H2 Blockers

H2 blockers reduce the amount of acid made by your stomach. They are used in conditions where it
is helpful to reduce stomach acid. For example, for acid reflux which causes heartburn. Most people
who take H2 blockers do not develop any side-effects.
What are H2 blockers?
H2 blockers are a group of medicines that reduce the amount of acid produced by the cells in the lining of the
stomach. They are also called 'histamine H2-receptor antagonists' but are commonly called H2 blockers. They
include: cimetidine, famotidine, nizatidine and ranitidine, and come in various different brand names.
How do H2 blockers work?
Your stomach normally produces acid to help with the digestion of food and to kill bacteria. This acid is corrosive
so your body produces a natural mucus barrier which protects the lining of the stomach from being eroded.
In some people this barrier may have broken down allowing the
acid to damage the stomach, causing an ulcer. In others there
may be a problem with the muscular band at the top of the
stomach (the sphincter) that keeps the stomach tightly closed.
This may allow the acid to escape and irritate the oesophagus
(gullet). This is called 'acid reflux' which can cause heartburn
and/or oesophagitis (inflammation of the gullet).
The letter H in their name stands for histamine. Histamine is a
chemical naturally produced by certain cells in the body,
including cells in the lining of the stomach, called the
enterochromaffin-like cells (ECL cells). Histamine released
from ECL cells then stimulates the acid-making cells (parietal
cells) in the lining of the stomach to release acid. What H2
blockers do is stop the acid making cells in the stomach lining
from responding to histamine. This reduces the amount of acid
produced by your stomach.
By decreasing the amount of acid, H2 blockers can help to
reduce acid reflux-related symptoms such as heartburn. This
can also help to heal ulcers found in the stomach or
duodenum.
Note: H2 blockers are a different class of drugs to 'antihistamine drugs' which block H1 receptors in cells that are
involved in allergy reactions.
What conditions are they used to treat?
H2 blockers are commonly used:
To reduce acid reflux which may cause heartburn or oesophagitis (inflammation of the gullet). These
conditions are sometimes called gastro-oesophageal reflux disease (GORD).
To treat ulcers in the stomach and duodenum (part of the gut).
Page 1 of 3
To help heal ulcers associated with anti-inflammatory medication called non-steroidal anti-
inflammatory drugs (NSAIDs).
In other conditions where it is helpful to reduce acid in the stomach.
At one time they were used as one part of a treatment to get rid of Helicobacter pylori , a bacterium (germ) found
in the stomach, which can cause ulcers. However, proton pump inhibitors are now preferred for this use.
How well or quickly do H2 blockers work?
No one H2 blocker is thought to work any better than another. However, the newer group of medicines mentioned
above - proton pump inhibitors - also reduce the amount of acid produced by the stomach. They include
omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. In general, proton pump inhibitors are
used first because they are better than H2 blockers at reducing stomach acid.
Generally, H2 blockers are well absorbed by the body and can provide quick relief of symptoms from some
problems. For example, heartburn caused by reflux. However, if you are taking them for other reasons, such as to
heal an ulcer, it may take longer for the drugs to have an underlying effect.
What are the possible side-effects?
Most people who take H2 blockers do not have any side-effects. However, side-effects occur in a small number
of users. The most common side-effects are: diarrhoea, headache, dizziness, rash and tiredness. For a full list
of side-effects and possible interactions associated with your medicine, consult the leaflet that comes with your
medication.
Can I buy H2 blockers or do I need a prescription?
You can buy some of these drugs over the counter at pharmacies. They are commonly marketed as drugs for
'relief of heartburn, indigestion, acid indigestion and excess stomach acid' - or similar. However, if you need to
use an H2 blocker regularly for more than two weeks, you should consult your doctor.
How long is treatment needed?
This can vary depending on the reason for treating you, so speak to your doctor for advice. In some cases your
doctor may prescribe an H2 blocker to use 'as required'. This means you only take it when you need it to relieve
your symptoms, rather than every day. In some situations you may be prescribed an H2 blocker to be taken every
day.
Who cannot take H2 blockers?
H2 blockers may not be suitable for people with kidney problems or for pregnant or breast-feeding mums. A full
list of people who should not take H2 blockers is included with the information leaflet that comes in the drug
packet. If you are prescribed or buy an H2 blocker, read this to be sure you are safe to take it.
Note: taking some H2 blockers can affect how well other drugs work. In particular, tell your doctor if you are
taking the blood-thinning drug warfarin or a drug for epilepsy called phenytoin (Epanutin). You should also tell
your doctor if you take theophylline, a drug commonly used to treat asthma or chronic obstructive pulmonary
disease (COPD).
Other considerations
You should consult your doctor if your symptoms worsen, or if you experience any of the following problems
which can indicate a serious gut disorder:
Vomiting blood. This may be obviously fresh blood, but altered blood in vomit can look like ground
coffee. Doctors call this 'coffee-ground vomit'.
Blood in your stools (faeces). This may be obvious blood, or it may just make your stools black.
Page 2 of 3
Unintentional weight loss.
Difficulty swallowing, including food getting stuck in the gullet.
Persistent abdominal pain or persistent vomiting.
If you are taking antacids you should not take them at the same time as you take your other medication, including
H2 blockers. This is because antacids can affect how well other medication is absorbed.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme.
You can do this online at the following web address: www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that
your medicines may have caused. If you wish to report a side-effect, you will need to provide basic information
about:
The side-effect.
The name of the medicine which you think caused it.
Information about the person who had the side-effect.
Your contact details as the reporter of the side-effect.
It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.
Further reading & references
Dyspepsia - proven gastro-oesophageal reflux disease, Prodigy (June 2008)
British National Formulary
The management of dyspepsia in primary care, MeReC Briefing, No 32, 2006
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical
conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its
accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
For details see our conditions.
Original Author:
Dr Tim Kenny
Current Version:
Mrs Jenny Whitehall
Peer Reviewer:
Dr Tim Kenny
Last Checked:
24/01/2012
Document ID:
9041 (v3)
EMIS
View this article online at www.patient.co.uk/health/h2-blockers.
Discuss H2 Blockers and find more trusted resources at www.patient.co.uk.
EMIS is a trading name of Egton Medical Information Systems Limited.
Page 3 of 3