PubMed · 8362187
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S L Chase. 1993. OTC interactions. Antacids.. https://pubmed.ncbi.nlm.nih.gov/8362187/
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Inhibitors of gastric acid secretion, particular proton pump inhibitors, are effective drugs in the treatment and prophylaxis of acid-related diseases. Proton pump inhibitors are therefore prescribed widely, often for minor complaints. Gastric acidity kills swallowed microorganisms, and acid secretion must be of biological importance because it is maintained in phylogenesis. Acid secretion is controlled by feedback mechanisms, mainly via gastrin. A decrease in acidity always causes an increase in plasma gastrin. The trophic effect of gastrin leads to hyperplasia and neoplasia of the enterochromaffin-like (ECL) cell. ECL cell derived tumours in man were previously regarded as rare, and also as rather benign. It is now clear that the ECL cell gives rise to a significant proportion of gastric carcinomas. Moreover, ECL cell carcinoids secondary to hypergastrinaemia may develop into highly malignant tumours. Treatment with a proton pump inhibitor is followed by rebound acid hypersecretion and decreased efficiency of H2-blockers, thus such treatment may induce a type of physical dependence. It is therefore reasonable to be cautious and not to treat younger (< 50 years) patients for long periods of time with profound inhibitors of gastric acid secretion. Chromogranin A in the blood is a sensitive marker of the ECL cell mass, and it could be used to survey patients on long-term proton pump inhibitors.
Norfloxacin is a fluorquinolone that can interfere with antacids that contain aluminum and magnesium salts by complexation and modification of its solubility, which reduces its absorption and may lead to therapeutic failures. The purpose of this work was to evaluate the effect of the pharmaceutical design on this interaction and to develop a formulation of norfloxacin tablets in which this process could be avoided. Norfloxacin tablets were designed in 28 formulations. The interaction was studied in terms of in vitro dissolution behavior (USP 23, apparatus 2) in simulated gastric fluid with different doses of four commercially available antacid preparations. It was observed that dissolution rates were markedly reduced in the presence of all antacids studied. This phenomenon was practically avoided with some formulations of norfloxacin tablets in which a disintegrant (sodium starch glycolate or crospovidone) was included. These results indicated that the chelation among metal ions and norfloxacin could be affected by the delivering ability of the drug in the tablet. It was demonstrated that the pharmacotechnical design could modify an interaction process. Some formulations of tablets, in which the reduced dissolution rates in the presence of nonsystemic antacids in vitro was practically avoided, were developed by direct compression.
Gastroesophageal reflux (GER) is one of the most common gastrointestinal problems in infants and children. Unfortunately, the diagnosis of GER is often made after development of serious complications, placing the child at medical and developmental risk. Early recognition by primary care providers is essential in preventing these serious, sometimes life-threatening complications of untreated GER. This article reviews the pathophysiology, clinical manifestations, diagnostics, and treatment modalities of GER along with developmental considerations. As a health care provider, the advanced practice nurse is in an ideal position to provide a complete assessment, develop a realistic plan of care, coordinate interventions, assess outcomes, and offer support to the family of the child with GER.