The 1988 Nobel Prize in
Physiology or Medicine was shared between James Black, Gertrude Elion, and
George Hitchings "for their discoveries of important principles for drug
treatment.” In 1964, histamine was known
to stimulate the secretion of stomach acid, but traditional antihistamines had
no effect on acid production. Tagamet was one of the first drugs discovered
using a rational drug design approach.
Hundreds of modified compounds were
synthesized in an effort to find a specific antihistamine to decrease
production of stomach acid. Tagamet was approved
by the FDA for prescriptions in 1976. By 1979, Tagamet was being sold in more
than 100 countries and became the top-selling prescription product in the U.S.
Tagamet became the first drug ever to reach more than $1 billion a year in
sales, thus making it the first blockbuster drug. Before the introduction of the drug,
treatment of peptic ulcers relied on extensive bed rest, imposition of a bland
diet, treatment with antacids, and often involved surgery if the ulcer
recurred. Tagamet's mode of action is to block the Histamine H2 receptor.
There are 3 types of heartburn medication:
- antacids such as Maalox, Mylanta, and Tums
- Histamine H2 receptor antagonists such as Pepcid and Tagamet
- proton pump inhibitors (PPIs) such as Prilosec and Prevacid
Prilosec was the first proton-pump inhibitor (PPI) on the market, in 1988. It was sold as a racemic mixture of R and S isomers. Prevacid was the second of the PPI drugs to reach the market, being launched in Europe in 1991 and the US in 1995. In 2001 Nexium was launched in USA, containing the S-isomer only of the same molecule as Prilosec, providing higher bioavailability and improved efficacy.
Aside from medication, there are dietary changes that can address acid reflux. Limit fried foods and fatty foods, such as butter, mayonnaise, cream sauces, gravies. Try
lower fat or skim milk, as this may also help reduce heartburn.
Limit foods that cause gas, like rich spicy foods.
Sit upright for at least one hour after a meal.
Lars Olbe, Enar Carlsson & Per Lindberg. Nature Reviews Drug Discovery 2, 132-139 (February 2003) http://www.nature.com/nrd/journal/v2/n2/fig_tab/nrd1010_F2.html
