Pharmacology Review

Abstract

The common pharmacologic strategies used to treat gastroesophageal reflux disease (GERD) in the neonatal intensive care unit (NICU) include suppression of gastric acid with histamine-2 (H2) receptor antagonists and proton pump inhibitors (PPIs) and stimulation of gastrointestinal motility with dopamine receptor antagonists or motilin receptor agonists. These medications are primarily metabolized by hepatic cytochrome P450 (CYP) enzymes. Although frequently used, none of these drugs has strong evidence for efficacy in decreasing the complications of reflux in preterm infants or term neonates. In addition, a few well-conducted, masked, randomized studies that have accounted for maturational changes in their design have raised concerns about the safety of these medications in infants.