Gastroesophageal Reflux Disease Drug Summary

Last updated: 23 March 2026
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Antacids*

Drug Available Strength Dosage Remarks
Alexitol sodium
(Na polyhydroxy-aluminum monocarbonate hexitol complex) 		360 mg/tab 1-2 tab PO 0.5-1 hour after each meal and at bedtime
Max dose: 4 tabs/day ≤2 weeks		 Adverse Reactions
  • Rarely nausea/vomiting, constipation
Special Instructions
  • Should be taken on an empty stomach
  • Use with caution in patients with renal insufficiency
Aluminum hydroxide
[Aluminium hydroxide, Al(OH)3] 		600 mg/tab 1-2 tab PO 6 hourly Adverse Reactions
  • Constipation; phosphate depletion may occur with prolonged use or in large doses
Special Instructions
  • May be taken with or without food
  • Contraindicated in patients with hypophosphatemia
  • Use with caution in patients with chronic renal failure; may cause phosphate depletion
Calcium carbonate (CaCO3) 500 mg/tab 1-2 tab PO as symptoms occur
Max dose: 16 tabs/day 		Adverse Reactions
  • GI effects (constipation, flatulence); Metabolic effects (hypercalcemia, metabolic alkalosis)
Special Instructions
  • May be taken with or without food
  • 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
Hydrotalcite 500 mg/tab,
100 mg/mL suspension		 1,000 mg PO 6-8 hourly Adverse Reactions
  • Occasionally diarrhea, soft stools, dry mouth
Special Instructions
  • Should be taken on an empty stomach
  • May interfere with absorption of tetracyclines
  • Use with caution in patients with renal or cardiac disorder, diarrhea, hypermagnesemia
Magnesium hydroxide
[Mg(OH)2] 		400 mg/5 mL suspension 5-15 mL PO 6 hourly Adverse Reactions
  • GI effects (diarrhea, abdominal cramps); Other effect (hypermagnesemia in patients with renal impairment)
Special Instructions
  • May be taken with or without food
  • 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
Magnesium oxide (MgO)   400 mg PO 12 hourly Adverse Reactions
  • GI effects (cramping, diarrhea, vomiting, upset stomach, paralytic ileus); Other effects (rashes, hives, itching, hypermagnesemia)
Special Instructions
  • Should be taken with food
  • Contraindicated in patients with renal failure
  • Use with caution in patients with renal impairment, bowel obstruction
Sodium bicarbonate
(NaHCO3) 		325 mg/tab 3-6 tab PO 6 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
  • Should be taken with food
  • Contraindicated in patients with renal failure
  • Use with caution in patients with renal impairment, bowel obstruction
650 mg/tab 2-4 tab PO 8 hourly
Bismuth Preparation
Bismuth salicylate (Bismuth subsalicylate) 262 mg/15 mL suspension,
262 mg/tab,
524 mg tab 		524 mg PO every 0.5-1 hour
Max dose: 8 doses/day 		Adverse Reactions
  • Darkening of stool and tongue, hypersensitivity reactions
Special Instructions
  • May be taken with or without food
  • Avoid in patients with salicylate or Aspirin sensitivity, history of severe GI bleeding and coagulopathy
  • Use with caution in patients with renal impairment
*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.

Histamine2-Receptor Antagonists (H2RAs)

Drug Dosage Remarks
Cimetidine 400-800 mg PO 12 hourly or
400 mg PO 6 hourly
Duration of treatment:
4-12 weeks, depending on severity 		Adverse Reactions
  • CNS effects (headache, dizziness, somnolence, insomnia, agitation); GI effects (diarrhea, nausea/vomiting); Other effects (rashes, myalgia, arthralgia)
  • Altered liver function tests (LFTs), reversible confusion in the elderly and those with renal failure have occasionally occurred
  • Rarely reported effects: Hepatotoxicity, hypersensitivity reactions, CV effects (tachycardia, bradycardia, hypotension), hematologic effects (leukopenia, thrombocytopenia, agranulocytosis), acute pancreatitis
  • Cimetidine has weak anti-androgenic effects; impotence and gynecomastia have occurred and are usually reversible
Special Instructions
  • May be taken with or without food; Cimetidine should be taken with food
  • Intravenous injections should be given slowly; intravenous 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
  • 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 Initial therapy: 20-40 mg PO 12 hourly x 6-12 weeks
Maintenance therapy:
20 mg PO 12 hourly or
Initial dose: 20 mg slow IV/IV infusion/IM
Repeat 20 mg slow IV/IV infusion/IM over 30 minutes 12 hourly
Max dose: 40 mg/day
Nizatidine 150 mg PO 12 hourly for up to 12 weeks
Ranitidine 150 mg PO 12 hourly or
300 mg PO at bedtime for up to 8 weeks or
50 mg IM or slow IV for 1-2 minutes 6-8 hourly or intermittent IV infusion at 25 mg/hr for 2 hours repeated 6-8 hourly
Severe cases: 150 mg PO 6 hourly x 12 weeks
Roxatidine 75 mg PO 12 hourly or
150 mg PO at bedtime x 6-8 weeks

