 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Pharmacy / February 2004Excruciating heartburn! - Help!!
Have had excruciating heartburn for the past two days. Mylanta, Bepto bismol and tums can't touch the pain. Food and water don't help much either. Have an appoitment with my gastroenterologist tomorrow, and will probably try Gaviscon tonight so that I might be able to sleep... My history in brief: been on prevacid 15mg once every two days. This has worked well for the past two years. The past few months, I've been on several different antibiotics to treat a prostate infection all to no avail: cephalexin (4 weeks), Macrobid (10 weeks), Levaquin (4 days - had to quit it because of pain _everywhere_), and lastly, Doxycycline (10 days). The chest pain started 7 days into the Doxy and I stopped taking it 3 days later. It's my prime suspect. Is it a good theory? I should say the the pain started oddly: it would first hurt a little when I bent my head to my chest. Does that somehow tug on the esophagous, which if inflamed might cause the pain? The pain progressed to intense pain under my left ribcage that radiated to the left back - sleeping on my left side was awful, and getting up from a supine position after being there a while was intensely painful too. Now it seems the pain is almost exclusively centered on the sternum, with painful swallowing and a need to cough. I went to the ER two days ago: blood tests, cardiogram and a chest xray ruled out heart attack, thought the doc said that hiatal hurnia might still be present. Advised I try antacids. My next step would seem to be an endoscopy. Any ideas on what the heck could be wrong with me? > Have had excruciating heartburn for the past two days. Mylanta, Bepto > bismol and tums can't touch the pain. Food and water don't help much [quoted text clipped - 9 lines] > and I stopped taking it 3 days later. It's my prime suspect. Is it a > good theory? Yes. It could be the doxycycline. Doxycycline has been reported to cause esophageal ulceration. That is why it should be taken with a full glass of water, and lying down should be avoided for a good hour or more afterward. You didn't happen to take it right before going to bed, either dry or with just a sip of water, I hope. <snip> > Any ideas on what the heck could be wrong with me? You should have your doc check you out, especially if you vomit any blood or have dark, tarry stools. Odds are that if it is the doxycycline, you have some ulceration and a week or so worth of antacids, acid reducers, and/or sucralfate should have you good as new. there are multiple things which could cause these symptoms, best thing to do is to go see you Gastroenterologist. > > Have had excruciating heartburn for the past two days. Mylanta, Bepto > > bismol and tums can't touch the pain. Food and water don't help much [quoted text clipped - 18 lines] > You didn't happen to take it right before going to bed, either dry or with > just a sip of water, I hope. Nope. I always took it with a meal. I was worried about that lessening the antibiotic effect but not about ulcers. Perhaps I was wrong? > <snip> > > Any ideas on what the heck could be wrong with me? > > You should have your doc check you out, especially if you vomit any blood > or have dark, tarry stools. I'm seeing him this afternoon. No vomiting yet - though the pain sure makes me imagine I'm bleeding out internally. My stool was dark, but I'm hoping that was due to the Pepto Bismol or Mylanta. > Odds are that if it is the doxycycline, you have some ulceration and a > week or so worth of antacids, acid reducers, and/or sucralfate should have > you good as new. I dearly hope you are right. But as I said, I've been taking a low dose of Prevacid for the past two years, so my stomach acid levels should already be low, no? Unless the Prevacid has since become ineffective, and I need to up the dose or perhaps try Prilosec or Nexium instead. John. > I'm seeing him this afternoon. Good to hear. > No vomiting yet - though the pain sure > makes me imagine I'm bleeding out internally. My stool was dark, but > I'm hoping that was due to the Pepto Bismol or Mylanta. Pepto Bismol can definitely cause dark stools. A significant amount of digested blood would give them a tarry consistency in addition to the dark color. > I dearly hope you are right. But as I said, I've been taking a low dose > of Prevacid for the past two years, so my stomach acid levels should > already be low, no? Unless the Prevacid has since become ineffective, > and I need to up the dose or perhaps try Prilosec or Nexium instead. Unless you have some liver impairment, the dose of Prevacid that you have been taking would generally be considered too low to be effective for treatment of ulcers, if that is what has occurred. > > I'm seeing him this afternoon. > [quoted text clipped - 16 lines] > been