Could the Heartburn Drug Famotidine Help Fight COVID-19? Here's What We Know Right Now

Scientists continue to look into potential treatments for COVID-19, and the latest to be touted is famotidine, which is the active ingredient in the popular over-the-counter heartburn medication Pepcid.

Kevin Tracey, MD, president of Feinstein Institutes for Medical Research at Northwell Health in New York City, told Science that preliminary results of a clinical trial of famotidine could be ready in the next few weeks. The trials have been underway since April 7 at Northwell, one of the largest hospital systems in New York City. As of April 25, 1,174 patients—including 187 who were critically ill—have taken part.

Dr. Tracey said that earlier in the outbreak, doctors who worked with coronavirus patients in Wuhan, China discovered that although one in five COVID-19 patients over the age of 80 died, many of those who survived had been taking heartburn meds. Studies on the Chinese patients have not yet been published, but the findings were enough to encourage US scientists to explore famotidine’s potential. 
Trialling an OTC drug intended to relieve heartburn might seem a bit out of left field, considering that COVID-19 is a disease affecting the lungs and airways. But Dr. Tracey pointed out in the Science interview that there are “many examples in the history of medicine where a drug that was designed for one purpose turns out to have an effect in another disease.”

The case for trialling famotidine was bolstered by a computer model used by Florida-based Alchem Laboratories to compile a list of existing drugs that might fight coronavirus. Famotidine showed up near the top of the list, and the company received a $20.7 million contract to conduct the trial at Northwell from the US Biomedical Advanced Research and Development Authority (BARDA).

According to Dr. Tracey, famotidine was flagged because—in theory—the drug is structured in a way that could prevent the coronavirus from replicating, in the same way that protease inhibitors, which are used to treat HIV, stop that virus from replicating.

“Famotidine is a histamine receptor blocker,” Solomon L. Lerer, MD, a gastroenterologist in Aventura, Florida, tells Health. Specifically, the compound blocks the H2 receptors that play a role in producing acid in the stomach, which can lead to heartburn, a main symptom of gastroesophageal reflux disease (GERD). Famotidine is considered a relatively safe drug, Dr. Lerer adds, but side effects can include diarrhea, muscle aches, and headaches. 

“Famotidine is most commonly used to treat gastroesophageal reflux disease,” Abraham Khan, MD, director of the Center for Esophageal Diseases at NYU Langone Health, tells Health. “Often, it works best in patients with mild GERD symptoms that do not need a daily stronger acid suppressive medication, such as a proton pump inhibitor (PPI).”

Dr. Khan says that “it is not intuitive to think that famotidine would be a successful treatment for COVID-19 patients.” However, based on the limited retrospective evidence on outcomes made available so far, as well as the possibility that the drug may bind to a viral enzyme to interfere with its replication, he believes it’s worth an official trial study to see if it can be a treatment option for COVID-19.

“The evidence from China is anecdotal, and a double-blind study is needed to really determine the effectiveness of famotidine," adds Dr. Lerer.

The patients participating in the clinical trial at Northwell Health include a group who are also taking the anti-malarial drug hydroxychloroquine, as well as patients who are on hydroxychloroquine only. Hundreds of patients treated early on in the COVID-19 outbreak are also part of the trial.

Hydroxychloroquine is the drug hailed as a “game changer” by President Trump in a coronavirus task force briefing on March 20. However, preliminary results from a study sponsored by the New York State Department of Health, which looked at about 600 patients at 22 hospitals in the greater New York City area, suggest that hydroxychloroquine "didn't really have much of an effect on the recovery rate,” according to New York Governor Andrew Cuomo, as reported by CNN.

The same discouraging result could come out of the famotidine study. Keep in mind that this is a trial, and no drug treatment—famotidine or something else—will be approved to treat COVID-19 anytime soon.

In the meantime, Dr. Lerer warns that people should absolutely not rush out to buy the drug from their local drugstore. “It's important to be aware that in this current Northwell study, patients are taking mega doses of famotidine intravenously and are not taking pills orally. There is always a possibility that mega doses of any drug can have potential negative long-term side effects,” he says. And if the general public starts stockpiling Pepcid, heartburn patients who really need it could suffer.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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Acid reflux linked to cancer of throat, tonsils and upper digestive tracts

The team conducted a study on 13,805 patients aged 66 or older with cancer of the respiratory and upper digestive tracts and 13,805 patients without cancer.

They wanted to analyse inflammatory condition gastroesophageal reflux disease (GERD or acid reflux) and the development of cancer.

