What is the best medication for abdominal pain (stomach pain)?

From the Guidelines

For stomach pain, tricyclic antidepressants (TCAs) such as amitriptyline are the most effective treatment option, initiated at a low dose of 10 mg once a day and titrated slowly to a maximum of 30–50 mg once a day, as they have been shown to be effective in reducing abdominal pain in patients with irritable bowel syndrome (IBS) 1. When considering treatment options for stomach pain, it's essential to evaluate the underlying cause of the pain. For patients with IBS, TCAs have been found to be effective in reducing abdominal pain, with a strong recommendation and moderate quality of evidence 1. Some key points to consider when treating stomach pain include:

• The use of antispasmodics, such as peppermint oil, which may be effective in treating global symptoms and abdominal pain in IBS, although the quality of evidence is very low 1.
• The role of dietary modifications, such as a low FODMAP diet, which may be beneficial in reducing symptoms in some patients with IBS 1.
• The importance of establishing an effective therapeutic relationship, providing patient education and reassurance, and helping with dietary and lifestyle modifications when needed 1. It's crucial to note that the treatment of stomach pain should be individualized, taking into account the patient's specific symptoms, medical history, and lifestyle. In addition to medication, simple remedies like drinking clear fluids, eating bland foods, applying a heating pad, and avoiding spicy foods, alcohol, and caffeine can complement treatment and help alleviate symptoms. Overall, a comprehensive approach to treating stomach pain, including medication, dietary modifications, and lifestyle changes, can help improve patient outcomes and reduce morbidity, mortality, and improve quality of life.

From the FDA Drug Label

As shown in Table 4,70% of patients treated with Famotidine 40 mg tablets at bedtime were healed by Week 4. In this study, time to relief of daytime and nocturnal pain was shorter for patients receiving Famotidine than for patients receiving placebo; patients receiving Famotidine also took less antacid than patients receiving placebo. Time to complete relief of daytime and nighttime pain was statistically significantly shorter for patients receiving Famotidine than for patients receiving placebo;

The best medicine for stomach pain is Famotidine.

• It has been shown to provide relief from daytime and nocturnal pain in patients with duodenal ulcers and gastric ulcers.
• Patients taking Famotidine also took less antacid than those receiving placebo. 2

From the Research

Medications for Stomach Pain

• The most effective medication for stomach pain depends on the underlying cause, with options including proton pump inhibitors (PPIs), H2-receptor antagonists, and antibiotics for Helicobacter pylori (H. pylori) infections 3, 4, 5, 6, 7.
• For nonsteroidal anti-inflammatory drug (NSAID)-associated gastric ulcers, lansoprazole has been shown to be superior to ranitidine in healing ulcers 4.
• Omeprazole has been found to be effective in preventing ulcer recurrence in chronic NSAID users, but not significantly better than misoprostol for preventing gastroduodenal ulcers 3.
• In cases of H. pylori infection, triple therapies combining a PPI or ranitidine bismuth citrate with two antibiotics have been shown to be effective in eradicating the infection 5, 6, 7.

Comparison of Medications

• A study comparing omeprazole and ranitidine combined with two antibiotics found that both were equally effective in eradicating H. pylori infection 5.
• Another study found that lansoprazole was superior to ranitidine in healing NSAID-associated gastric ulcers 4.
• A meta-analysis comparing PPIs and ranitidine bismuth citrate with two antibiotics found that both were effective in eradicating H. pylori, but ranitidine bismuth citrate may have a higher efficacy when combined with clarithromycin and a nitroimidazole 7.

Treatment Considerations

• The choice of medication should be based on the underlying cause of stomach pain and the presence of any underlying conditions, such as H. pylori infection or NSAID use 3, 4, 5, 6, 7.
• Patients with H. pylori infection should be treated with a combination of antibiotics and a PPI or ranitidine bismuth citrate 5, 6, 7.
• Patients taking NSAIDs should be considered for prophylactic treatment with a PPI or misoprostol to prevent gastric ulcers 3, 4.