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GI Disorders

BDK

Generic NameBrand NamePharmacologic CategoryClassificationCommon IndicationsKey Side EffectsUS Boxed Warnings & ContraindiDrug Interactions
Calcium carbonate Tums, Os-Cal Antacid OTC Mild/moderate episodic heartburn; bone health supplement Constipation, bloating, belching/flatulence C/I: Hypercalcemia, severe renal dysfunction Medications should be separated from antacids by 2-4 hours
Aluminum hydroxide/ magnesium hydroxide/ simethicone Maalox Advanced Maximum Strength Liquid Antacid OTC Mild/moderate episodic heartburn Constipation/diarrhea, hypophosphatemia, renal failure, bone demineralization C/I: Severe renal dysfunction Medications should be separated from antacids by 2-4 hours, aluminum combined with magnesium to balance bowel effects
Aluminum hydroxide/ magnesium hydroxide/ simethicone Mylanta Maximum Strength Liquid Antacid OTC Mild/moderate episodic heartburn Constipation/diarrhea, hypophosphatemia, renal failure, bone demineralization C/I: Severe renal dysfunction Medications should be separated from antacids by 2-4 hours, aluminum combined with magnesium to balance bowel effects
Magnesium hydroxide Milk of Magnesia Antacid OTC Mild/moderate episodic heartburn Diarrhea C/I: Severe renal dysfunction Medications should be separated from antacids by 2-4 hours, aluminum combined with magnesium to balance bowel effects
Sodium bicarbonate/ anhydrous citric acid Alka-Seltzer Heartburn Antacid OTC Mild/moderate episodic heartburn Belching/flatulence; may worsen edema in HF, renal failure, pregnancy, or cirrhosis; milk-alkali syndrome C/I: Severe renal dysfunction Medications should be separated from antacids by 2-4 hours
Sodium bicarbonate/ anhydrous citric acid/ aspirin Alka-Seltzer Original Antacid OTC Mild/moderate episodic heartburn Belching/flatulence; may worsen edema in HF, renal failure, pregnancy, or cirrhosis; milk-alkali syndrome C/I: Salicylates, high bleeding risk; children <18 y/o Medications should be separated from antacids by 2-4 hours
Aluminum hydroxide/ magnesium carbonate Gaviscon Extra Strength Liquid Antacid OTC Mild/moderate episodic heartburn Constipation/diarrhea, hypophosphatemia, renal failure, bone demineralization C/I: Severe renal dysfunction Medications should be separated from antacids by 2-4 hours, aluminum combined with magnesium to balance bowel effects
Famotidine Pepcid, Pepcid AC, Zantac 360 H2 receptor antagonist Mild to moderate episodic heartburn, GERD hallucinations (elderly); ↓ libido, impotence, gynecomastia, galactorrhea, breast soreness QID dosing, dose adjustments required in renal dysfunction, tachyphylaxis after 2 weeks scheduled use
Famotidine/calcium carbonate/magnesium hydroxide Pepcid Complete H2 receptor antagonist Post-prandial heartburn if not premedicated with an H2RA or antacid hallucinations (elderly); ↓ libido, impotence, gynecomastia, galactorrhea, breast soreness BID max, dose adjustments required in renal dysfunction, tachyphylaxis after 2 weeks scheduled use
Cimetidine Tagamet H2 receptor antagonist Mild to moderate episodic heartburn, GERD hallucinations (elderly); ↓ libido, impotence, gynecomastia, galactorrhea, breast soreness BID max, dose adjustments required in renal dysfunction, tachyphylaxis after 2 weeks scheduled use
Nizatidine Axid H2 receptor antagonist Mild to moderate episodic heartburn, GERD hallucinations (elderly); ↓ libido, impotence, gynecomastia, galactorrhea, breast soreness BID max, dose adjustments required in renal dysfunction, tachyphylaxis after 2 weeks scheduled use
Ranitidine Zantac H2 receptor antagonist Mild to moderate episodic heartburn, GERD hallucinations (elderly); ↓ libido, impotence, gynecomastia, galactorrhea, breast soreness BID max, dose adjustments required in renal dysfunction, tachyphylaxis after 2 weeks scheduled use
