Dyspepsia Drug Summary

Last updated: 16 March 2026
Reviewed by

Antacids*

Drug Available Strength Dosage Remarks
Alexitol sodium
(Na polyhydroxy-aluminum
monocarbonate hexitol complex) 		360 mg/tab 1-2 tab PO 30 minutes-1 hour
after each meal and at bedtime
Max dose: 4 tab/day x 2 weeks		 Adverse Reactions
  • Rarely: nausea/vomiting, constipation
Special Instructions
  • Use with caution in patients with renal insufficiency
Aluminum hydroxide [Al(OH)3] oral suspension 640 mg PO 5-6x/day Adverse Reactions
  • Constipation; phosphate depletion may occur with prolonged use or in large doses
Special Instructions
  • Contraindicated in patients with hypophosphatemia
  • Use with caution in patients with chronic renal failure; may cause phosphate depletion
  • To reduce constipating effects, Aluminum hydroxide is often given with magnesium-containing antacid (eg Magnesium hydroxide, Magnesium oxide)
tab 600-1,200 mg PO 6-8 hourly
Calcium carbonate
(CaCO3) 		500 mg/tab 1-4 tab PO as required
Max dose: 15 tab/day 		Adverse Reactions
  • GI effects (constipation, flatulence); Metabolic effects (hypercalcemia, metabolic alkalosis)
Special Instructions
  • Contraindicated in patients with hypercalcemia, presence of or history of renal calculi, hypophosphatemia, patients with suspected Digoxin toxicity
  • Use with caution in patients with renal impairment, hypercalcemia-associated diseases, hypoparathyroid disease
1 g/tab 0.5-3 g PO as needed
Magnesium
hydroxide
[Mg(OH)2] 		400 mg/5 mL suspension 5-15 mL PO up to 4x/day Adverse Reactions
  • GI effects (diarrhea, abdominal cramps, nausea/vomiting); Other effects (hypermagnesemia in patients with renal impairment, muscle weakness, respiratory depression, hypotension)
Special Instructions
  • Contraindicated in patients with intestinal obstruction, fecal impaction, renal failure
  • Use with caution in patients with colostomy, ileostomy, electrolyte imbalance
  • Monitor for toxicity in patients with impaired renal function
1,325 mg/5 mL paste
concentrated suspension		 5-10 mL diluted in small amount of water PO as necessary
2,400 mg/10 mL suspension 5-20 mL PO 24 hourly
Magnesium oxide (MgO) 140 mg/cap 1 cap PO 6-8 hourly Adverse Reactions
  • GI effects (cramping, diarrhea, vomiting, upset stomach, paralytic ileus); Other effects (rashes, hives, itching, hypermagnesemia)
Special Instructions
  • Contraindicated in patients with renal failure
  • Use with caution in patients with renal impairment, bowel obstruction
400 mg/tab 1 tab PO 24 hourly
Sodium bicarbonate (NaHCO3) 1-5 g PO 4-6 hourly as necessary or
0.65-2.6 g PO 4 hourly 		Adverse Reactions
  • GI effects (cramps, belching, flatulence)
  • Excessive use of bicarbonate may lead to hypokalemia and metabolic alkalosis, especially in patients with impaired renal function
Special Instructions
  • Contraindicated in patients with renal failure
  • Use with caution in patients with renal impairment, bowel obstruction
325 mg/tab 1-2 tab PO 8 hourly or
3-6 tab PO 6 hourly
650 mg/tab 2-4 tab PO 8 hourly
Alginic Acid  
Sodium alginate/Potassium bicarbonate Sodium alginate
1,000 mg/Potassium bicarbonate
200 mg per 10 mL oral suspension		 5-10 mL PO after meals and at bedtime Adverse Reactions
  • Very rarely allergic reactions (skin rash, itching, dizziness, difficulty breathing, swelling of face, lips, tongue or throat)
Special Instructions
  • Use with caution in patients with hypercalcemia, nephrocalcinosis, recurrent Ca-containing renal calculi, reduced renal function; patients on Na-restricted and K-controlled diet
Bismuth Preparation
Bismuth salicylate (Bismuth subsalicylate) 262 mg/15 mL suspension 524 mg PO every ½-1 hour
Max dose: 8 doses/day 		Adverse Reactions
  • Darkening of stool and tongue, hypersensitivity reactions
Special Instructions
  • Avoid in patients with salicylate or Aspirin sensitivity, history of severe GI bleeding and coagulopathy
  • Use with caution in patients with renal impairment
524 mg/tab
1048 mg/tab 1 tab PO 12 hourly
May repeat every 1 hour to
Max dose: 4 doses/day
*Various combinations of antacids are available. Al and Mg are usually combined to decrease constipation/diarrhea. Please see the latest MIMS for specific formulations and prescribing information.