taking would generally be considered too low to be effective for > treatment of ulcers, if that is what has occurred. My gastroenterologist upped the prevacid to 30mg 1x/day and added sucralfate 4x/day dissolved in water first. He thought that would cure it or significantly improve it in a week. However, I had another night of virtually no sleep last night, because of excruciating "fileball"-like heartburn pain. Unless the pain is severely lessened soon, I'm not going to last much longer without another trip to the ER. I read that ERs sometimes use a "GI cocktail" that has lidocaine in it for pain relief. Is there an OTC version of that perchance? Are there any other OTC pain killers that might work? (Tylenol 1200mg doesn't touch tha pain at all for me!) > My gastroenterologist upped the prevacid to 30mg 1x/day and added > sucralfate 4x/day dissolved in water first. He thought that would cure [quoted text clipped - 6 lines] > any other OTC pain killers that might work? (Tylenol 1200mg doesn't > touch tha pain at all for me!) Just curious, did they do an endoscopy? If the pain is that severe, call your doctor. He may want to see you again, or may call in a prescription for a pain reliever that would help. That being said, it takes a while for the Prevacid to reach full effect. I would see how it goes tonight. Elevate the head of the bed (don't just use extra pillows under your head) about 6 inches. Avoid alcohol, caffeine, and heavy meals near bedtime. No, there is no OTC "GI Coctail" with lidocaine, and the sucralfate probably works as good if not better than the concoctions that don't use lidocaine. Something like Sucrets or Chloraseptic lozenges _may_ be of some benefit, but its doubtful that they would have significant effect on the lower esophagus. You could also use a few rolaids or tums at bedtime in addition to the prevacid unless your doctor advised against it for some reason. Do not use any other OTC pain relievers (e.g., ibuprofen, aspirin, naproxen, etc.) except for Tylenol. The others could potentially worsen the situation or delay healing. > > My gastroenterologist upped the prevacid to 30mg 1x/day and added > > sucralfate 4x/day dissolved in water first. He thought that would cure [quoted text clipped - 8 lines] > > Just curious, did they do an endoscopy? No. I suppose that would be the next step. First drugs, then invasive diagnostic tests only if the drugs fail seems to be my doctors modus operandi. I guess I can't blame him though: he apparently has more faith in the predictive power of symptoms than I do, who would much prefer an eyes-on look at my esophagus and stomach. > If the pain is that severe, call your doctor. He may want to see you > again, or may call in a prescription for a pain reliever that would help. I did call him again. He wouldn't even speak to me except through his secretary who related that I had to "give it time for the medicine to work". I specifically asked to be prescribed a pain killer, but there was no convincing him. Being compassionate is not this guy's strong suit :-) > That being said, it takes a while for the Prevacid to reach full effect. I > would see how it goes tonight. [quoted text clipped - 13 lines] > naproxen, etc.) except for Tylenol. The others could potentially worsen > the situation or delay healing. Well, I do feel much better today after all. Ended up just taking Tylenol again plus a sleep aid to be sure (though probably not needed as I was pretty exhausted). Got a good 8 hours sleep and the burning pain is much reduced. I suppose the medicine is finally kicking in. Thank god. And thank you for your help. John. > My gastroenterologist upped the prevacid to 30mg 1x/day and added > sucralfate 4x/day dissolved in water first. He thought that would [quoted text clipped - 6 lines] > Are there any other OTC pain killers that might work? (Tylenol 1200mg > doesn't touch tha pain at all for me!) If you really want to see the best effect of the new combination that you have been prescribed, be sure to take your Prevacid a few hours before you take the sucralfate. The reason for this is because it order for Prevacid to work there must be an initial acidic environment to activate the drug. If you take both at the same time, the sucralfate will coat your stomach and help reduce the pH, thereby slowing down and decreasing the activation of Prevacid. Hope you get a good night's sleep tonight. > If you really want to see the best effect of the new combination that > you have been prescribed, be sure to take your Prevacid a few hours [quoted text clipped - 4 lines] > decreasing the activation of Prevacid. Hope you get a good night's > sleep tonight. May I ask where you obtained this information? Proton pump inhibitors, including prevacid, degrade in acidic environments. That is why they use delayed-release formulations, to