What are the recommended medications and their dosages for Gastroesophageal Reflux Disease (GERD)?

From the Guidelines

For GERD, I would prescribe the following medications:

Proton Pump Inhibitors (PPIs)

• Omeprazole 20mg orally once daily for 8 weeks 1
• Alternatively, Lansoprazole 30mg orally once daily for 8 weeks 1
• Or, Esomeprazole 40mg orally once daily for 8 weeks 1

Histamine-2 (H2) blockers

• Ranitidine 150mg orally twice daily for 8 weeks 1
• Alternatively, Famotidine 20mg orally twice daily for 8 weeks 1

Antacids

• Aluminum hydroxide 500-1000mg orally as needed, up to 4 times a day
• Alternatively, Magnesium hydroxide 500-1000mg orally as needed, up to 4 times a day For maintenance therapy, the lowest effective dose should be used 1. It's essential to reassess the patient after 8 weeks to determine the need for continued therapy 1. If symptoms persist, dosing can be increased to twice a day or switched to a more effective acid suppressive agent once a day 1. Some key points to consider when treating GERD include:
• A 4- to 8-week trial of single-dose PPI therapy is considered safe and appropriate for patients with typical reflux symptoms and no alarm symptoms 1
• Patients should receive education on GERD pathophysiology and lifestyle modifications, and be involved in a shared decision-making model 1
• Objective reflux testing should be offered to establish a diagnosis of GERD and a long-term management plan when long-term PPI therapy is planned 1

From the FDA Drug Label

2.1 Recommended Adult Dosage by Indication Indication Recommended Dose Frequency Gastroesophageal Reflux Disease (GERD) Short-Term Treatment of Symptomatic GERD 15 mg Once daily for up to 8 weeks Short-Term Treatment of Erosive Esophagitis 30 mg Once daily for up to 8 weeks Maintenance of Healing of Erosive Esophagitis 15 mg Once daily

Table 1 shows the recommended dosage of Famotidine 20 mg and 40 mg tablets in adults and pediatric patients weighing 40 kg or greater with normal renal function. Indication Recommended Dosage Recommended Duration Symptomatic non-erosive GERD 20mg twice daily Up to 6 weeks Erosive esophagitis diagnosed by endoscopy 20mg twice daily; or 40mg twice daily Up to 12 weeks

The recommended medications and their dosages for Gastroesophageal Reflux Disease (GERD) are:

• Lansoprazole:
  • Short-Term Treatment of Symptomatic GERD: 15 mg once daily for up to 8 weeks
  • Short-Term Treatment of Erosive Esophagitis: 30 mg once daily for up to 8 weeks
  • Maintenance of Healing of Erosive Esophagitis: 15 mg once daily
• Famotidine:
  • Symptomatic non-erosive GERD: 20 mg twice daily for up to 6 weeks
  • Erosive esophagitis diagnosed by endoscopy: 20 mg twice daily or 40 mg twice daily for up to 12 weeks 2 3

From the Research

Medications for Gastroesophageal Reflux Disease (GERD)

The following medications are recommended for the treatment of GERD:

• Proton pump inhibitors (PPIs) 4, 5, 6, 7, 8
• Histamine receptor antagonists (H2-RAs) 4, 5, 6, 7, 8
• Potassium-competitive acid blockers (PCABs) 4, 8
• Prokinetics 4, 7
• Mucosal protectants, such as alginates, hyaluronic acid/chondroitin-sulfate, and poliprotect 4, 8

Dosages and Treatment Approaches

The optimal dosage and treatment approach for GERD may vary depending on the individual patient's characteristics and the severity of their symptoms.

• PPIs are effective in the treatment of severe disease and in the healing of erosive esophagitis, and may be used once or twice daily 5, 6
• H2-RAs may be used as an alternative to PPIs, or in combination with PPIs for patients with persistent symptoms 5, 6
• Combination therapy with PPIs and H2-RAs may be considered for patients with refractory symptoms, but its effectiveness has not been proven in clinical trials 6
• Long-term medical therapy for GERD should be tailored to each patient to provide symptomatic control and maintain esophageal mucosal healing 7