Antispasmodics

Drug Dosage Remarks
Chlordiazepoxide/Clidinium Br Chlordiazepoxide 5 mg/Clidinium Br 2.5 mg per tab 3-4 tab PO 24 hourly Adverse Reactions
  • GI effects (dry mouth, constipation, nausea); CNS effects (drowsiness, amnesia, aggressive or hyperactive behavior); Other effects (hypotension, urinary retention)
Special Instructions
  • Use with caution in patients with epilepsy; CV, hepatic, or renal disease; respiratory depression; osteomalacia
  • Contraindicated in patients with glaucoma, prostatic hypertrophy, paralytic ileus
Fenoverine 100 mg PO 8 hourly or
200 mg PO 12 hourly for not >6 weeks		 Adverse Reactions
  • Gastric upset, myalgias, reversible rhabdomyolysis
Special Instructions
  • Contraindicated in patients with current or history of chronic liver disease, history of hyperthermia, mitochondrial myopathy, renal insufficiency
  • Use with caution in patients >60 years old or on multiple drug therapy

Charcoal Preparation

Drug Dosage Remarks
Activated charcoal1 750 mg PO 6-8 hourly
or 
600-1,200 mg PO 8 hourly 		Adverse Reactions
  • GI effects (diarrhea, black coloration of stool); Metabolic effects (hypernatremia, hypokalemia)
Special Instructions
  • Should be avoided in patients with intestinal obstruction
  • Use with caution in patients with vomiting
1Various combinations of Activated charcoal are available. Please see the latest MIMS for specific formulations and prescribing information.

Cholagogues, Cholelitholytics & Hepatic Protectors

Drug Dosage Remarks
Ursodeoxycholic acid1 50 mg PO 8 hourly Adverse Reactions
  • Pulpy stools, diarrhea, pasty stools
Special Instructions
  • Avoid in patients with acute cholecystitis, obstructive hepatobiliary disease, inflammatory bile duct disease, parenchymal liver disease, starvation diet; pregnant and fertile women who do not use contraception
  • Monitor LFTs every 4 weeks for the first 3 months then every 3 months thereafter
1Various combinations of Ursodeoxycholic acid are available. Please see the latest MIMS for specific formulations and prescribing information.

Digestives

Drug Dosage Remarks
Biodiastase/Lipase/Newlase 2-3 tab PO 8 hourly Adverse Reactions
  • GI effects (nausea, abdominal cramps, diarrhea)
Special Instructions
  • Should be taken with food
  • Use with caution in pregnancy
Pancreatin/Enzyme concentrate from Aspergillus oryzae 1-2 tab PO with meals Adverse Reactions
  • GI effects (nausea/vomiting, abdominal discomfort); hypersensitivity reaction; hyperuricemia or hyperuricosuria has occurred with high doses
Special Instructions
  • Maintain hydration when receiving high-strength preparation

