Improve Control of Night-Time Acid Reflux with New Drugs for GERD

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Approaches to treating acid reflux or GERD depend on the severity and frequency of symptoms as well as coexisting conditions such as Barrett’s Esophagus, considered a pre-cursor to esophageal cancer. Simple and infrequent indigestion may need only antacids and/or diet modification. Sometimes patients can reduce the problem by raising the head of the bed six inches on blocks so that gravity decreases nocturnal reflux.

More severe or frequent acid reflux may be treated with H2 blockers—over-the-counter or prescription strength drugs such as Zantac, Tagamet, Pepcid or Axid and their generic versions, cimetidine, famotidine, nizatidine and ranitidine. When GERD becomes severe and frequent enough to raise the potential of physiological damage such as an erosive esophageal condition, an acid-caused stricture of the esophagus, or Barrett’s Esophagus, a stronger class of drugs may be prescribed. These are called Proton Pump Inhibitors (PPI). In most cases, PPI dosing instructions call for taking the drug an hour before breakfast or dinner because the effect of the medicine is triggered by the process that increases stomach acid to deal with food digestion. The drug then continues to act throughout the day on a delayed release basis. Several new drugs for GERD have been approved in the last few years.


Some individuals seem to suffer more from nocturnal increases in gastric acidity than during the day. Zegerid is a combination of an immediate release of the proton pump inhibitor (PPI) drug omeprazole and sodium bicarbonate. It was the first immediate release PPI to reach the market. It is available in two strengths, 40 mg omeprazole/1100 mg sodium bicarbonate or 20 mg omeprazole/1100 mg sodium bicarbonate. Although the FDA approved the drug in 2006, from anecdotal evidence and Web reports, it has been a bit slow in being recognized and/or accepted by gastroenterologists or primary care physicians. Studies have demonstrated that it has a more positive effect on nocturnal gastric acidity after bedtime than PPIs taken before breakfast or dinner. This is important because studies show that reflux episodes are coordinated with the circadian rhythm of gastric acid production, which increases late in the evening and gets to a maximum level in the early part of sleep. A PPI taken in the early morning or even before dinner is not the best solution for this kind of GERD. The sodium bicarbonate protects the PPI part of the capsule from stomach acid, allowing rapid absorption [1].

This drug is now available as an over-the-counter product (Zegerid OTC) at the 20 mg strength level.

Caution: In both the prescripton and OTC product, the 20-mg and the 40-mg forms of have the same strength of sodium bicarbonate. Do not take two 20-mg capsules to equal one 40-mg capsule.


Dexilant (former name Kapidex) is the latest of the new drugs for GERD to receive FDA approval. This drug comes as a delayed-release capsule for once-a-day treatment of GERD and erosive esophagitis. Although most PPIs consist of some form of delayed release, Dexilant has a duel delayed release formulation, which supplies two separate doses in one capsule through two types of enteric-coated granules. The drug is taken with or without food, giving it an advantage over the typical PPI, which relies upon food in the stomach for maximum effect. Kapidex capsules may be opened and sprinkled on a tablespoon of applesauce as well [2].

Adverse Reactions

The most typical side effect of most PPI drugs is diarrhea. Kapidex includes a possibility of upper respiratory tract infection. Note: While these effects are common to PPIs, they also account for a small percentage in numbers of patients participating in the tests. For example, the upper respiratory infection effect with Kapidex occurred in 2.9 percent of patients on a 30 mg per day does and 1.7 percent on the 60 mg dose compared to 0.8 percent with placebo. Overall, with both dosages, diarrhea happened in 4.8 percent of the study groups versus 2.9 percent with placebo [3].


[1]. Alimentary Pharmacology and Therapeutic, Comparison of the effects of immediate-release omeprazole power . . ..2005

[2]. About Kapidex

[3]. RxList: Kapidex


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