Esomeprazole Nexium Proton pump inhibitor heartburn occurring 2 or more days per week or diagnosed GERD HA, abdominal pain, nausea, diarrhea, constipation, flatulence, rebound acid hypersecretion, AIN, cutaneous and systemic lupus erythematosus; traveler’s diarrhea, CDI, SBP, Mg, B12, Ca, Fe, reduced BMD/osteoporosis, CV events, pneumonia, CKD, dementia IV available, daIily - BID, do not chew/crush/take with food
Omeprazole Prilosec Proton pump inhibitor heartburn occurring 2 or more days per week or diagnosed GERD HA, abdominal pain, nausea, diarrhea, constipation, flatulence, rebound acid hypersecretion, AIN, cutaneous and systemic lupus erythematosus; traveler’s diarrhea, CDI, SBP, Mg, B12, Ca, Fe, reduced BMD/osteoporosis, CV events, pneumonia, CKD, dementia daily – BID, do not chew/crush/take with food
Omeprazole/sodium bicarbonate Zegerid Proton pump inhibitor + antacid heartburn occurring 2 or more days per week or diagnosed GERD HA, abdominal pain, nausea, diarrhea, constipation, flatulence, rebound acid hypersecretion, AIN, cutaneous and systemic lupus erythematosus; traveler’s diarrhea, CDI, SBP, Mg, B12, Ca, Fe, reduced BMD/osteoporosis, CV events, pneumonia, CKD, dementia daily – BID, do not chew/crush/take with food
Lansoprazole Prevacid Proton pump inhibitor heartburn occurring 2 or more days per week or diagnosed GERD HA, abdominal pain, nausea, diarrhea, constipation, flatulence, rebound acid hypersecretion, AIN, cutaneous and systemic lupus erythematosus; traveler’s diarrhea, CDI, SBP, Mg, B12, Ca, Fe, reduced BMD/osteoporosis, CV events, pneumonia, CKD, dementia daily – BID, do not chew/crush/take with food
Dexlansoprazole Dexilant Proton pump inhibitor (dual delayed-release) heartburn occurring 2 or more days per week or diagnosed GERD HA, abdominal pain, nausea, diarrhea, constipation, flatulence, rebound acid hypersecretion, AIN, cutaneous and systemic lupus erythematosus; traveler’s diarrhea, CDI, SBP, Mg, B12, Ca, Fe, reduced BMD/osteoporosis, CV events, pneumonia, CKD, dementia daily – BID, do not chew/crush, taken without regard to meals
Pantoprazole Protonix Proton pump inhibitor heartburn occurring 2 or more days per week or diagnosed GERD thrombophlebitis, SJS/TEN, HA, abdominal pain, nausea, diarrhea, constipation, flatulence, rebound acid hypersecretion, AIN, cutaneous/SLE; traveler’s diarrhea, CDI, SBP, Mg, B12, Ca, Fe, reduced BMD/osteoporosis, CV events, pneumonia, CKD, dementia IV available, daily - BID, do not chew/crush, EC taken without regard to meals
Rabeprazole AcipHex Proton pump inhibitor heartburn occurring 2 or more days per week or diagnosed GERD HA, abdominal pain, nausea, diarrhea, constipation, flatulence, rebound acid hypersecretion, AIN, cutaneous and systemic lupus erythematosus; traveler’s diarrhea, CDI, SBP, Mg, B12, Ca, Fe, reduced BMD/osteoporosis, CV events, pneumonia, CKD, dementia daily – BID, do not chew/crush, EC taken without regard to meals
Sucralfate Carafate Gastrointestinal protectant (coating agent) PUD Constipation, salicylate toxicity with high dose/prolonged use; hypophosphatemia; bezoar formation C/I: Renal failure (aluminum accumulation), children, pregnancy QID dosing; give other meds ≥2 h before or 4 h after;
Metoclopramide Reglan Prokinetic; D2 antagonist simple NV, especially associated with gastroparesis, refractory pregnancy-associated NV, PONV extrapyramidal symptoms, CNS depression, diarrhea, QT prolongation, galactorrhea, gynecomastia BBW: Tardive dyskinesia risk Reduce dose in renal impairment
Bismuth subsalicylate Pepto-Bismol topical antibacterial; gastroprotective H. pylori (part of BQT), dyspepsia Black stool/tongue; bleeding risk C/I: Salicylate allergy; children/teens with viral illness (Reye’s risk) If salicylate allergy, use bismuth subcitrate
Bismuth subcitrate Pylera (when in combo) topical antibacterial; gastroprotective H. pylori (BQT alternative) Black stool/tongue; bleeding risk C/I: Caution in renal failure/elderly Use when salicylate allergy present