GIT Regulators, Antiflatulents & Anti-inflammatories

Drug Dosage Remarks
Acotiamide 100 mg PO 8 hourly Adverse Reactions
  • GI effects (diarrhea, constipation); Metabolic effects (increased ALT, AST, gamma-GTP, blood prolactin and triglyceride)
Special Instructions
  • No effect against pain and burning sensation in epigastric region associated with functional dyspepsia
  • Consider upper GI tract endoscopy along with other tests if symptoms persist
Clebropride 0.5 mg PO 8 hourly Adverse Reactions
  • On large doses: Drowsiness, dizziness, breast tension
Special Instructions
  • Avoid in patients in whom stimulation of gastric motility may be harmful (eg hemorrhage, obstruction, perforation), patients with proven tardive dyskinesia to neuroleptics
  • Use with caution in first trimester of pregnancy, lactation
Domperidone 10-20 mg PO 6-8 hourly 15-30 minutes
before meals and at bedtime for up to
12 weeks
Max initial course of treatment:
2-4 weeks		 Adverse Reactions
  • GI effects (abdominal cramps, dry mouth, abnormal liver function tests); Endocrine effects (elevated prolactin levels, galactorrhea, gynecomastia); Dermatologic effects (rash, urticaria); CNS effects (extrapyramidal reactions, drowsiness, headache)
  • Associated with increased risk of ventricular arrhythmia or sudden cardiac death, particularly with doses >30 mg/day or when used in patients >60 years old
Special Instructions
  • Use the lowest effective dose for the shortest duration necessary
  • Avoid in patients with prolactinoma, GI perforation, hemorrhage or obstruction, moderate or severe hepatic impairment, significant electrolyte disturbances, known existing prolongation of cardiac conduction intervals (particularly QTc), underlying cardiac disease, concomitant use of QT-prolonging drugs or CYP3A4 inhibitors
  • Use with caution in patients with renal or mild hepatic impairment
Itopride 50 mg PO 8 hourly before meals up to
8 weeks		 Adverse Reactions
  • CNS effects (dizziness, headache, tremor); Endocrine effects (increase in prolactin level, gynecomastia); GI effects (diarrhea, constipation, abdominal pain, nausea); Hepatic effect (jaundice); Hematologic effects (leukopenia, thrombocytopenia); Other effects (rash, redness, itching, anaphylactoid reaction)
  • Acetylcholine action is enhanced and may produce cholinergic side effects
Special Instructions
  • Contraindicated in pregnancy and in patients with known hypersensitivity to Itopride and in whom increase in GI motility could be harmful
  • Use with caution in the elderly and in patients with renal or hepatic impairment
Metoclopramide 5-10 mg PO 8 hourly
or
10 mg IM/slow IV
8 hourly
Max dose:
30 mg/day 		Adverse Reactions
  • CNS effects (restlessness, drowsiness, headache, extrapyramidal reactions and dystonic reactions have been reported [eg tardive dyskinesia and parkinsonian symptoms]); Endocrine effects (increased prolactin resulting in galactorrhea or gynecomastia); GI effect (diarrhea)
Special Instructions
  • Avoid in patients in whom stimulation of muscular contractions may adversely affect GI conditions (eg GI hemorrhage, obstruction, perforation)
  • Should be avoided in patients with pheochromocytoma, epilepsy, Parkinson’s disease, history of depression and in patients taking drugs that can also cause extrapyramidal symptoms
  • Use with caution in patients with renal or hepatic impairment
Mosapride 5 mg PO 8 hourly
or
15 mg PO 24 hourly 		Adverse Reactions
  • GI effects (diarrhea, dry mouth, increased LFTs, hepatic dysfunction, abdominal pain, nausea/vomiting); CNS effects (headache, dizziness); Hematologic effects (eosinophilia, leukopenia); Other effects (malaise, palpitations, increased triglycerides)
Special Instructions
  • May take before or after meals
  • Should not be taken for >2 weeks if no clinically therapeutic outcome is observed
  • Should be avoided in patients with GI hemorrhage, mechanical obstruction or perforation
Simeticone
(Simethicone)1		 40-160 mg PO after meals and at bedtime
or
60-120 mg PO 24 hourly
or
200 mg PO 12-24 hourly 		Adverse Reactions
  • Diarrhea, constipation
Special Instructions
  • Impaired renal function, low phosphate diet
1Various combinations of Simeticone are available. Please see the latest MIMS for specific formulations and prescribing information.

Histamine2-Rececptor Antagonists (H2RAs)

Drug Dosage Remarks
Cimetidine 200 mg PO 6-12 hourly x 4 weeks Adverse Reactions
  • CNS effects (headache, dizziness, somnolence, insomnia, agitation); GI effects (diarrhea, nausea/vomiting); Other effects (rashes, myalgia, arthralgia)
  • Altered LFTs, reversible confusion in the elderly and those with renal failure have occasionally occurred
  • Rarely reported effects: Hepatotoxicity, hypersensitivity reactions, acute pancreatitis; CV effects (tachycardia, bradycardia, hypotension); Hematologic effects (leukopenia, thrombocytopenia, agranulocytosis)
  • Cimetidine has weak anti-androgenic effects; impotence and gynecomastia have occurred and are usually reversible
Special Instructions
  • IV injections should be given slowly; IV infusion is preferred (especially for high doses and in patients with CV impairment)
  • Use with caution in patients with hepatic and renal impairment; dose adjustment recommended
  • Rule out presence of gastric malignancy prior to start of therapy
  • Cimetidine may reduce hepatic metabolism of some drugs through inhibition of cytochrome P450 isoenzymes; closely monitor those on oral anticoagulants, Lidocaine, Phenytoin or Theophylline; dose reduction may be necessary
Famotidine 10-20 mg PO 12 hourly
or
20 mg IV 12 hourly
Nizatidine 75 mg PO 12-24 hourly x 2 weeks
Max dose: 150 mg/day
Ranitidine 150 mg PO 12 hourly for up to 6 weeks
or
300 mg PO at bedtime x 6 weeks
or
50 mg slow IV/IM 6-8 hourly