The patients with cancer of the respiratory and upper digestive tracts (outcome) were compared to those without cancer to examine whether GERD (exposure) was associated with cancer.

The results suggested that GERD was associated with cancer of the throat, tonsils and parts of the sinuses.

Author  explained that GERD was associated with cancer in older adults in the respiratory and upper digestive tracts.

This association requires further study to determine causality and to possibly identify an at-risk population so surveillance can be improved and treatment initiated earlier. 

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.   

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Aging And Digestion

Chewing

As we age, chewing food can become more difficult, especially if you have dentures or no teeth. Chewing is in fact the first and most important step in taking care of your digestive system. When you chew, you are breaking down the food so that the stomach acid and intestinal enzymes can later break it apart into nutrients to be absorbed into your intestines.

In order to avoid choking on your food or slowing down your digestion, make sure to chew your food as thoroughly as possible or to cut up your food into smaller pieces. Also, it is important to continue visiting the dentist on a regular basis, about twice a year to make sure that your mouth is healthy and ready to chew. Taking calcium and vitamin D supplements or getting them through your diet can also help with your digestion and other aspects of your internal health. Women ages 50-70 should get about 1,200 mg of calcium and 600 IUs of vitamin D and men of the same age should get 1,000 mg of calcium and 600 IUs of vitamin D daily.     

Swallowing

After chewing, the next most important part of digestion is swallowing your food properly. As you age, your esophagus, does not contract like it used to, make it more difficult to swallow larger pieces of food. Indeed, when individuals over 50 need to swallow large pieces of food, it can take them 50 to 100 percent longer for the food to make its way to you stomach because your esophagus muscles are out of shape. One of the most common conditions among aging individuals is called gastroesophageal reflux disease (GERD), which can cause pain or a burning sensation in your chest when you digest and even the narrowing of your esophagus. Although there is not cure for a narrowing esophagus, one way to prevent this condition and to maximize your digestion with age is to chew your food slowly and in small pieces and to exercise and maintain a healthy weight. Avoid foods high in fat or sodium, which can worsen the feeling of heart burn or reflux, and if the symptoms still do not subside, it is recommended to visit your doctor for medical treatment.

Stomach

At the end of your esophagus lies the entry into your stomach called the lower esophageal sphincter. As you age, this ring-like muscle at the opening of the stomach gets weaker, once again contributing to heartburn and acid reflux. The muscle fails to relax properly, which allows acid and sometimes other stomach contents to make their way back up the esophagus pipe.

It is important that if you have suffered from heartburn or indigestion in the past to take note of the foods that may make you feel that way. Spicy and highly acidic foods are some of the major triggers for this condition, along with citrus fruits and high-fat foods. It helps to eat smaller meals that are low in acid and sodium because this can dramatically decrease your chances for heartburn.

Another common condition to watch out for in your stomach is called H. Pylori, or a bacteria on your stomach lining that can cause ulcers or sores in the morning or when your stomach is empty. The infection can be detected through blood tests, blood tests and endoscopy, a small tube inserted in your mouth that extends down to your stomach. If you discover that you have H. Pylori there is no need to worry because the condition can be treated with a combination of antibiotics and acid-suppressing medications.

 Intestines

With age, your intestines start to get lazy when it comes to absorbing key nutrients like calcium, vitamins A, B-12, K and D. This is because the muscle movements get slower and the colon function also changes. As a result, adults from ages 50 and up may experience more constipation and have a greater risk of developing colon cancer or diverticulitis, a condition in which small pouches in the colon become infected. It is recommended to make up for these missing vitamins either in your diet or with supplements. You can relieve your constipation by increasing your daily fiber intake and decreasing your intake of fatty and high-cholesterol foods. In order to naturally increase your fiber intake, eat more whole grains and try to have a fruit or vegetable with every meal.

 Liver

You may not know that people ages 60 and over have a greater risk of developing gallstones, or hard crystals that form in the gallbladder when your liver is unable to process the cholesterol and other parts of its bile. Bile is a substance you need to digest fat, which is made by the liver, but is stored in the gallbladder. Your risk for gallstones increases with age because the because the bile duct at the opening of your intestine narrows, forcing the bile to stay in the gallbladder for longer periods of time, which causes it to harden.

In order to help prevent the formation of gallstones, which can be painful and often require removal surgeries, it is recommended to strictly control your fat intake so as not to overwhelm your gallbladder. Unfortunately, if you have gallstones you most likely won't experience symptoms, and if you do it is usually a mild pain in the pit of your stomach or the upper right part of your belly. The pain can even spread to your right upper back and shoulder blade. If you experience or have experienced any of these symptoms, it is important to immediately contact your doctor.

