H2 Blockers (H2-Receptor Antagonists) | Reducing Stomach Acid | Patient https://patient.

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H2 Blockers
Authored by Dr Colin Tidy, Reviewed by Dr John Cox | Last edited 16 Mar 2018 | Certified by The Information Standard

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 have various different brand names.

How do H2 blockers work?

Your stomach normally produces acid to help with the digestion of food and to kill germs (bacteria). This acid
is corrosive so your body produces a natural mucous barrier which protects the lining of the stomach from
being worn away (eroded).

Upper gastrointestinal tract and acid

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 gullet (oesophagus).
This is called 'acid reflux', which can cause heartburn and/or inflammation of the gullet (oesophagitis).

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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 in part of the gut (the 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 inflammation of the gullet (oesophagitis). These
conditions are sometimes called gastro-oesophageal reflux disease (GORD).

To treat ulcers in the stomach and in part of the gut (the duodenum).

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 germ (bacterium)
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. However, if you
don't get on with a proton pump inhibitor (for example, because of side-effects), your doctor may prescribe
an H2 blocker.

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 medication to have an underlying effect.

Side-effects of H2-Blockers
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

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with your medication.

Can I buy H2 blockers or do I need a prescription?

You can buy some of these medicines over the counter at pharmacies. They are commonly marketed as
medicines 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 with 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 breastfeeding mums. A
full list of people who should not take H2 blockers is included with the information leaflet that comes in the
medicine 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 medicines work. In particular, tell your doctor if
you are taking the blood-thinning medicine warfarin or a medicine for epilepsy, called phenytoin
(Epanutin®). You should also tell your doctor if you take theophylline, a medicine 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:

Bringing up (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.

Unintentional weight loss.

Difficulty swallowing, including food getting stuck in the gullet (oesophagus).

Persistent tummy (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.

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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 www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new
side-effects that medicines or any other healthcare products 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.

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.

F U RT H E R RE A D I NG A ND RE F E RE NC E S

Dyspepsia and gastro‑oesophageal reflux disease: Investigation and management of dyspepsia - symptoms
suggestive of gastro‑oesophageal reflux disease - or both; NICE Clinical Guideline (Sept 2014)

Ansari S, Ford AC; Initial management of dyspepsia in primary care: an evidence-based approach. Br J Gen
Pract. 2013 Sep63(614):498-9. doi: 10.3399/bjgp13X671821.

Dyspepsia - proven functional; NICE CKS, September 2017 (UK access only)

Dyspepsia - proven GORD; NICE CKS, April 2017 (UK access only)

Dyspepsia - proven peptic ulcer; NICE CKS, September 2017 (UK access only)

Dyspepsia - pregnancy-associated; NICE CKS, April 2017 (UK access only)

A R TI C L E I N F O R MAT I O N

Last Reviewed 16 March 2018

Next Review 15 March 2021

Document ID 9041 (v5)

Author Dr Colin Tidy The information on this page is

written and peer reviewed by
Peer reviewer Dr John Cox qualified clinicians.

Disclaimer: This article is for information only and should not be used

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for the diagnosis or treatment of medical conditions. Patient

Platform Limited has used all reasonable care in compiling the
information but make no warranty as to its accuracy. Consult a
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