Acid reduction in peptic ulcer disease. Choosing therapy according to drug interactions, individual response, and cost.

Reduction of gastric acid secretion is important in healing ulcers and maintaining remission. As pharmacologic agents have improved, first-line therapy has moved from antacids and anticholinergics to histamine2 (H2) receptor antagonists and the proton pump inhibitor omeprazole (Prilosec). If H2 blocker therapy is used, choosing one of the newer agents may be prudent to avoid potential drug interaction. Omeprazole is an effective acid reducer, particularly at the high dose (40 mg/day). However, cost and uncertainty regarding long-term safety prevent some physicians from abandoning the effective H2 blockers in favor of omeprazole. Cimetidine is now available in generic form, which will probably influence the choice of acid-reduction therapy.