Amoxicillin Aminopenicillin antibiotic Diarrhea, stomach upset, hypersensitivity reactions C/I: Penicillin allergy
Metronidazole Flagyl Antibiotic anaerobes; CDI Metallic taste, nausea; disulfiram-like reaction with alcohol C/I: Alcohol use No alcohol during therapy
Tetracycline Tetracycline antibiotic Photosensitivity; esophagitis C/I: Pregnancy; children <8 years Take with plenty of fluids to reduce esophagitis
Rifabutin Rifamycin antibiotic Rash, leukopenia; orange discoloration; GI upset; diarrhea High pill burden; now first-line in some cases
Clarithromycin Biaxin Macrolide antibiotic Metallic taste, diarrhea; QT prolongation Avoid empiric use due to resistance unless susceptibilities known
Vonoprazan Voquezna Potassium-competitive acid blocker (PCAB) GERD; H. pylori (dual/triple) ↑ fracture risk (high dose or >1 yr) can take with or without food
Levofloxacin Levaquin Fluoroquinolone antibiotic QTc prolongation, tendon rupture, increased LFTs, photosensitivity BBW: tendon rupture, peripheral neuropathy, CNS effects, exacerbation of myasthenia gravis
Misoprostol Cytotec Prostaglandin Nausea, diarrhea, abdominal cramping, flatulence, hypophosphatemia BBW: abortifacient properties, uterine rupture, do not used for reducing risk of NSAID-induced ulcers in women of childbearing potential unless patient is high risk; requires pregnancy testing and effective contraception QID dosing
Ondansetron Zofran, Zuplenz 5-HT3 receptor antagonist simple nausea/vomiting, pregnancy associated NV, CINV (acute phase), PONV Headache, constipation; QTc prolongation, serotonin syndrome C/I with apomorphine (severe hypotension, LOC) IV doses should not exceed 16 mg due to QTc prolongation
Granisetron (patch) Sancuso (patch) 5-HT3 receptor antagonist simple nausea/vomiting, pregnancy associated NV, CINV (acute phase), PONV Headache, constipation; QTc prolongation, serotonin syndrome C/I with apomorphine (severe hypotension, LOC) applied 24-48 hours before chemotherapy, may leave in place up to 7 days
Granisetron (SubQ) Sustol (SC ER) 5-HT3 receptor antagonist simple nausea/vomiting, pregnancy associated NV, CINV (acute phase), PONV Headache, constipation; QTc prolongation, serotonin syndrome C/I with apomorphine (severe hypotension, LOC) extended release, effective for delayed CINV
Palonosetron Aloxi 5-HT3 receptor antagonist simple nausea/vomiting, pregnancy associated NV, CINV (acute phase), PONV Headache, constipation; QTc prolongation, serotonin syndrome C/I with apomorphine (severe hypotension, LOC) PO formulation only available in combination with netupitant
Dolasetron Anzemet 5-HT3 receptor antagonist simple nausea/vomiting, pregnancy associated NV, CINV (acute phase), PONV Headache, constipation; QTc prolongation, serotonin syndrome C/I with apomorphine (severe hypotension, LOC) PO only
Prochlorperazine Compazine Dopamine antagonist (Phenothiazine) Simple NV, PONV, breakthrough CINV prolonged QTc interval, anticholinergic effects, EPS, neuroleptic malignant syndrome Boxed: increased mortality in elderly patients with dementia-related psychosis Oral, IM, IV, rectal
Chlorpromazine Thorazine Dopamine antagonist (Phenothiazine) Simple NV, PONV, breakthrough CINV prolonged QTc interval, anticholinergic effects, EPS, neuroleptic malignant syndrome Boxed: increased mortality in elderly patients with dementia-related psychosis Oral, IM, IV
Promethazine Phenergan, Promethegan Dopamine antagonist (Phenothiazine) Simple NV, PONV, breakthrough CINV prolonged QTc interval, anticholinergic effects, EPS, neuroleptic malignant syndrome BBW: Do not use in <2 years (risk of respiratory depression); severe tissue injury w/injectable formulation: do not give intra-arterial or SQ, IV route can cause tissue necrosis if extravasation occurs, deep IM preferred if oral unavailable Deep IM preferred if oral unavailable; avoid IV where possible