Potassium-Competitive Acid Blockers (PCABs)

Drug Dosage Remarks
Fexuprazan HCl Erosive esophagitis:
40 mg PO 24 hourly x 4 weeks
Additional 4-week therapy may be considered in patients with untreated esophagitis or persistent symptoms 		Adverse Reactions
  • GI effects (diarrhea, nausea, indigestion, abdominal discomfort, gastritis); Other effects (headache, low back pain, skin erythema)
Special Instructions
  • Can be taken with or without food
  • Avoid in patients receiving Atazanavir, Nelfinavir or Rilpivirine-containing products; patients with congenital conditions for lactose
  • Use with caution in patients with hepatic or renal impairment; confirm malignancy of tumor prior to administration
Tegoprazan Non-erosive GERD:
50 mg PO 24 hourly x 4 weeks
Erosive GERD:
50 mg PO 24 hourly x 4 weeks
Additional 4-week therapy may be considered in patients who do not heal or have persistent symptoms 		Adverse Reactions
  • GI effects (diarrhea, nausea, dyspepsia); Respiratory effects (nasopharyngitis, viral upper respiratory tract infection); Other effect (chest discomfort)
Special Instructions
  • Can be taken with or without food
  • Avoid in patients receiving Atazanavir, Nelfinavir or Rilpivirine-containing products
  • Use with caution in patients taking Ketoconazole, Itraconazole, Ampicillin ester, Fe salts, Erlotinid, Gefitinib, Mycophenolate mofetil or Digoxin and in patients with renal or hepatic impairment
Vonoprazan Reflux esophagitis (erosive esophagitis):
20 mg PO 24 hourly up to 4-8 weeks
Recurrent and relapsing reflux esophagitis: 10 mg PO 24 hourly
May be increased to 20 mg PO 24 hourly if necessary 		Adverse Reactions
  • GI effects (constipation, diarrhea, nausea, abdominal discomfort, taste disturbances, stomatitis); Hypersensitivity reactions (rash, urticaria, drug eruption, anaphylactic shock); Hepatic effects (hepatotoxicity, jaundice); Other effects (edema, eosinophilia)
Special Instructions
  • Can be taken with or without food
  • Increased risk for GI infection caused by C difficile and osteoporosis-related fractures of hip, wrist or spine
  • Avoid in patients receiving Atazanavir sulphate or Rilpivirine HCl
  • Use with caution in patients with hepatic and renal disorders

