Should we use Zantac and Prevacid together for GI reflux? Even though both drugs are pretty safe, they can have side effects.

Dr. Greene:

I’m not usually a fan of using Zantac and Prevacid daily. Both medications reduce acid in the stomach. And each one individually can increase the chance of gut infections (some acid is there for good reason!). Taken together this risk can be higher. It’s usually an either/or choice. Not both/and.

Even though both drugs are pretty safe, they can have side effects.

Long term use of proton pump inhibitors (PPIs like Prevacid) has recently been linked to an increased risk later of Alzheimer’s and other forms of dementia. The risk is small – and a long way off – but another reason I prefer not doubling up. We know less about the combo than either individually.

In general for reflux at that age I prefer starting with

  1. Increasing saliva – the body’s own way of neutralizing acid. This can be done by chewing gum (with xylitol) or by sucking on lozenges.
  2. Reducing foods that could increase reflux (including sodas or other caffeinated beverages or energy drinks, peppermint, chocolate, and orange juice).
  3. Positioning – avoiding lying flat or having pressure on the stomach soon after eating. And head of bed elevation for kids who have nighttime symptoms.
  4. Weight management for kids who are overweight.
  5. Some kids benefit from gentle natural remedies including chamomile, fresh ginger, and slippery elm.

Beyond this I might try Zantac or one of the related meds, because they act quickly, to see if they bring relief. And then switch to Prevacid, or one of the related meds for longer use.

How far I go will depend on how much of a problem the acid is causing. I’d do much more for someone where the acid is triggering asthma or esophagitis. Everything comes down to benefits versus risk.

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Alan Greene MD contributor

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