In the United States, at least once in a month, 10 million people suffer from heartburn(Staff, 2017). Heartburn can be described as painful burning in the throat or chest associated with the backs ups of the stomach acid in the esophagus. Cimetidine was the first histamine2-receptor antagonist to be marketed. The drug inhibits the metabolism of cytochrome p-450 metabolism, and this is associated with decreased clearance of warfarin. The clinical interaction of the warfarin and cimetidine has been questioned for various reason(Lim et al., 2016). For instance, the interaction has been associated with the lowering of therapeutic range of warfarin. Importantly, the interaction is also associated with the lowering of the therapeutic cimetidine daily basis. The interaction causes the advent of the cimetidine daily dosage. The drug to drug interaction causes decreases in the less active R-enantiomer clearance compared to the more active forms-enantiomer.
Rolaids are chewable tablets for the treatment of heartburn. The tablets work by neutralizing the acid in the stomach(Glancy, 2016). The drug may decrease the INR effects. The drug mostly works by neutralizing the excess acid in the stomach, and the drug bioavailability in blood is little. The drug interacts less with warfarin.
The drug mechanism of action includes the formation of the protective raft in the top of the stomach after the initial contact with the acid in the stomach. The raft is so strong and enables the content of the stomach to stay in the stomach. The drug also neutralizes the excess acid in the stomach. Gaviscon decreases the INR effects(De Ruigh, 2014). The drug bioavailability in the general circulation is small, and the amount available to interact with warfarin is small.
Most people prefer the use of over the counter drugs for the treatment of heartburn. Some of this medication may interact with warfarin medication. Patients are required to test the INR on a regular basis. Some safe heartburn medication includes Gaviscon and Rolaids.
De Ruigh, A., Roman, S., Chen, J., Pandolfino, J. E., & Kahrilas, P. J. (2014). Gaviscon Double Action Liquid (antacid & alginate) is more effective than antacid in controlling post‐prandial oesophageal acid exposure in GERD patients: a double‐blind crossover study. Alimentary pharmacology & therapeutics, 40(5), 531-537.
Glancy, D. L. (2016). ECG of the Month: Subtle ECG Change in a 31 Year-Old Man with Recent Chest Pain. The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society, 168(4), 146.
Lim, A. W., Löbmann, K., Grohganz, H., Rades, T., & Chieng, N. (2016). Investigation of physical properties and stability of indomethacin–cimetidine and naproxen–cimetidine co‐amorphous systems prepared by quench cooling, coprecipitation and ball milling. Journal of Pharmacy and Pharmacology, 68(1), 36-45.
Staff, A. (2017). PTINR.com | Treating Heartburn While On Warfarin. Retrieved from http://www.ptinr.com/en/home/warfarin-you/general-information/wellness/treating-heartburn-while-warfarin.html