The Lunar New Year has arrived! Family gatherings inevitably mean feasting on big meals. However, foods high in oil, sugar, and those that are difficult to digest can easily cause indigestion, bloating, stomach pain, and other gastrointestinal issues, which can really spoil the fun. With so many types of gastric medicines available, which one is right for you? Below is an introduction to several common categories of gastric medication to help you enjoy a comfortable New Year!
Gastric medicines are primarily divided into three categories based on their function: neutralizing stomach acid, reducing stomach acid secretion, and protecting the gastric mucosa. Most gastric medicines that the general public can purchase directly at pharmacies are antacids (which neutralize acid). Other types usually require a doctor’s prescription or guidance from a physician or pharmacist.
❖ Antacids (制酸劑)
These contain various metal ions such as Sodium (Na), Calcium (Ca), Magnesium (Mg), and Aluminum (Al), all of which are alkaline substances. They neutralize stomach acid immediately to reduce the sensation of stomach pain and are commonly referred to as “stomach tablets.” However, antacids can interact with certain antibiotics; pay close attention to the timing between doses or avoid combined use. Consult a doctor or pharmacist if you need to take both.
- Aluminum Hydroxide
Al(OH)3Al(OH)_3Al(OH)3, Aluminum PhosphateAlPO4AlPO_4AlPO4: Likely to cause constipation as a side effect. - Magnesium Hydroxide
Mg(OH)2Mg(OH)_2Mg(OH)2: Likely to cause loose stools or diarrhea. - Calcium Carbonate
CaCO3CaCO_3CaCO3: Likely to cause “rebound” acid hypersecretion, and is therefore less commonly used now. - Sodium Bicarbonate
NaHCO3NaHCO_3NaHCO3: Patients with heart disease, hypertension, or kidney disease must use this with extreme caution. - Note: Magnesium and Aluminum are often combined into a single formula to cancel out each other’s side effects. Examples include Iwell and Strocain (which also contains a local anesthetic for pain relief).
- Reminder: If stomach pain persists after using these for a while, seek medical attention immediately.
❖ H2-Receptor Antagonists (組織胺阻斷劑)
These work by blocking the early stages of stomach acid secretion, thereby reducing acid production. They can alleviate indigestion or bloating caused by excessive acid. However, the effect is not immediate; they must be taken regularly to be effective. Additionally, because the human body secretes more histamine at night, these drugs are more effective at inhibiting nocturnal acid. It is recommended to take them at bedtime, once or twice a day (after breakfast and before bed). Side effects may include gastrointestinal discomfort, headaches, or dizziness.
- Cimetidine (e.g., CIMETIN F.C. Tablets 400mg): May produce anti-androgenic effects, leading to gynecomastia (enlarged male breasts) or galactorrhea. It also inhibits the CYP450 enzyme, affecting the metabolism of drugs like Warfarin, Phenytoin, and Clopidogrel. Users must be wary of drug interactions.
- Ranitidine (e.g., Culcer Extra F.C. Tablets 150mg): Since 2019, products containing this ingredient (including the well-known Zantac) were removed from shelves due to potential carcinogenic impurities (NDMA) and have not yet been reintroduced to the market.
- Famotidine (e.g., Famo F.C. tab 20 mg)
- Nizatidine (e.g., Tazac Capsules 150mg)
❖ Proton Pump Inhibitors (PPIs) (氫離子幫浦阻斷劑)
These inhibit the final step of stomach acid secretion. Their effect is more comprehensive, and they are currently the strongest known inhibitors of acid secretion. However, they require several cumulative doses to reach a stable effect; generally, it takes 3 to 4 days of use to fully inhibit acid secretion. The efficacy of these drugs is easily affected by food, so it is recommended to take them 30 to 60 minutes before breakfast, once a day. Additionally, PPIs are unstable in the acidic environment of the stomach, so they are mostly made into enteric-coated formulations. They should not be crushed, halved, or powdered for tube feeding. Side effects may include GI discomfort and interference with Vitamin B12 absorption.
- Omeprazole (e.g., Ceisjoy Delayed Release Microencapsulated Capsule 20mg): Inhibits the CYP2C19 enzyme, which may affect the metabolism of drugs like Warfarin, Phenytoin, and Clopidogrel.
- Esomeprazole (e.g., Nexium Tab 40mg): A special enteric-coated microgranule formulation that can be dissolved in water for patients with feeding tubes or difficulty swallowing.
- Lansoprazole (e.g., TAKEPRON OD 15mg): An orally disintegrating tablet (ODT) suitable for tube feeding or patients with difficulty swallowing.
- Rabeprazole (e.g., PARIET F.C. Tablets 20mg)
- Pantoprazole (e.g., Pantoloc Gastro-resistant Tablets 40mg)
❖ Gastric Mucosal Protectors (胃黏膜保護劑)
- Sucralfate: In an acidic environment, it polymerizes into a paste-like substance that coats the lower esophagus and gastric mucosa, forming a physical barrier to reduce damage from stomach acid. It is recommended to take this before meals, four times a day. Do not take it simultaneously with antacids.
In conclusion, while there are countless stomach medicines on the market, whether you buy them over-the-counter or receive them via prescription, you should seek medical help immediately if your pain does not improve or if your condition worsens (e.g., discovering gastrointestinal bleeding or black, tarry stools). Do not delay the “golden window” for treatment for the sake of temporary convenience. Always inform your doctor of the medications you are currently taking to avoid duplicate prescriptions or adverse drug interactions.
Ultimately, medication is only an external aid. Making an effort to change your diet and lifestyle habits is the fundamental way to resolve gastrointestinal discomfort. Take good care of your stomach to ensure a wonderful New Year!