Droperidol Inapsine Dopamine antagonist (Butyrophenone) Rescue antiemetic for PONV prolonged QTc interval, anticholinergic effects, EPS, neuroleptic malignant syndrome BBW: QTc prolongation—12-lead EKG prior and monitor 2–3 h post-dose
Haloperidol Haldol Dopamine antagonist (Butyrophenone) Breakthrough CINV; palliative care prolonged QTc interval, anticholinergic effects, EPS, neuroleptic malignant syndrome Boxed: ↑ mortality in dementia-related psychosis (antipsychotics)
Olanzapine Zyprexa Dopamine antagonist; antipsychotic CINV in combination with aprepitant/fosaprepitant & 5-HT3-RA, adjunct PONV sedation, orthostatic hypotension, ↑QTc, neuroleptic malignant syndrome (rare) Boxed: ↑ mortality in dementia-related psychosis
Aprepitant Emend NK1 receptor antagonist CINV, PONV (off-label) constipation, headache, QTc prolongation, serotonin syndrome ↓ dexamethasone dose by ~50%; ↓ hormonal contraceptive exposure during & 28 days after (back-up birth control); redosing on subsequent days for high emetic risk chemotherapy
Fosaprepitant Emend (IV) NK1 receptor antagonist CINV, PONV (off-label) constipation, headache, QTc prolongation, serotonin syndrome ↓ dexamethasone dose by ~50%; ↓ hormonal contraceptive exposure during & 28 days after (back-up birth control); redosing on subsequent days for high emetic risk chemotherapy
Netupitant/palonosetron Akynzeo NK1 antagonist + 5-HT3 antagonist CINV, PONV (off-label) constipation, headache, QTc prolongation, serotonin syndrome Oral combo; IV prodrug available as fosnetupitant/palonosetron
Dronabinol Marinol Cannabinoid (CB1/CB2 agonist) Rx (C-II solution / C-III capsule) Breakthrough CINV; appetite stimulation Cannabinoid-induced hyperemesis syndrome (CHS), somnolence, euphoria, increased appetite Solution contains 50% alcohol; refrigerate; solution higher bioavailability than capsules
Nabilone Cesamet Cannabinoid (CB1 agonist) Rx (C-II) Breakthrough CINV; appetite stimulation Cannabinoid-induced hyperemesis syndrome (CHS), somnolence, euphoria, increased appetite Use caution with psychiatric history/substance abuse
Scopolamine Transderm Scop Antimuscarinic Rx (patch) Motion sickness; adjunct for NV/PONV Anticholinergic AEs (dry mouth, blurred vision, confusion) Apply 4 h before travel; replace q72h; remove before MRI; behind ear application
Dimenhydrinate Dramamine Antihistamine (H1) with antimuscarinic activity OTC Motion sickness; NV Drowsiness, anticholinergic AEs; constipation caution in angle-closure glaucoma, BPH; avoid in elderly, asthma Take 30–60 min before travel, continue during travel
Diphenhydramine Benadryl Antihistamine (H1) OTC (Rx IV) Motion sickness; NV prolong QTc; sedation; anticholinergic AEs QTc prolonging drugs; caution in angle-closure glaucoma, BPH; avoid in elderly, asthma Avoid operating machinery; caution in elderly/asthma
Meclizine Antivert, Bonine, Dramamine All Day Less Drowsy Antihistamine (H1) OTC Motion sickness; NV Drowsiness (less), anticholinergic AEs caution in angle-closure glaucoma, BPH; avoid in elderly, asthma Take 1 h before travel then q12–24 h PRN
Hydroxyzine Vistaril, Atarax Antihistamine (H1) Rx NV (limited), anxiety adjunct prolong QTc; sedation; anticholinergic AEs QTc prolonging drugs; caution in angle-closure glaucoma, BPH; avoid in elderly, asthma Avoid in elderly and when operating machinery
Doxylamine — Antihistamine (H1) OTC NV of pregnancy (with or without pyridoxine) Sedation; anticholinergic AEs caution in angle-closure glaucoma, BPH; avoid in elderly, asthma Common combo with pyridoxine
Pyridoxine (Vitamin B6) — Vitamin OTC First-line for nausea of pregnancy High-dose neuropathy (long-term) Typical 12.5–25 mg PO TID–QID; combine with doxylamine if needed
Ginger — Herbal product OTC Pregnancy NV, motion sickness, PONV Mild GI upset; belching; potential bleeding risk Doses 250 mg–2 g/day divided; ~1 g/day may be more effective
Clarithromycin Antibiotic (macrolide)
Metronidazole Antibiotic
Created by: CaristW
 

 



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