Lastly, make sure that you remain in constant consultation with your doctor about your digestive health.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.






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Breathing Trouble? 7 Signs Your Lungs Are in the Danger Zone

We hear a lot about the risks of lung cancer -- but less about a lung condition that's just as common and debilitating, called COPD. This term, which stands for chronic obstructive pulmonary disease, refers to a combination of two conditions, emphysema and chronic obstructive bronchitis, both of which are caused by lung damage from smoking or exposure to other lung irritants, such as asbestos. Whether you're a smoker, a former smoker, or just unlucky, you can develop COPD as a result of damage to your lungs that gradually limits their ability to take in oxygen.

When your lungs aren't functioning at full capacity, symptoms begin to appear that are sometimes so subtle that you may not recognize them as such. And because COPD is a progressive disease that can't be slowed without treatment -- and because it's the fourth leading cause of death in the U.S. -- it's critical to catch it as soon as possible. Here, seven signs that your lungs are trying to tell you they're in trouble.

1. Shortness of breath

"Many people start to experience shortness of breath, and they just think 'I'm old, I'm out of shape,' and they don't do anything about it other than cutting back their activity level," says Byron Thomashow, a physician and professor at Columbia University Medical Center and chairman of the board of the COPD Foundation. "Then when you have shortness of breath just getting to the bathroom, all of a sudden you take notice."

The problem with this, Thomashow says, is that the lung damage that constitutes COPD can't be reversed; all you can do is halt or slow the progression of the disease. And if you don't start treating it until you're already out of breath just walking around the house, you've got a lot less to work with. Not only that, but cutting back is the last thing you want to do to prevent COPD progression; maintaining and even increasing your activity level is key to keeping the lung function that you have.

One thing to look for: When you're climbing steps or exercising, do you have trouble inhaling a deep breath? An even more telltale sign: Do you take the elevator instead of the stairs to avoid this feeling? Experiment with different activities to see if you have shortness of breath when you increase your level of exertion, and note if there have been any changes over time. "I ask people, how's your breathing compared to last year -- can you do what you used to do a year ago?" says Thomashow. If you feel your ability to draw a deep breath is declining, ask your doctor to perform lung function tests to give you a clear picture of your lung health.

2. Frequent or worsening coughs

Everyone gets a cough once in awhile, but if you seem to be getting them more frequently, or they linger for a long time or become chronic, it's time to talk to your doctor. COPD inflames the bronchial tubes and the tiny sacs called alveoli that line the lungs, making them less flexible and elastic. When that happens, the walls of the airways thicken and produce more mucus than usual, which clogs them up.

What you'll notice is a phlegmy cough that feels like the type that usually accompanies the flu -- except you don't have other flu symptoms. If you cough up mucus that's any other color than clear, that can be a sign your condition is worsening, says Byron Thomashow of Columbia and the COPD Foundation. The mucus may be yellow, green, or even have blood in it.

One interesting fact to be aware of: If you're still smoking, your sputum production may not increase despite advancing COPD, whereas sputum production tends to increase after you quit.

3. Morning headaches

One of the more mysterious symptoms of COPD is waking up after a night's sleep with a dull, throbbing headache. "What's happening is that you're not breathing deeply enough at night, and the carbon dioxide builds up while you're sleeping," says physician Norman Edelman, chief medical officer for the American Lung Association. The buildup of carbon dioxide causes blood vessels in the brain to dilate, resulting in headaches.

Many people don't connect the headaches to COPD, though; instead they treat them as a separate symptom. But unless you treat the underlying cause -- making sure you get enough oxygen into your lungs while you sleep -- the headaches won't go away. Talk to your doctor about setting up a treatment regimen for COPD designed to reduce inflammation and increase the absorbent capacity of the lungs.

4. Swollen ankles

As COPD advances, it becomes intertwined with heart failure, because your circulatory system isn't getting the oxygen it needs to be healthy. This can lead to fluid buildup, which is most easily recognizable as swollen feet and ankles. "As lungs get progressively worse, the ability of the body to compensate goes down and the heart can't pump strongly enough," says Norman Edelman of the American Lung Association.

When the heart can't pump enough blood to supply the liver and kidneys, they can't perform their necessary functions of flushing out toxins and removing fluid. The result: the same type of edema many people experience while flying or women experience when pregnant.

5. Trouble sleeping or staying asleep

Ask yourself this: Do you pile up pillows to raise your chest and head and make it easier to breathe while you sleep? Do you sleep in a chair, such as a recliner, because breathing's easier in that position? It's also possible that you sleep flat but wake up feeling unwell or even dizzy.

