H2 Antagonist
If symptoms persist after two weeks of therapy with an H2-antagonist for acid reflux, you can consult a specialist in esophageal disease to determine the need for further evaluation or delay consultation in favor of adding a motility drug to the regimen. The decision is controversial. If you decide to try a motility drug to improve lower esophageal sphincter tone, prescribe bethanechol chloride (Duvoid, Myotonachol, Urecholine, etc.), 25 mg 3-4 times/d on an empty stomach.
Nausea and vomiting may occur if bethanechol chloride is taken too soon after eating. Other adverse effects are uncommon. Although metoclopramide (Reglan), 10 mg 3-4 times/d, is an alternative, about a third of those who take the drug encounter problems: Prominent side effects include irritability, nervousness, muscle spasm, and, occasionally, depression. Inadequate relief with a motility agent confirms the need for consultation and further evaluation.