Propulsives

Drug Dosage Remarks
Alizapride 75-300 mg/day PO in divided doses Adverse Reactions
  • CNS effects (drowsiness, dizziness, headache, extrapyramidal symptoms or EPS); Endocrine effects (amenorrhea, galactorrhea); GI effect (diarrhea)
Special Instructions
  • Contraindicated in patients with Parkinson’s disease, GI perforation, pheochromocytoma
  • Use with caution in patients with renal impairment
  • May impair ability to drive or operate machineries
Bromopride 20-60 mg/day PO in divided doses or
10-20 mg/day IV/IM 		Adverse Reactions
  • CNS effects (drowsiness, dizziness, headache, EPS, depression); Endocrine effect (galactorrhea); CV effects (hypotension, hypertension); GI effect (diarrhea)
Special Instructions
  • Contraindicated in patients with GI hemorrhage, obstruction and perforation, in pheochromocytoma
  • Use with caution in patients with renal impairment, Parkinson’s disease, history of depression
  • May impair ability to drive or operate machineries
Cisapride 5 mg PO 6-8 hourly
May be increased to 40 mg/day PO in 3-4 divided doses 		Adverse Reactions
  • GI effects (abdominal cramps, loose stools); CNS effects (headache, lightheadedness, convulsions); Other effects (hypersensitivity, frequent urination)
Special Instructions
  • Take on empty stomach
  • Contraindicated in patients with GI hemorrhage, obstruction or perforation, history of irregular heart beat, abnormal ECG, heart disease, pulmonary disease, dehydration or persistent vomiting
  • Use with caution in patients with renal or hepatic impairment
Domperidone 10-20 mg PO 6-8 hourly
Max dose: 40 mg/day 		Adverse Reactions
  • GI effects (abdominal cramps, dry mouth, abnormal LFTs); 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
  • Should be taken 15-30 minutes before meals and at bedtime
  • 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 Adverse Reactions
  • CNS effects (dizziness, headache, tremor); Endocrine effects (gynecomastia, increased prolactin levels); GI effects (diarrhea, constipation, abdominal pain, nausea, jaundice); Dermatologic effects (rash, redness, itching); Hematologic effects (leukopenia, thrombocytopenia)
Special Instructions
  • Should be taken before meals
  • Contraindicated in patients with GI perforation, hemorrhage and obstruction
  • Itopride enhances the action of acetylcholine and may produce cholinergic side effects; data on long-term use are not available
Metoclopramide 10-15 mg PO 6-8 hourly
Max dose: 60 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
  • Should be taken at least 15 minutes before meals
  • 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 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 be taken 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

Proton Pump Inhibitors (PPIs)

Drug Dosage Remarks
Dexlansoprazole Healing of erosive esophagitis: 60 mg PO 24 hourly x 8 weeks
Maintenance of healed erosive esophagitis and relief of heartburn: 30 mg PO 24 hourly x 6 months
Heartburn and acid regurgitation associated with symptomatic non-erosive GERD: 30 mg PO 24 hourly x 4 weeks		 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); Other effects (dizziness, fatigue, insomnia, cough, upper resp tract infection)
  • Hypersensitivity reactions, elevated liver enzymes, and isolated cases of photosensitivity and hepatotoxicity have been reported
Special Instructions
  • Should be taken 30-60 min prior to meals; Dexlansoprazole can be taken with or without food
  • Use with caution in patients with hepatic impairment; dose adjustment recommended
  • Concomitant use with Atazanavir or Nelfinavir 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
Esomeprazole 20-40 mg IV/IV infusion over 30 minutes 24 hourly
or
Initial therapy: 20-40 mg PO 24 hourly x 4-8 weeks
Maintenance therapy: 20 mg PO 24 hourly
Similar doses may be given IV for those unable to tolerate oral medications
Lansoprazole Initial therapy: 30 mg PO 24 hourly x 4-8 weeks
or 30 mg IV (over 30 minutes) 24 hourly x 7 days
Maintenance therapy: 15 mg PO 24 hourly
Omeprazole Initial therapy: 20 mg PO 24 hourly x 4-12 weeks
or 40 mg IV (over 20-30 minutes) 24 hourly
Refractory cases: 40 mg PO 24 hourly x 8 weeks
Maintenance therapy: 10-20 mg PO 24 hourly
Pantoprazole Initial therapy: 20-40 mg PO 24 hourly x 4-8 weeks
or 40 mg IV (over 2-15 minutes) 24 hourly x 7-10 days
Severe cases: 40 mg PO 24 hourly x 4-8 weeks
Maintenance therapy: 20-40 mg PO 24 hourly
Rabeprazole (Na rabeprazole, Sodium rabeprazole) Initial therapy: 10-20 mg PO 24 hourly x 4-8 weeks
Maintenance therapy: 10-20 mg PO 24 hourly
Drug Available Strength Dosage Remarks
Combination Products
Omeprazole/Sodium bicarbonate Omeprazole 20 mg/Sodium bicarbonate 1,680 mg Symptomatic GERD without esophageal erosions: 20 mg PO 24 hourly x 4 weeks
Erosive esophagitis:
20 mg PO 24 hourly x 4-8 weeks		 Adverse Reactions
  • GI effects (pancreatitis [sometimes fatal], abdominal swelling, anorexia); Other effects (anaphylaxis, fever, pain, fatigue, malaise, chest pain, nervousness, myalgia, epistaxis)
Special Instructions
  • Use with caution in patients with atrophic gastritis, Na-restricted diet, hypokalemia, hypocalcemia and problems with acid-base balance, hepatic impairment, Barrett's syndrome
  • Symptomatic response to therapy with Omeprazole does not preclude the presence of gastric malignancy
Pantoprazole Na sesquihydrate/Domperidone Pantoprazole Na sesquihydrate 40 mg/Domperidone 30 mg 1-2 cap PO 24 hourly Adverse Reactions
  • Pantoprazole: CNS effects (headache, dizziness); Other effects (skin rash, pruritus, diarrhea)
  • Domperidone: CNS effects (headache, nervousness); Other effects (galactorrhea, gynecomastia, skin rashes, pruritus, thirst)
Special Instructions
  • Pantoprazole: Long-term therapy may lead to bacterial overgrowth in gastrointestinal tract
  • Contraindicated in pregnant and lactating women
  • Use with caution in patients with hepatic or renal impairment
Rabeprazole/Itopride Rabeprazole 20 mg/Itopride 150 mg 1 cap PO 24 hourly x 4-8 weeks Adverse Reactions
  • Rabeprazole: CV effects (CV signs, edema); Hematologic effects (hemopoietic changes, abnormal blood count); GU effects (genital system affections, dysuria, abnormal urinalysis); Dermatologic effects (allergic reactions, photosensitivity reactions, skin lesions); CNS effects (sleep disturbances, other central nervous symptoms); Metabolic effects (abnormalities in lipid profile, electrolytes, glucose, LFTs); Other effects (asthenia, fever, chills, malaise, weight change, musculoskeletal pain and aches, digestive system complaints, respiratory features, thyroid abnormalities, sight and hearing difficulties, decreased libido)
  • Itopride: GI effects (diarrhea, constipation, increased salivation, abdominal pain, nausea, GI disturbances); Other effects (hypersensitivity, headache, rarely, tremor, galactorrhea, gynecomastia)
Special Instructions
  • Should be used during pregnancy only if the potential benefit justifies the probable risks involved
  • Contraindicated in patients with hypersensitivity to any of its ingredients or to substituted benzimidazole