Because lying flat forces your lungs to work harder, many people with COPD find they have trouble sleeping deeply -- but they may not realize it's the lung condition causing it. "Sleep is also hard for people with COPD because they may cough throughout the night, waking themselves up or interrupting deep sleep," says Byron Thomashow of the COPD Foundation.

The relationship between COPD and poor sleep gets complicated, because many people with COPD also develop sleep apnea and GERD (gastroesophageal reflux disease), neither of which is conducive to deep, refreshing sleep.

The bottom line: If you wake regularly throughout the night with breathing difficulties or coughing, or you wake up in the morning feeling weak, unrested, and possibly with a headache, talk to your doctor.

6. A barrel chest

One informal test that some doctors use to check for COPD progression is to have you breathe while raising your arms over your head. Why? They're looking for a change known as "barrel chest," which describes a particular posture and body shape that tends to develop as a secondary symptom of COPD.

As a result of chronic inflammation, the lungs become enlarged and push the diaphragm downward, which makes it harder for the diaphragm to contract as efficiently. The chest wall becomes enlarged as well, weakening muscles in the chest, neck, and between the ribs; these are known as the "accessory respiratory muscles." When this happens, people with COPD unconsciously try to compensate by leaning forward when sitting, with their arms on their knees or in front of them. This posture stabilizes the upper chest and shoulders, making it easier to use the accessory breathing muscles.

7. A bluish tinge to lips or fingernails

Over time, if your blood doesn't circulate enough oxygen throughout your body, your lips and fingernails can take on a blue or gray tone. Sometimes the color, known as cyanosis, is most apparent in the nail beds; some people develop an overall grayish-blue tinge to the skin. The cause: Oxygen-rich blood is bright red, while blood with less oxygen turns dark and bluish-colored.

In dark-skinned people, the discoloration is most visible in the lips, gums, and around the eyes, and it can be easier to spot. Cyanosis usually occurs when oxygen levels in the blood drop below 90 percent. A doctor can check this for you; you can also monitor it yourself using a finger pulse oximeter, available in medical supply stores.

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Heartburn, Gastroesophageal reflux disease (GERD)- symptoms, medications

Heartburn is a burning feeling in the chest or throat. It's a key symptom of acid reflux. That's when acids from the stomach "leak" up into the esophagus, the muscular tube that goes from your throat to your stomach. Persistent reflux that occurs more than twice a week may be diagnosed as gastroesophageal reflux disease, or GERD.

Other symptoms of acid reflux may include:
Acid taste in the mouth
Dry cough
A feeling like a lump in the throat
Difficulty swallowing
Sore throat
Hoarseness
Excessive mouth watering
Worsening dental disease

Acid reflux stems from problems with our digestive anatomy and function. One factor could be a poorly working lower esophageal sphincter (LES). The LES is a ring of muscle that acts like a "valve" to keep stomach contents from moving back up into the esophagus. Reflux can occur if the LES either opens when it shouldn't or it doesn't close properly. Another factor could be a slow-moving digestive system. The longer the stomach holds onto food, the more likely it is to cause acid reflux symptoms.

There are several ways to treat GERD, including diet and lifestyle changes, and medication. See the remaining "Next Steps" sections of this report for information about the various treatment approaches.

If left untreated, GERD can cause serious complications. These include:
An inflammation of the lining of the esophagus known as esophagitis
Scarring and narrowing in the esophagus
Ulcers in the esophagus
An increased risk for esophageal cancer due to changes in the cells lining the esophagus

The Asthma Connection
Because you have asthma, you may be interested to know that people with asthma have a higher risk of developing GERD.

Each condition may contribute to the other: When acid reflux irritates the airways and lungs, it may make asthma symptoms worse. And asthma flare-ups may cause the LES to relax, which allows stomach acid to reflux into the esophagus. In addition, some asthma medications, such as theophylline, may make GERD symptoms worse.

The good news? Studies of people with asthma and GERD have shown that those who treat their GERD see an improvement in their asthma symptoms.

If you are concerned that your asthma (or the medications you take for it) may be making your GERD symptoms worse -- or vice-versa -- talk with your health care provider about strategies for managing both conditions.

Is Your Hiatal Hernia Related to Your Symptoms?
You've told us you have a hiatal hernia. This is when the upper part of the stomach and the LES push up through an opening in the diaphragm -- the muscle that keeps the stomach and other abdominal organs separate from the chest. The opening in the diaphragm is called the hiatus; that's where a hiatal hernia gets its name.