survive passing through the acidic environment in the stomach. They only inhibit active proton pumps, but that shouldn't be construed to believing they need an acid environment in the stomach to activate. They are best taken ~30 minutes prior to eating in order to maximize their effect. >>If you really want to see the best effect of the new combination that >>you have been prescribed, be sure to take your Prevacid a few hours [quoted text clipped - 16 lines] > They are best taken ~30 minutes prior to eating in order to maximize their > effect. I must apologize for my post, I must have not been thinking when I posted it. Its Carafate (sucralfate) that requires an acidic environment for maximal activation and coating. Thus both should not be taken at the same time since the PPI will reduce the amount of carafate that will be activated in the stomach. Sorry again for the misinformation about prevacid. > I must apologize for my post, I must have not been thinking when I > posted it. Its Carafate (sucralfate) that requires an acidic > environment for maximal activation and coating. Thus both should not be > taken at the same time since the PPI will reduce the amount of carafate > that will be activated in the stomach. Sorry again for the > misinformation about prevacid. Forgot to add that carafate may prevent absorption of Prevacid as well. Although it may not be a drastic difference, with the amount of trouble this person is having with his stomach, maximizing absorption may help. > > I must apologize for my post, I must have not been thinking when I > > posted it. Its Carafate (sucralfate) that requires an acidic [quoted text clipped - 6 lines] > trouble this person is having with his stomach, maximizing absorption > may help. So, I'm currently taking the Prevacid an hour before the sucralfate in the afternoon. I got this idea from drugstore.com's drug interaction feature, which said this about prevacid/sucralfate interaction: --------- SUCRALFATE and PREVACID (LANSOPRAZOLE) Severity: Minor Description: Treatment with both LANSOPRAZOLE and SUCRALFATE may result in lansoprazole having a decreased effect for you. Being treated with both lansoprazole and sucralfate may result in decreased effectiveness of lansoprazole. Your physician may decide that treating you with both lansoprazole and sucralfate is the best option. It is recommended to wait at least 30 minutes after taking lansoprazole before taking sucralfate. --------- This agrees with your second comment, and apparently should be done in order that the prevacid be least affected by the sucralfate. But in order for the sucralfate to be least affected by the prevacid, the sucralfate should be taken first before the prevacid has reduced the acid much? Perhaps they should just be taken at the same time in my case... >I must apologize for my post, I must have not been thinking when I >posted it. Its Carafate (sucralfate) that requires an acidic >environment for maximal activation and coating. Thus both should not be >taken at the same time since the PPI will reduce the amount of carafate >that will be activated in the stomach. Sorry again for the >misinformation about prevacid. USENET is all about misinformation and confusion. As for the OP, listen to your doctor and stick with the course of doxycycline. While drinking plenty of fluids will reduce the risk of esophageal irritation most people report nausea or heart burn like you describe. Antacids (Mg or Al based), sucralate (an Al salt) or supplements that contain Fe or Zn should not be taken 6 hours before or 2 hours after a dose; too many free alcohol groups in the molecule. In my experience, I use antacids at will; the discomfort is usually too great. Do you have an allergy to Levofloxacin? > >I must apologize for my post, I must have not been thinking when I > >posted it. Its Carafate (sucralfate) that requires an acidic [quoted text clipped - 13 lines] > In my experience, I use antacids at will; the discomfort is usually > too great. I stopped the doxy a week ago at the doctors suggestion, and am not inclined to try it again because of the extreme reaction I apparently had with it. > Do you have an allergy to Levofloxacin? Well, I was only able to take Levaquin for 4 days before I had to stop because of excessive chest and abdominal pain, so perhaps I have an allergy to it - or worse. : > Have had excruciating heartburn for the past two days. Mylanta, Bepto : > bismol and tums can't touch the pain. Food and water don't help much [quoted text clipped - 9 lines] : > and I stopped taking it 3 days later. It's my prime suspect. Is it a : > good theory? : Yes. It could be the doxycycline. Doxycycline has been reported to cause : esophageal ulceration. It's a great irritant. They like to use it for pleuradesis for that reason. Emma |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.