Page 135 - Community pharmcy practice E-book 2025

02/11/2025, 00:29

• H2-receptor antagonists (H2RAs) such as famotidine, cimetidine, nizatidine for
intermittent symptoms.
• Proton pump inhibitors (PPIs) (e.g., omeprazole) for more frequent or persistent
symptoms (or when reflux/ulcer component suspected) — note OTC vs prescription strength.
• Prokinetic agents in some cases of delayed gastric emptying (under prescription,
pharmacist may refer or liaise).
•
• Important pharmacist considerations: Check for overlapping medication use and risk
factors (e.g., NSAIDs, aspirin) that may worsen condition.
• Ensure correct use: e.g., PPIs should be taken before meals for optimal effect; H2RAs per
label.
• Monitor for duration of use: if using OTC PPIs for longer than recommended or frequent
use, refer for evaluation.
• Be aware of contraindications/interactions (e.g., PPIs with certain drugs, H2RAs with
renal/hepatic impairment).
Emphasise that medication is adjunct to lifestyle modification, not substitute.
When initial therapy fails or red-flags appear → referral.

Patient Counselling Tips
• Explain clearly: “Dyspepsia means the stomach/up-upper-abdomen is uncomfortable or
irritated; you often feel full too early, bloated, or have burning/pain”.
• Ask: “When do your symptoms start? After large meals? At night? What foods/drinks make
them worse? Are you on pain-killers/NSAIDs regularly? Do you smoke or drink alcohol?” This
helps tailor advice.
• Advise how to use medications: for example, take antacid when you feel discomfort; when
taking PPI or H2RA, follow the timing instructions; do not exceed recommended duration.
• Highlight lifestyle changes: “Try smaller meals, avoid triggers (fatty foods, carbonated
drinks, caffeine, alcohol), don’t lie down straight after eating, quit smoking, lose weight if
needed.”

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