While a hiatal hernia usually doesn't cause symptoms, some experts believe people who have one may be more likely to have acid reflux. That is because a hiatal hernia can make it more difficult for the diaphragm to help the LES keep acid in the stomach.

Surgery can help relieve acid reflux in people with large hiatal hernias.

How Extra Weight Can Affect GERD Symptoms
You say you are not at your ideal weight. Did you know that the extra pounds you are carrying could contribute to your GERD symptoms? The bulk of research suggests there is a likely link between the two.

There are several ways that excess weight can contribute to acid reflux. One theory is that carrying too much weight, particularly around the waist, puts increased pressure on the stomach, which leads to acid reflux. Another theory is that the stomachs of people who are overweight may get "stretched," which relaxes the barrier between the stomach and the esophagus.

Losing weight could help you improve your symptoms. To help shed some pounds, you might try moderate exercise, such as a walking program. Slimming down may also help if your clothes are too snug, which could be making your symptoms worse.

Check Your Medications
Several medications and dietary supplements can increase the risk for acid reflux and make GERD symptoms worse. Some of these may cause symptoms by irritating the lining of the esophagus. These types of medicines include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
Potassium supplements
Iron supplements
Tetracyclines, which treat infections
Bisphosphonates, used for osteoporosis

Other medicines contribute to acid reflux symptoms by relaxing the LES. These medicines include:
Beta-agonists and theophylline used for asthma
Some medicines for high blood pressure, including calcium channel blockers and alpha-blockers
Nitrates, used for chest pain
Some sedatives, also known as tranquilizers
Hormone replacement such as estrogen and progesterone
Birth control pills
Anticholinergic medicines, which treat a variety of conditions

If you regularly take one of these types of medications or supplements, talk with your healthcare provider about whether it could be contributing to your symptoms.

Heartburn Symptoms

Heartburn is the symptom of acid reflux and GERD; however, not everyone with acid reflux 

has heartburn and not everyone with heartburn has acid reflux. The symptom of heartburn 

can also be caused by other unusual things such as intestinal motility problems. Cardiac 

problems can also mimic heartburn and you should not confuse the two. Unexplained chest 

pain should be evaluated by an exercise stress test or EKG prior to an evaluation for 

gastrointestinal problems.

Many people have different acid reflux-related heartburn triggers, but most people have 

similar heartburn symptoms.

• A burning feeling in the chest just behind the breastbone that occurs after eating and lasts 
• a few minutes to several hours.
• 
  
• Chest pain, especially after bending over, lying down, or eating.
• 
  
• Burning in the throat -- or hot, sour, acidic or salty-tasting fluid at the back of the throat.
• 
  
• Difficulty swallowing.
• 
  
• Feeling of food "sticking" in the middle of the chest or throat.
• 
  
• Heartburn may cause chronic cough, sore throat, or chronic hoarseness.

Reporting these symptoms is usually all that is needed for your doctor to make the diagnosis 

of heartburn. However, your doctor may perform special tests to determine the severity of 

your problem or to monitor your treatment. Special tests may also be needed if you have 

unusual symptoms such as weight loss or suffer from the complications of GERD.

Is It Heartburn or a Heart Attack?

Chest pain is one of the most common reasons a person goes to the emergency room. 

While many of these patients are suffering from a heart attack, some actually may be 

experiencing severe heartburn.

Often, the pain caused by a heart attack and during a severe heartburn episode is so difficult 

to distinguish that sophisticated medical testing is needed to determine whether or not you 

are having a heart attack. To complicate matters even more, the two problems have many of 

the same symptoms and occur in similar types of people (For example, older age and 

overweight people.)

Signs more typical of heartburn include:

• A sharp, burning sensation just below the breastbone or ribs.
• Pain generally does not radiate to the shoulders, neck, or arms, but it can.
• Pain usually comes after meals, when lying on the back, when exercising or when experiencing anxiety.
• Symptoms usually respond quickly to antacids.
• Rarely accompanied by a cold sweat.

Signs more typical of angina (severe pain in chest area) or heart attack include:

• A feeling of fullness, tightness, or dull pressure or pain generally in the center of the chest.
• The feeling of a belt being tightened around your chest
• Sudden chest pain or pressure that worsens
• Dizziness
• Pain may spread to the shoulders, neck, jaw or arms
• Pain often responds quickly to nitroglycerin
• Shortness of breath
• Often accompanied by a cold sweat
• Possible light-headedness

If you have any pain that lasts for more than a few minutes or any warning signs of a heart 

attack, seek immediate medical attention. If there's any confusion about whether your 

symptoms are heartburn or a heart attack, also seek immediate medical attention.