Other Drugs Used in the Treatment of GERD*

Drug Dosage Remarks
Alginic acid/Al(OH)3/Mg carbonate Alginic acid 200 mg/Al(OH)3 30 mg/Mg carbonate 40 mg/tab
1-2 tab PO 12 hourly
Max dose: 3 g of Al(OH)3,
2 g of Mg carbonate in a
24-hour period × <2 weeks		 Adverse Reactions
  • GI effects (diarrhea or constipation, abdominal distention, hiccups)
Special Instructions
  • Should be taken with meals
  • Use with caution in patients with Na-restricted diet
Na alginate/
K bicarbonate 		500-1,000 mg (Na alginate) PO after meals and at bedtime Adverse Reactions
  • Skin rashes have been reported
Special Instructions
  • Should be taken with food
  • Use with caution in patients on Na-restricted diet
Na alginate/Na bicarbonate/Ca carbonate 500-1,000 mg (Na alginate) PO after meals and at bedtime Adverse Reactions
  • GI effect (abdominal distension)
Special Instructions
  • Should be taken with food
  • Use with caution in patients with Na- and Ca-restricted diet, in heart failure and renal dysfunction
  • May be used during pregnancy and lactation
Sucralfate 1 g PO 6 hourly or
2 g PO 12 hourly 		Adverse Reactions
  • GI effects (constipation; less frequently GI disturbances and dry mouth); Other effects (dizziness, skin rashes)
Special Instructions
  • Should be taken on an empty stomach (1 hour before or 2 hours after meals)
  • Concomitant use with antacids should not be <30 minutes before or after Sucralfate
  • Contraindicated in patients on dialysis
  • Use with caution in patients with renal impairment
*Various combinations are available. Please see the latest MIMS for specific formulations and prescribing information.

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