull motion sickness by acting on your brain. They block messages from reaching the part of the brain that controls nausea and vomiting

Side effects of bismuth subsalicylate are usually very minor and short-lived; the most common side effects are a darkened tongue or stools, however, it’s important not to give medicines with bismuth subsalicylate to children or teenagers with chicken pox or flu-like symptoms, since symptoms such as changes in behavior with nausea or vomiting could be an early sign of Reye’s syndrome, a rare but serious illness. Talk to a doctor right away. Since some antiemtics can make you sleepy,  read the label carefully and heed any warnings about mixing with alcohol, driving or operating machinery. Don’t take antiemetics without reading the label first, and talk to your doctor if there are any warnings on your medication of choice: there are several drugs and health conditions that don’t mix well with antiemetics, including certain common pain relievers.

For Constipation

What’s causing your constipation? Most likely, something on your dinner table. A diet high in dairy products and low in fiber and water can make it difficult for you to pass a stool. If you’ve gone more than three days without a bowel movement, or are having trouble passing a stool, you might consider temporarily taking a laxative to help you through the problem.

There are several types of laxatives available over-the counter; your doctor can help you decide which one is best for you:

• Bulk-forming laxatives, which often contain ingredients like psyllium, methylcellulose and polycarbophil, draw water into the stool to make them larger and easier to pass. Drink plenty of water while taking.
• Osmotic laxatives draw fluid into the bowel from the nearby tissue. Osmotic laxatives often have ingredients like polyethylene glycol or magnesium. Lubricant laxatives, such as glycerin suppositories, coat the surface of stools or the anus to make it easier for stools to pass. Mineral oil is a common lubricant laxative.
• Stimulant laxatives should only be used for a few days, as they are harsh on the body. They cause the bowels to squeeze the stool out.

Laxatives don’t usually have side effects, but, in some cases, they can cause cramping, gas, bloating, nausea or diarrhea. Don’t use laxatives for more than a week without checking in with your doctor: long-term laxative use can be unhealthy, and may mask a problem your doctor should know about. Your doctor can help you make lifestyle and dietary changes to treat constipation long-term.

Talk to your doctor before using laxatives if you have stomach pain, nausea, vomiting, a fever of over 101.5 degrees or a sudden change in your bowel habits that continues for two or more weeks. You should also consult your doctor if you are currently taking prescription medication: laxatives make it more difficult for your body to absorb certain medicines and nutrients.

For Diarrhea

Everyone experiences it now and again—the dreaded diarrhea. Diarrhea (large amounts of loose or watery stools) occurs when your colon is unable to adequately absorb the liquid from the food and fluids you ingest, and is most often caused by a stomach bug. Diarrhea doesn’t usually require medication, and resolves itself after a couple of days; most times, lifestyle changes can help prevent future cases of diarrhea. However, antidiarrheal medications can help with symptoms, especially if you have cramping. Your doctor may suggest one of two common over-the-counter antidiarrheals:

• Loperamide slows down fluid moving through your bowels.
• Bismuth subsalicylate decreases the flow of fluids in your bowel, and also reduces inflammation and may kill the bacteria that cause the diarrhea in the first place.

Loperamide can make you drowsy, so be sure to read the label carefully; the label will tell you what behaviors, if any, you should avoid while on the medication.  Bismuth subsalicylate can make your tongue and/or stool look black; this side effect is harmless. If you think your diarrhea might be caused by an infection, talk to your doctor, as another medicine might be better at treating the bug. You should also talk to your doctor if you have a fever or find mucus or blood in your stools, as your diarrhea may signal a more serious problem.

Finding Relief

The right over-the-counter medicine can bring quick relief for many short-term gastrointestinal problems. Remember to read the labels of any medicines you are planning to take, and talk to your doctor if you have questions or concerns.

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