Proton Pump Inhibitors (PPIs)

Drug Dosage Remarks
Esomeprazole 10-20 mg PO 24 hourly x 2-4 weeks
or
40 mg slow IV injection or infusion
over 20-30 minutes		 Adverse Reactions
  • Generally well tolerated; most commonly reported: Headache, diarrhea, rash
  • Less common: GI effects (constipation, flatulence, abdominal pain, nausea/vomiting, dry mouth); Dermatologic effects (pruritus, urticaria); Musculoskeletal effects (arthralgia, myalgia); Hematologic effects (eosinophilia, leukopenia, thrombocytopenia); Other effects (dizziness, fatigue, insomnia, cough, upper respiratory tract infection)
  • Hypersensitivity reactions, elevated liver enzymes, and isolated cases of photosensitivity and hepatotoxicity have been reported
Special Instructions
  • Use with caution in patients with hepatic impairment; dose adjustment recommended
  • Concomitant use with Atazanavir, Nelfinavir or Methotrexate is not recommended (PPIs reduce exposure to these drugs)
  • Exclude possibility of gastric malignancy prior to treatment
  • Bone fracture: Several published observational studies suggest that PPI therapy may be associated with an increased risk for osteoporosis-related fractures of the hip, wrist or spine; patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated
Lansoprazole 15-30 mg PO 24 hourly x 2-4 weeks
Omeprazole 10-20 mg PO 24 hourly x 2-4 weeks
or
40 mg slow IV injection or infusion
over 20-30 minutes
Pantoprazole 10-40 mg PO 24 hourly x 2-4 weeks
or
40 mg IV 24 hourly over 2-15 minutes
Rabeprazole 20 mg PO 24 hourly x 2 weeks
Drug Available Strength Dosage Remarks
Combination Products
Pantoprazole Na sesquihydrate/Domperidone Pantoprazole Na sesquihydrate 40 mg/Domperidone 30 mg
per cap 		1 cap PO 24 hourly Adverse Reactions
  • Pantoprazole: CNS effects (headache, dizziness); Other effects (skin rash, pruritus, diarrhea)
    • Long-term therapy may lead to bacterial overgrowth in gastrointestinal tract
  • Domperidone: CNS effects (headache, nervousness); Other effects (galactorrhea, gynecomastia, skin rashes, pruritus, thirst)
Special Instructions
  • Contraindicated in pregnant and lactating women
  • Use with caution in patients with hepatic or renal impairment
Rabeprazole/Itopride Rabeprazole 20 mg/Itopride 150 mg percap 1 cap PO 24 hourly Adverse Reactions
  • Rabeprazole: Asthenia, fever, allergic reactions, photosensitivity reactions, chills, malaise, musculoskeletal pain and aches, CV signs, digestive system complaints, thyroid abnormalities, hematopoietic changes, edema, weight change, sleep disturbances and other central nervous symptoms, decreased libido, respiratory features, sight and hearing difficulties, dysuria, genital system affections and skin lesions; there may be abnormalities in parameters tested in laboratory such as blood count, urinalysis, lipid profile, electrolytes, glucose and LFTs
  • Itopride: GI effects (diarrhea, constipation, increased salivation, abdominal pain, nausea, GI disturbances); Other effects (hypersensitivity, headache, rarely, tremor, galactorrhea, gynecomastia)
Special Instructions
  • Contraindicated in patients with hypersensitivity to any of its ingredients or to substituted benzimidazole
  • Should be used during pregnancy only if the potential benefit justifies the probable risks involved

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries. 
 Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

Related MIMS Drugs